Respiratory symptoms, sleep-disordered breathing and biomarkers in nocturnal gastroesophageal reflux

Abstract

BackgroundNocturnal gastroesophageal reflux (nGER) is associated with respiratory symptoms and sleep-disordered breathing (SDB), but the pathogenesis is unclear. We aimed to investigate the association between nGER and respiratory symptoms, exacerbations of respiratory symptoms, SDB and airway inflammation.MethodsParticipants in the European Community Respiratory Health Survey III in Iceland with nGER symptoms (n = 48) and age and gender matched controls (n = 42) were studied by questionnaires, exhaled breath condensate (EBC), particles in exhaled air (PEx) measurements, and a home polygraphic study. An exacerbation of respiratory symptoms was defined as an episode of markedly worse respiratory symptoms in the previous 12 months.ResultsAsthma and bronchitis symptoms were more common among nGER subjects than controls (54 % vs 29 %, p = 0.01; and 60 % vs 26 %, p < 0.01, respectively), as were exacerbations of respiratory symptoms (19 % vs 5 %, p = 0.04). Objectively measured snoring was more common among subjects with nGER than controls (snores per hour of sleep, median (IQR): 177 (79–281) vs 67 (32–182), p = 0.004). Pepsin (2.5 ng/ml (0.8–5.8) vs 0.8 ng/ml (0.8–3.6), p = 0.03), substance P (741 pg/ml (626–821) vs 623 pg/ml (562–676), p < 0.001) and 8-isoprostane (3.0 pg/ml (2.7–3.9) vs 2.6 pg/ml (2.2–2.9), p = 0.002) in EBC were higher among nGER subjects than controls. Albumin and surfactant protein A in PEx were lower among nGER subjects. These findings were independent of BMI.ConclusionIn a general population sample, nGER is associated with symptoms of asthma and bronchitis, as well as exacerbations of respiratory symptoms. Also, nGER is associated with increased respiratory effort during sleep. Biomarker measurements in EBC, PEx and serum indicate that micro-aspiration and neurogenic inflammation are plausible mechanisms.

Clinical presentation of patients with suspected obstructive sleep apnea and self‐reported physician‐diagnosed asthma in the ESADA cohort

“…The severe obesity found in women with asthma might interact with OSA pathogenesis (Alkhalil, Schulman, & Getsy, 2009;Prasad, Nyenhuis, & Weaver, 2014). OSA is associated with huge variations in intrathoracic pressure, especially in obese patients, increasing the burden of gastroesophageal reflux (Emilsson et al, 2016), which in turn can promote asthma symptoms. Although the use of proton pump inhibitors was higher in asthmatic than in non-asthmatic patients, no relationship was found between use of such medications and OSA severity in our cohort.…”

Cardiovascular disorders in patients with combined course of obstructive sleep apnea and gastroesophageal reflux diseaseCardiovascular disorders in patients with combined course of obstructive sleep apnea and gastroesophageal reflux disease

“…У сучасній медичній літературі широко обговорюються причини патогенезу кардіоваскулярних ускладнень при синхронному перебігу ОАС та ГЕРХ [6,7]. Серед основних чинників, науковці відзначають активацію симпато-адреналової та ренін-ангіотензинової систем в наслідок розвитку гіпоксемії [8], наявність спільних ланок інервації стравоходу і серця [9].…”

“…Розвиток кардіоваскулярних ускладнень у хворих з поєднаним перебігом ОАС та ГЕРХ не підлягає сумніву [6,7]. Більше того, останнім часом з'являється все більше досліджень, в яких автори констатують вірогідну асоціацію між ОАС, ГЕРХ та смертністю від фатальних серцевих аритмій, ішемії міокарда, мозкового інсульту.…”

Survey of nocturnal reflux in patients with gastroesophageal reflux disease in China

“…Nocturnal gastroesophageal reflux (nGER) has been reported to have negative effect on sleep quality, emotions, and work productivity of the patients. Moreover, nGER is considered to be related to bronchitis and asthma and may aggravate respiratory symptoms . A previous study by Shaker et al included 1000 patients with reflux symptoms and demonstrated that 79% of the participants had prevalent nocturnal heartburn .…”

“…Moreover, nGER is considered to be related to bronchitis and asthma and may aggravate respiratory symptoms . A previous study by Shaker et al included 1000 patients with reflux symptoms and demonstrated that 79% of the participants had prevalent nocturnal heartburn . Two‐thirds of participants who experienced heartburn at least thrice per week were more likely to remain awake or to wake up at night due to reflux symptoms …”