Obstructive Sleep Apnea and Gastroesophageal Reflux

Gilani, Sapideh; Quan, Stuart F.; Pynnonen, Melissa A.; Shin, Jennifer J.

doi:10.1177/0194599815621557

Cited by 34 publications

(25 citation statements)

References 16 publications

(47 reference statements)

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“…Gastroesophageal reflux disease (GERD) is more common in patients with OSA . Increased GERD in OSA is likely due to more frequent transient lower oesophageal sphincter relaxations …”

Section: To What Degree Do Comorbidities Contribute To Difficult Asthma?mentioning

confidence: 99%

Comorbid “treatable traits” in difficult asthma: Current evidence and clinical evaluation

Tay

Hew

2017

Allergy

125

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The care of patients with difficult-to-control asthma ("difficult asthma") is challenging and costly. Despite high-intensity asthma treatment, these patients experience poor asthma control and face the greatest risk of asthma morbidity and mortality.Poor asthma control is often driven by severe asthma biology, which has appropriately been the focus of intense research and phenotype-driven therapies. However, it is increasingly apparent that extra-pulmonary comorbidities also contribute substantially to poor asthma control and a heightened disease burden. These comorbidities have been proposed as "treatable traits" in chronic airways disease, adding impetus to their evaluation and management in difficult asthma. In this review, eight major asthma-related comorbidities are discussed: rhinitis, chronic rhinosinusitis, gastroesophageal reflux, obstructive sleep apnoea, vocal cord dysfunction, obesity, dysfunctional breathing and anxiety/depression. We describe the prevalence, impact and treatment effects of these comorbidities in the difficult asthma population, emphasizing gaps in the current literature. We examine the associations between individual comorbidities and highlight the potential for comorbidity clusters to exert combined effects on asthma outcomes. We conclude by outlining a pragmatic clinical approach to assess comorbidities in difficult asthma.

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“…Gastroesophageal reflux disease (GERD) is more common in patients with OSA . Increased GERD in OSA is likely due to more frequent transient lower oesophageal sphincter relaxations …”

Section: To What Degree Do Comorbidities Contribute To Difficult Asthma?mentioning

confidence: 99%

Comorbid “treatable traits” in difficult asthma: Current evidence and clinical evaluation

Tay

Hew

2017

Allergy

125

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“…A recent study expanded the relationship between GER and OSA to a population‐based level and showed that GER is independently associated with OSA. A significant positive relationship between GER and OSA has been recognized in a national database, with OSA defined on the basis of the International Classification of Diseases, 9th edition (ICD‐9). The strongest relationship was seen when using the strictest definitions of GER and OSA in a study that was performed by 24‐h pH monitoring and nocturnal PSG.…”

Section: Is There Any Causal Relationship Between Gerd and Osa?mentioning

confidence: 99%

Gastroesophageal reflux disease: recent advances and its association with sleep

2016

Annals of the New York Academy of Sciences

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Gastroesophageal reflux disease (GERD) is prevalent in Asia as well as in Western countries. Sleep disturbance and breathing disorders during sleep are becoming increasingly prevalent, and they are commonly associated with GERD. The relationship between GERD and obstructive sleep apnea (OSA) is still questionable, and it has expanded to include Barrett's esophagus. Nocturnal gastroesophageal reflux (nGER) symptoms might be clinically important in the explanation of this association. The therapy for reflux symptoms has resulted in improved subjective sleep parameters and enhanced sleep quality, thus supporting a direct relationship between GERD and sleep disturbance. This review discusses the epidemiology of sleep disturbances in GERD patients; the causative relationship between GERD and OSA, even though it remains an area of controversy; and the possible role of nGER in sleep problems. It also provides an update on the current state of knowledge linking GERD and sleep.

