Conscious Awakenings Are Commonly Associated With Acid Reflux Events in Patients With Gastroesophageal Reflux Disease

Poh, Choo Hean; Allen, Larissa; Gąsiorowska, Anita; Navarro–Rodriguez, Tomás; Quan, Stuart F.; Malagon, Isaac; Powers, Jeannette; Willis, Marcia R.; Ashpole, Nicole; Fass, Ronnie

doi:10.1016/j.cgh.2010.05.022

Cited by 30 publications

(34 citation statements)

References 25 publications

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“…A clinical study involving the use of pH monitoring and actigraphy showed that conscious awakenings associated with reflux events during sleep are seldom symptomatic [29], suggesting that arousals during sleep because of nighttime heartburn could not adequately explain the association between GERD and sleep disturbances. There were two patterns of nighttime reflux in the absence of GERD symptoms, as follows: a typical long reflux event without awakening and a very short amnestic reflux event with consciousness awakening.…”

Section: Discussionmentioning

confidence: 99%

Acid Reflux Directly Causes Sleep Disturbances in Rat with Chronic Esophagitis

et al. 2014

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Background & AimsGastroesophageal reflux disease (GERD) is strongly associated with sleep disturbances. Proton pump inhibitor (PPI) therapy improves subjective but not objective sleep parameters in patients with GERD. This study aimed to investigate the association between GERD and sleep, and the effect of PPI on sleep by using a rat model of chronic acid reflux esophagitis.MethodsAcid reflux esophagitis was induced by ligating the transitional region between the forestomach and the glandular portion and then wrapping the duodenum near the pylorus. Rats underwent surgery for implantation of electrodes for electroencephalogram and electromyogram recordings, and they were transferred to a soundproof recording chamber. Polygraphic recordings were scored by using 10-s epochs for wake, rapid eye movement sleep, and non-rapid eye movement (NREM) sleep. To examine the role of acid reflux, rats were subcutaneously administered a PPI, omeprazole, at a dose of 20 mg/kg once daily.ResultsRats with reflux esophagitis presented with several erosions, ulcers, and mucosal thickening with basal hyperplasia and marked inflammatory infiltration. The reflux esophagitis group showed a 34.0% increase in wake (232.2±11.4 min and 173.3±7.4 min in the reflux esophagitis and control groups, respectively; p<0.01) accompanied by a reduction in NREM sleep during light period, an increase in sleep fragmentation, and more frequent stage transitions. The use of omeprazole significantly improved sleep disturbances caused by reflux esophagitis, and this effect was not observed when the PPI was withdrawn.ConclusionsAcid reflux directly causes sleep disturbances in rats with chronic esophagitis.

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Section: Discussionmentioning

confidence: 99%

Acid Reflux Directly Causes Sleep Disturbances in Rat with Chronic Esophagitis

et al. 2014

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“…We observed no association between reflux medications and disturbed sleep. GERD, on the other hand, might cause or worsen sleep disturbances [16], [23]. Nocturnal reflux might lead to uneasy sleep and repeated awakenings, which are common in GERD patients [23].…”

Section: Discussionmentioning

confidence: 99%

A Population-Based Study of Gastroesophageal Reflux Disease and Sleep Problems in Elderly Twins

et al. 2012

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Background & AimsPrevious studies indicate an association between sleep problems and gastroesophageal reflux disease (GERD). Although both these conditions separately have moderate heritabilities, confounding by genetic factors has not previously been taken into account. This study aimed to reveal the association between sleep problems and GERD, while adjusting for heredity and other potential confounding factors.MethodsThis cross-sectional population-based study included all 8,014 same-sexed twins of at least 65 years of age and born in Sweden between 1886 and 1958, who participated in telephone interviews in 1998–2002. Three logistic regression models were used 1) external control analysis, 2) within-pair co-twin analysis with dizygotic (DZ) twin pairs discordant for GERD, and 3) within-pair co-twin analysis with monozygotic (MZ) twin pairs discordant for GERD. Odds ratios (ORs) with 95% confidence intervals (CIs) were calculated and adjusted for established risk factors for GERD, i.e. sex, age, body mass index (BMI), tobacco smoking, and educational level.ResultsA dose-response association was identified between increasing levels of sleep problems and GERD in the external control analysis. Individuals who often experienced sleep problems had a two-fold increased occurrence of GERD compared to those who seldom had sleep problems (OR 2.0, 95% CI 1.8–2.4). The corresponding association was of similar strength in the co-twin analysis including 356 DZ pairs (OR 2.2, 95% CI 1.6–3.4), and in the co-twin analysis including 210 MZ pairs (OR 1.5, 95% CI 0.9–2.7).ConclusionA dose-dependent association between sleep problems and GERD remains after taking heredity and other known risk factors for GERD into account.

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“…However, arousal during sleep is associated with decreased sleep QOL [40]. Recently, Fass and colleagues reported novel mechanisms underlying the associations between GERD and sleep disturbances, using an actigraph [41][42][43][44][45], a watch-like device that has been shown to be highly comparable to a polysomnogram in terms of determining sleep duration and awakening [46]. They showed that acid reflux events occur after an awakening episode but conscious awakenings associated with reflux events are seldom symptomatic [41].…”

Section: Mechanisms Of Associations Between Gerd and Sleep Disturbancesmentioning

confidence: 97%

Gastroesophageal reflux disease and sleep disturbances

2012

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Nighttime reflux during sleep plays a crucial role in several conditions associated with gastroesophageal reflux disease (GERD). Reflux patterns during arousal and sleep are different because of delayed gastric emptying, reduced esophageal peristalsis, decreases in swallowing and salivary secretion, and prolonged esophageal clearance during sleep. Clinical evidence strongly suggests that GERD is associated with sleep disturbances such as shorter sleep duration, difficulty falling asleep, arousals during sleep, poor sleep quality, and awakening early in the morning. New mechanisms on how GERD affects sleep have been recently identified by using actigraphy, and sleep deprivation was found to induce esophageal hyperalgesia to acid perfusion. Thus, the relationship between GERD and sleep disturbances is bidirectional. Among lifestyle modifications, avoidance of a late night meal plays a role in prevention of nighttime reflux. Treatment with a proton pump inhibitor (PPI) improves both nighttime symptoms and subjective sleep parameters, but its effects on objective sleep parameters remain unclear. Better control of nighttime acid secretion by administering a PPI at different times or by providing a double-dose PPI, adding H(2) receptor antagonists, or other new agents is proposed. The effects of such treatments on sleep disturbances remain to be elucidated. GERD patients with sleep disturbances report more severe symptoms and poorer quality of life as compared to those without sleep disturbances. Consequently, GERD should also be classified as GERD with sleep disturbance and GERD without sleep disturbance.

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Conscious Awakenings Are Commonly Associated With Acid Reflux Events in Patients With Gastroesophageal Reflux Disease

Cited by 30 publications

References 25 publications

Acid Reflux Directly Causes Sleep Disturbances in Rat with Chronic Esophagitis

Acid Reflux Directly Causes Sleep Disturbances in Rat with Chronic Esophagitis

A Population-Based Study of Gastroesophageal Reflux Disease and Sleep Problems in Elderly Twins

Gastroesophageal reflux disease and sleep disturbances

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