Arousal in patients with gastro-oesophageal reflux and sleep apnoea

Abstract

Nocturnal gastro-oesophageal reflux has been observed in patients with obstructive sleep apnoea (OSA). Negative intrathoracic pressure during apnoeas and arousal have been suggested as the underlying mechanisms.In order to evaluate this hypothesis, the coincidence and sequence in time of arousal, apnoea and reflux events were analysed. Fifteen patients with OSA or heavy snoring were studied by means of standard polysomnograpy with parallel recording of 24-h oesophageal pH.Reflux events during the day were present in all patients, five of whom had symptoms of reflux. In three of these and in five other patients, a total of 69 nocturnal reflux events were found. In 68 events, arousal was found with the reflux event. Only one reflux without arousal was found (sleep stage 2). Seventeen events occurred during wakefulness after sleep onset. The percentage of time with a pH of <4 during wakefulness after sleep onset was significantly higher than the percentage of time with a pH of <4 during total sleep time (p<0.05). In 37 of the 52 reflux events which occurred during sleep, either an apnoea or a hypopnoea was found prior to the event. The investigation of sequence in time did not prove a causal relation between respiratory events and reflux events.The results indicate that gastro-oesophageal reflux and obstructive sleep apnoea are two separate disorders, which both have a high prevalence in obese patients.

Symptoms of gastro‐oesophageal reflux disease and the severity of obstructive sleep apnoea syndrome are not related in sleep disorders center patients

“…However, the authors could not establish a specific linkage between GERD and apnoea events. 3 More recent studies [4][5][6][7][8] showed that OSAS patients frequently manifest GERD, but did not establish a cause-effect relationship. For example, Ing et al 6 determined that OSAS patients manifested more reflux and greater time with an oesophageal pH below 4.0.…”

Mechanism of Gastroesophageal Reflux in Obstructive Sleep Apnea: Airway Obstruction or Obesity?

“…10,11 While some studies suggest a temporal relationship between obstructed breathing events and sleep reflux events, 4,12 previous studies have not demonstrated a consistent association. In addition, the number of obstructed breathing events far outweighs the number of sleep reflux events; therefore, there is a high likelihood that these two phenomena may occur by chance.…”

“…events in temporal association with an obstructed airway, this relationship is weak at best. 4,7,12 The role of obesity in the link between OSA and GER remains unclear. Obesity is a risk factor common to both OSA and GER and therefore represents a potential mechanism for the link between the two conditions.…”

“…1 Gastroesophageal reflux appears to be a particular problem for patients with OSA, as they exhibit an increase in GER symptoms and events during waking and sleep compared to individuals without OSA. [2][3][4][5][6][7][8] The precise mechanism underlying the increase in nocturnal GER in OSA patients remains unclear. Previous hypotheses, including the specific development of negative intrathoracic pressures generated during obstructive events, have not been substantiated by recent studies.…”

Meta-Analysis of the Effect of Proton Pump Inhibitors on Obstructive Sleep Apnea Symptoms and Indices in Patients with Gastroesophageal Reflux Disease

“…T he prevalence of gastroesophageal refl ux disease (GERD) is signifi cantly higher in patients with obstructive sleep apnea (OSA) (1)(2)(3)(4)(5)(6), and 54% to 76% of patients with OSA have GERD (2,3). Th ese two conditions share one common risk factor, namely obesity, which increases the risk for both apnea and refl ux (7).…”