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“…1 Laryngopharyngeal reflux (LPR) is an extraesophageal manifestation of GERD that may be present in up to 10% of patients presenting for ambulatory otolaryngology visits. 2 Typical symptoms that have been attributed to LPR include globus sensation, laryngospasm, throat clearing, and hoarseness. Moreover, it has been postulated that mucosal inflammation due to LPR may extend beyond the larynx and oropharynx to the nasopharynx and nasal cavity, contributing to the pathogenesis of sinonasal diseases.…”

Section: Invited Commentarymentioning

confidence: 99%

Treatment of Laryngopharyngeal Reflux May Decrease Subjective Symptoms of Nasal Congestion and Objective Measures of Nasal Resistance

Gray

Sedaghat

2017

JAMA Otolaryngol Head Neck Surg

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Gastroesophageal reflux disease (GERD) is highly prevalent, and its most common symptoms, including heartburn and regurgitation, may be present in up to 45% of the population. 1 Laryngopharyngeal reflux (LPR) is an extraesophageal manifestation of GERD that may be present in up to 10% of patients presenting for ambulatory otolaryngology visits. 2 Typical symptoms that have been attributed to LPR include globus sensation, laryngospasm, throat clearing, and hoarseness. Moreover, it has been postulated that mucosal inflammation due to LPR may extend beyond the larynx and oropharynx to the nasopharynx and nasal cavity, contributing to the pathogenesis of sinonasal diseases. For example, an association between chronic rhinosinusitis (CRS) and GERD has been shown through epidemiologic studies that have found high rates of pharyngeal reflux in CRS, 3 as well as the finding of digestive enzymes in the nasal secretions of patients with CRS. 4 Despite this, few studies have objectively examined the effect of treatment of LPR on sinonasal symptoms.In this issue of JAMA Otolaryngology-Head & Neck Surgery, Dagli and colleagues 5 report their experience with the symptom of nasal obstruction in patients with LPR and report how the use of a proton pump inhibitor (PPI) to treat these patients' LPR affects concomitant nasal obstruction. The authors conducted a prospective observational clinical study in which 50 patients with confirmed esophagitis and symptoms of LPR, making up the study group, were treated with a PPI for 12 consecutive weeks and no other treatment for nasal obstruction, such as intranasal corticosteroids, was given. The study group had no other evidence of sinonasal disease, such as CRS or allergic rhinitis, and was compared with a control group, consisting of 50 patients with no evidence of LPR or other sinonasal diseases who had no symptoms of nasal obstruction. Pretreatment assessment of the LPR group included a subjective measurement of nasal congestion with the Nasal Obstruction Symptom Evaluation (NOSE) instrument and an objective measurement of total nasal resistance (TNR) using rhinomanometry. Compared with the control group, the LPR group had a significantly higher median NOSE score and TNR before treatment with a PPI. After 12 weeks of treatment with a PPI, not only did the study group demonstrate significantly lower NOSE scores and TNR, but the posttreatment NOSE scores and TNR of the study group also normalized to be no different than what was found in the control group. This is the first study to prospectively study the impact of LPR treatment on subjective and objective measures of nasal obstruction, and the results provide novel evidence for the relationship of LPR to sinonasal symptoms. The finding that treatment of LPR with a PPI alone-and no treatment directed at nasal symptoms-was sufficient to reduce nasal obstruction in patients with LPR suggests that LPR at the very least has the ability to contribute to nasal symptoms. Moreover, the findings of this study have important implications for the...

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Obstructive Sleep Apnea and Gastroesophageal Reflux

Abstract: In this analysis of a national database defining the 3 most prioritized diagnoses, GER is independently associated with OSA, with double the odds of concurrent occurrence, even while controlling for potentially related conditions.

Cited by 34 publications

References 16 publications

Comorbid “treatable traits” in difficult asthma: Current evidence and clinical evaluation

Comorbid “treatable traits” in difficult asthma: Current evidence and clinical evaluation

Gastroesophageal reflux disease: recent advances and its association with sleep

Treatment of Laryngopharyngeal Reflux May Decrease Subjective Symptoms of Nasal Congestion and Objective Measures of Nasal Resistance

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