Nocturnal gastroesophageal reflux increases the risk of daytime sleepiness in women

Hägg, Shadi Amid; Emilsson, Össur Ingi; Franklin, Karl A.; Janson, Christer; Lindberg, Eva

doi:10.1016/j.sleep.2018.08.036

Cited by 12 publications

(11 citation statements)

References 78 publications

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“…Similar to this study, gastroesophageal reflux has also been shown to be associated with daytime sleepiness [ 11 , 43 , 44 ]. In a study examining patients undergoing sleep studies, Guda et al [ 11 ] found reports that patients with symptoms of gastroesophageal reflux had a poorer sleep and consequently greater EDS compared to those without these symptoms.…”

Section: Discussionsupporting

confidence: 81%

“…In a study examining patients undergoing sleep studies, Guda et al [ 11 ] found reports that patients with symptoms of gastroesophageal reflux had a poorer sleep and consequently greater EDS compared to those without these symptoms. Results from a more recent study showed that there was a four-times greater risk of reporting daytime sleepiness with the combination of gastroesophageal reflux and snoring in women [ 43 ]. This combination resulted in EDS due to poor sleep quality related to recurrent disruption.…”

Section: Discussionmentioning

confidence: 99%

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Association between Co-Morbidities and the Prevalence of Excessive Daytime Sleepiness over a Four-Year Period

et al. 2019

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Excessive daytime sleepiness (EDS) is a common problem in general the Canadian population. It can effect day-to-day activities and is also associated with several health issues. This study aimed to investigate the association between co-morbidities and the prevalence of EDS over a four-year period in adults living in two First Nation communities. Data collected during the First Nations Lung Health Project (FNLHP) conducted in two Cree First Nation communities in Saskatchewan in 2012–2013 (Cycle 1) and 2016 (Cycle 2) were used for this analysis. There were 859 participants aged 18 years and older at baseline (Cycle 1) and 821 participants aged 18 years and older at follow-up (Cycle 2) who completed the interviewer-administered questionnaire. An Epworth Sleepiness Scale (ESS) score > 10 was considered to be abnormal and identified as a case of EDS at both time points. A multilevel logistic regression model using a generalized estimating equations approach was used to analyze the data. The prevalence of EDS at baseline (Cycle 1) was 11.2% (91/815) and 10.0% (80/803) at follow-up (Cycle 2). Based on the predicted model, longitudinal change in the prevalence of EDS was −0.11% for 358 individuals who participated in both cycles. There were 49% males at baseline and 48% males at follow-up. Multivariate regression model results revealed that crowding, shortness of breath, loud snoring, chronic lung disease, depression and gastric reflux were the main significant predictors of EDS. In addition, the interaction between sex and age was significant. Some of the co-morbid conditions were associated with EDS. Therefore, managing such conditions requires considerations in strategies to decrease the prevalence of daytime sleepiness.

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Section: Discussionsupporting

confidence: 81%

Section: Discussionmentioning

confidence: 99%

Association between Co-Morbidities and the Prevalence of Excessive Daytime Sleepiness over a Four-Year Period

et al. 2019

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“…In the present prospective pilot study, using subgroup analysis, a series of certain risk and/or protective factors associated with daytime sleepiness in patients with hepatitis B or hepatitis C were identified; however, there was an ob-vious difference between the two groups concerning these factors: gastroesophageal reflux was a risk factor in hepatitis B patients exclusively, while hypertension was an exclusive risk factor in hepatitis C patients. In a previous study, nocturnal gastroesophageal reflux is reported as a risk factor for daytime sleepiness in women and is mentioned to have a more negative effect when combined with snoring (13). Also, snoring and gastrointestinal reflux are lifestyle factors that are both associated with obesity, but the association with daytime sleepiness is independent of obesity, indicating that obesity is not a risk factor for daytime sleepiness (16).…”

Section: Discussionmentioning

confidence: 95%

“…can possibly be explained by the high prevalence of earlystage hepatitis in the study population, and also that they only reported "snoring" and not more severe sleep disturbances such as sleep apnea, which is positively associated with daytime sleepiness (1). However, snoring is a feature of obstructive sleep apnea (OSA) and is still reported to be a risk factor for daytime sleepiness (13). More studies are needed to determine the symptoms that may be resolved by eradicating the virus.…”

Section: Discussionmentioning

confidence: 99%

Risk and Protective Factors Associated with Daytime Sleepiness in Patients Diagnosed with Hepatitis B or Hepatitis C Infection

