Management of patients with coexisting obstructive sleep apnea and laryngopharyngeal reflux disease

Abstract

Obstructive sleep apnea syndrome (OSAS) and Laryngopharyngeal reflux disease (LPR) are both common health problems causing severe morbidity. Since they have similar risk factors, the prevalence of LPR among patients with OSAS is higher compared with general population. However, there exist only a few studies showing the potential causal relation between LPR and OSAS. The aim of this study was to evaluate the coexistence between OSAS and LPR and to determine whether the therapy of OSAS alters LPR parameters and vice versa. In this study, 44 patients underwent double probed 24 h pH monitoring simultaneously with polysomnography due to the complaints of obstructive sleep apnea and reflux. Twenty of those 44 patients were diagnosed with both OSAS and LPR. Among those patients, 10 patients with mild to moderate OSAS were given only LPR treatment for 3 months. The remaining 10 patients who had severe OSAS underwent CPAP treatment for 3 months. After the end of treatment, all patients were reevaluated with double probed 24 h pH monitoring simultaneously with PSG. Moreover, the patients were evaluated subjectively by Epworth Sleepiness Scale (ESS), snoring Visual Analogue Scale (VAS), Reflux Symptom Index (RSI), and Reflux Finding Score (RFS). The results of this study revealed that OSAS and LPR coexist frequently. LPR treatment did not improve the polysomnographic parameters, but significantly reduced ESS and snoring VAS (p = 0.02 and p = 0.007, respectively). Although the CPAP treatment significantly improved subjective parameters of reflux, such as RSI and RFS (p = 0.016 for both), there was no significant improvement in objective parameters of 24-h pH monitoring. We concluded that since there is a high frequency of coexistence between LPR and OSAS, all patients with OSAS should also be queried for LPR symptoms. In addition, more in-depth and comprehensive research is required to elucidate the association between OSAS and LPR.

Adult obstructive sleep apnoea and the larynx

“…Although acid suppression therapy improves signs of laryngeal inflammation in OSA patients, it does not appear to improve AHI [71]. Additionally, CPAP treatment may be able to improve symptoms and signs of LPR in OSA patients even in the absence of objective improvements in pH monitoring [72].…”

Gastroesophageal reflux disease and pharyngo-laryngeal reflux in the patients presenting with obstructive sleep apnea syndrome

“…В результате, по дан ным полисомнографии, курс антирефлюксной те рапии никак не повлиял на выраженность СОАС, хотя дневная сонливость у пациентов субъективно уменьшилась. В то же время и СРАРтерапия не по влияла на частоту развития рефлюкса, хотя выра женность характерных жалоб по опроснику RFS у больных уменьшилась [41].…”

Esophageal Functional Changes in Obstructive Sleep Apnea/Hypopnea Syndrome and Their Impact on Laryngopharyngeal Reflux Disease

“…Obstructive sleep apnea/hypopnea syndrome (OSAHS) is characterized by repetitive upper-airway collapse during sleep, causing sleep fragmentation, oxygen desaturation, and daytime sleepiness. [ 1 2 ] Approximately, 2–5% of the population are affected by OSAHS problems. [ 2 ] Two factors that are generally accepted to have an effect on OSAHS are upper-airway muscular hypotonia (from neuromuscular diseases or toxic reactions) and abnormal anatomical narrowing.…”

“…[ 1 2 ] Approximately, 2–5% of the population are affected by OSAHS problems. [ 2 ] Two factors that are generally accepted to have an effect on OSAHS are upper-airway muscular hypotonia (from neuromuscular diseases or toxic reactions) and abnormal anatomical narrowing. [ 3 ] Many systemic diseases, such as congestive heart failure, cerebrovascular incidents, and metabolism syndrome, are demonstrated to be related to this syndrome.…”