Sleep dysfunction in patients with gastro‐oesophageal reflux disease: prevalence and response to GERD therapy, a pilot study

Abstract

Summary Background : There is little information on the prevalence of pathological sleep disorders in patients with gastro‐oesophageal reflux disease and whether pharmacological treatment of patients with gastro‐oesophageal reflux disease will lead to improvement in sleep. Aims: This pilot study determined the prevalence of sleep disorder in patients with erosive gastro‐oesophageal reflux disease, correlated subjective (questionnaire) and objective (actigraphy – a watch worn on the wrist that monitors motion to help differentiate sleep from awake states) assessment of sleep dysfunction and determined whether therapeutic resolution of oesophageal symptoms was associated with an improvement in sleep. Methods : Eighteen patients with erosive gastro‐oesophageal reflux disease received esomeprazole 40 mg once daily for 8 weeks. Assessments at 0, 4 and 8 weeks included: Gastrointestinal Symptoms Rating Scale, Pittsburgh Sleep Quality Index questionnaire and ambulatory wrist actigraphy. Results : Unrecognized sleep disturbance occurred in 81% of this cohort of patients with gastro‐oesophageal reflux disease and erosive oesophagitis. Median reflux syndrome score (heartburn and acid regurgitation) on Gastrointestinal Symptoms Rating Scale decreased from 2 at baseline to 0 at weeks 4 and 8 (P ≤ 0.0001). Median global Pittsburgh Sleep Quality Index score decreased from 8.50 at baseline to 4.50 at week 4 (P = 0.002) and to 7.00 at week 8 (P = 0.043). There were no significant changes in actigraphy measurements. Conclusions : Sleep disturbance is common in patients with gastro‐oesophageal reflux disease with erosive oesophagitis. This study which is the first to evaluate sleep abnormalities and gastro‐oesophageal reflux disease using a validated questionnaire, demonstrates that in patients with gastro‐oesophageal reflux disease, sleep improvement, may be effected by gastro‐oesophageal reflux disease therapy. Actigraphy may be inappropriate for measurement of sleep disturbance in gastro‐oesophageal reflux disease patients.

Nationwide epidemiological study on gastroesophageal reflux disease and sleep disorders in the Japanese population

“…One possible mechanism may be implicated in the pathogenesis of sleep disorders in patients with GERD: arousal stimulated by acid refl ux into the esophagus, followed b an unconscious acid-swallowing response to the perceived acid refl ux (microarousal). It has been reported that sleep disorders are improved in GERD patients after administration of ranitidine and esomeprazole, 14,15 supporting this mechanistic hypothesis.…”

Sleep Dysfunction in Japanese Patients with Gastroesophageal Reflux Disease: Prevalence, Risk Factors, and Efficacy of Rabeprazole

“…Rabeprazole significantly reduced FSSG and PSQI global scores, indicating that the PPI is effective in the improvement of reflux symptoms and sleep dysfunction in Japanese GERD patients [21]. A large, randomized, controlled trial using esomeprazole demonstrated a significant reduction in nighttime heartburn and sleep disturbance, and improved sleep quality compared to patients receiving a placebo [22]. Additional studies reported that PPIs, such as esomeprazole and rabeprazole, improved the subjective sleep quality while not affecting objective sleep measurements as assessed by actigraph or polysomnograph [23,24].…”

Impact of Nocturnal Heartburn on Quality of Life, Sleep, and Productivity: The SINERGE Study

“…Moreover, compared to these 2 groups, nocturnal heartburn significantly impaired all dimensions of sleep except "sleep efficiency" and "use of drugs for sleep." Although that effect on subjective sleep measures has been observed in the Gallup survey [4] and some therapeutic trials [30][31][32], the effect of GERD symptoms on objective sleep measures is more controversial. Some studies have suggested that gastroesophageal reflux can disrupt objective sleep [33] with an increased arousal and decreased durations spent in deeper stages of sleep.…”