Chang

Liu

et al. 2021

Hepat Mon

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Background: Poor sleep quality and daytime fatigue are common features of chronic hepatitis. Objectives: To evaluate the association between daytime sleepiness and hepatitis and to identify factors that contribute to daytime sleepiness in patients with hepatitis B and those with hepatitis C. Methods: In this prospective cross-sectional pilot study, outpatients with fatigue who did not receive any treatment for hepatitis were recruited from the Department of Gastroenterology and Hepatology and were classified into 5 groups of hepatitis B, hepatitis C, hepatitis B + C, other hepatitis types, and without hepatitis (controls). Gastroesophageal reflux and daytime sleepiness were determined based on two self-reported questionnaires, and linear and logistic regression analyses were performed. Results: In total 42 subjects had hepatitis B, 62 had hepatitis C, 9 had hepatitis B + C, 4 had other hepatitis types, and 14 had no hepatitis. Of them, 38 (29.01%) had gastroesophageal reflux (GERDQ score ≥ 12), and 13 (9.92%) had daytime sleepiness (ESS score ≥ 8). Hepatitis B patients with gastroesophageal reflux had significantly higher odds of daytime sleepiness [odds ratio (OR) = 12.44, 95% confidence interval (CI) = 1.59 - 261.02]. In hepatitis C patients, hypertension was significantly associated with daytime sleepiness (OR = 15.6, 95% CI = 2.13 - 143.21), while those with taller body height and elevated serum glutamic-oxaloacetic transaminase (GOT) levels had significantly lower odds of daytime sleepiness (body height: OR = 0.81, 95% CI = 0.65 - 0.93; GOT: OR = 0.76, 95% CI = 0.55 - 0.95). Conclusions: Gastroesophageal reflux is a risk factor for daytime sleepiness in hepatitis B patients. In hepatitis C patients, hypertension is a risk factor, while taller body height and elevated serum GOT are protective factors for daytime sleepiness.

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“…11 A study in Sweden using surveys conducted 10 years apart reported that a higher risk of daytime sleepiness was associated with persistent nocturnal GER symptoms among women (odds ratio, 3.0; 95% CI, 1.5-5.9). 16 Several mechanisms may underlie the association between GER symptoms and sleep quality.…”

Section: Discussionmentioning

confidence: 99%

Assessment of Gastroesophageal Reflux Symptoms and Sleep Quality Among Women in the Nurses’ Health Study II

Mehta

Cao

et al. 2023

JAMA Netw Open

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ImportanceLimited data exist on the association of gastroesophageal reflux (GER) symptoms with sleep quality.ObjectiveTo prospectively investigate the association between GER symptoms and sleep quality.Design, Setting, and ParticipantsThis prospective cohort study included data from the Nurses’ Health Study II of female nurses in the US. Participants self-reported the frequency and duration of GER symptoms beginning June 2005, with updates every 4 years through June 2015. Follow-up was completed June 2019, and data were analyzed from November 15, 2022, to June 4, 2023.ExposuresFrequency and duration of GER symptoms.Main Outcomes and MeasuresPoor sleep quality was assessed in 2017 through a modified Pittsburgh Sleep Quality Index, which included difficulty in falling asleep, restlessness of sleep, daytime sleepiness, sleep disturbance, and sleep duration. Relative risk (RR) for poor sleep quality and individual components of poor sleep quality was estimated according to the frequency and duration of GER symptoms.ResultsAmong 48 536 women (median age, 59 years [range, 48-69 years]), 7929 (16.3%) developed poor sleep quality during 4 years of follow-up. Compared with those with GER symptoms less than once a month, the multivariable RR for poor sleep quality among women with GER symptoms more than once a week was 1.53 (95% CI, 1.45-1.62). Women who had GER symptoms once or more a week for more than 7 years had an RR of 1.36 (95% CI, 1.30-1.43) compared with women who had not had GER symptoms once or more a week. The frequency and duration of GER symptoms were significantly associated with each individual component of poor sleep quality; for example, the multivariable RRs for GER symptoms 2 or more times per week compared with no GER symptoms were 1.49 (95% CI, 1.39-1.58) for difficulty in falling asleep, 1.47 (95% CI, 1.39-1.56) for excessive daytime sleepiness, and 1.44 (95% CI, 1.36-1.53) for restlessness of sleep.Conclusions and RelevanceIn this prospective cohort study of female nurses in the Nurses’ Health Study II, the frequency and duration of GER symptoms were associated with subsequent risk of poor sleep quality. The findings suggest that effective treatment of GER disease may be important not only for improvement of symptoms but also for the reduction of comorbidities associated with poor sleep quality.

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Nocturnal gastroesophageal reflux increases the risk of daytime sleepiness in women

Cited by 12 publications

References 78 publications

Association between Co-Morbidities and the Prevalence of Excessive Daytime Sleepiness over a Four-Year Period

Association between Co-Morbidities and the Prevalence of Excessive Daytime Sleepiness over a Four-Year Period

Risk and Protective Factors Associated with Daytime Sleepiness in Patients Diagnosed with Hepatitis B or Hepatitis C Infection

Assessment of Gastroesophageal Reflux Symptoms and Sleep Quality Among Women in the Nurses’ Health Study II

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