Supraesophageal Reflux: Correlation of Position and Occurrence of Acid Reflux–Effect of Head-of-Bed Elevation on Supine Reflux

Scott, David; Simon, Ronald A.

doi:10.1016/j.jaip.2014.11.019

Cited by 16 publications

(9 citation statements)

References 39 publications

(59 reference statements)

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“…Even though supine position generally worsens the nocturnal refl ux symptoms, 11 supine AHI (p = 0.81) in our study was not statistically signifi cant in predicting severity of nGER. On the other hand, we found an interesting observation about the relationship of OSA severity (total AHI) in predicting baseline nGER in simple linear regression model.…”

Section: S Tamanna D Campbell R Warren Et Al Effect Of Cpap On Symcontrasting

confidence: 76%

Effect of CPAP Therapy on Symptoms of Nocturnal Gastroesophageal Reflux among Patients with Obstructive Sleep Apnea

Tamanna

Campbell

Warren

et al. 2016

Journal of Clinical Sleep Medicine

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Study Objectives: Nocturnal gastroesophageal reflux (nGER) is common among patients with obstructive sleep apnea (OSA). Previous studies demonstrated that continuous positive airway pressure (CPAP) reduces symptoms of nGER. However, improvement in nGER symptoms based on objective CPAP compliance has not been documented. We have examined the polysomnographic characteristics of patients with nGER and OSA and looked for association of OSA severity and CPAP compliance with improvement in nGER symptoms. Methods: We interviewed 85 veterans with OSA to assess their daytime sleepiness (Epworth Sleepiness scale [ESS]) and nGER symptom frequency after their polysomnography and polysomnographic data were reviewed. At 6 months' follow-up, ESS score, nGER score, and CPAP machine compliance data were reassessed. Data from 6 subjects were dropped from final analysis due to their initiation of new medication for nGER symptom since the initial evaluation. Results: Sixty-two of 79 (78%) patients complained of nGER symptoms during initial visit. At baseline, nGER score was correlated with sleep efficiency (r = 0.43), and BMI correlated with the severity of OSA (r = 0.41). ESS and nGER improved (p < 0.0001) in all patients after 6 months, but more significantly in CPAP compliant patients. A minimum CPAP compliance of 25% was needed to achieve any benefit in nGER improvement. Conclusions: Nocturnal gastroesophageal reflux is common among patients with OSA which increases sleep disruption and worsens the symptoms of daytime sleepiness. CPAP therapy may help improve the symptoms of both nocturnal acid reflux and daytime sleepiness, but adherence to CPAP is crucial to achieve this benefit. Keywords: OSA, obstructive sleep apnea, GERD, nocturnal reflux, CPAP Citation: Tamanna S, Campbell D, Warren R, Ullah MI. Effect of CPAP therapy on symptoms of nocturnal gastroesophageal reflux among patients with obstructive sleep apnea.

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Section: S Tamanna D Campbell R Warren Et Al Effect Of Cpap On Symcontrasting

confidence: 76%

Effect of CPAP Therapy on Symptoms of Nocturnal Gastroesophageal Reflux among Patients with Obstructive Sleep Apnea

Tamanna

Campbell

Warren

et al. 2016

Journal of Clinical Sleep Medicine

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“…A systematic review of lifestyle interventions in GORD concluded that weight loss and tobacco smoking cessation should be recommended when relevant, and that avoiding late-evening meals and head-of-bed elevation were effective in nocturnal GORD. 125 In a study of supra-oesophageal reflux prevalence, timing and response to head-of-bed elevation by 6 inches, 126 nasopharyngeal pH-metry detected acid in 113 (48%) participants, with over half being only in the supine position. Sequential overnight nasopharyngeal pH monitoring before and after head-of-bed elevation was obtained in only 13 of those with supine reflux.…”

Section: Lifestyle Modificationmentioning

confidence: 99%

“…Ten subjects demonstrated significant improvement, with complete resolution in most. 126 However, some bed types, such as storage divans, do not lend themselves easily to elevation and so the use of a mattress-top wedge is becoming increasing popular in the commercial sector (e.g. https://putnams.co.uk/products/memory-foam-bed-wedge; accessed 30 October 2019).…”

Section: Lifestyle Modificationmentioning

confidence: 99%

Lansoprazole for persistent throat symptoms in secondary care: the TOPPITS RCT

Wilson

Stocken

Watson

et al. 2021

Health Technol Assess

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Background Persistent throat symptoms are commonly attributed to ‘laryngopharyngeal reflux’. Despite a limited evidence base, these symptoms are increasingly being treated in primary care with proton pump inhibitors. Objective To assess the value of proton pump inhibitor therapy in patients with persistent throat symptoms. Design This was a double-blind, placebo-controlled, randomised Phase III trial. Setting This was a multicentre UK trial in eight UK ear, nose and throat departments. Participants A total of 346 participants aged ≥ 18 years with persistent throat symptoms and a Reflux Symptom Index score of ≥ 10, exclusive of the dyspepsia item, were recruited. Intervention Random allocation (1 : 1 ratio) to either 30 mg of lansoprazole twice daily or matched placebo for 16 weeks. Main outcome measure Symptomatic response (i.e. total Reflux Symptom Index score after 16 weeks of therapy). Results A total of 1427 patients were screened and 346 were randomised. The mean age was 52 years (standard deviation 13.7 years, range 20–84 years); 150 (43%) participants were male and 196 (57%) were female; 184 (53%) participants had a mild Reflux Symptom Index minus the heartburn/dyspepsia item and 162 (47%) had a severe Reflux Symptom Index minus the heartburn/dyspepsia item. A total of 172 patients were randomised to lansoprazole and 174 were randomised to placebo. Main outcomes A total of 267 participants completed the primary end-point visit (lansoprazole, n = 127; placebo, n = 140), of whom 220 did so between 14 and 20 weeks post randomisation (‘compliant’ group); 102 received lansoprazole and 118 received placebo. The mean Reflux Symptom Index scores at baseline were similar [lansoprazole 22.0 (standard deviation 8.0), placebo 21.7 (standard deviation 7.1), overall 21.9 (standard deviation 7.5)]. The mean Reflux Symptom Index scores at 16 weeks reduced from baseline in both groups [overall 17.4 (standard deviation 9.9), lansoprazole 17.4 (standard deviation 9.9), placebo 15.6 (standard deviation 9.8)]. Lansoprazole participants had estimated Reflux Symptom Index scores at 16 weeks that were 1.9 points higher (worse) than those of placebo participants (95% confidence interval –0.3 to 4.2; p adj = 0.096), adjusted for site and baseline severity. Secondary outcomes Ninety-five (43%) participants achieved a Reflux Symptom Index score in the normal range (< 12) at 16 weeks: 42 (41%) in the lansoprazole group and 53 (45%) in the placebo group. A total of 226 participants completed the end-of-trial follow-up visit (lansoprazole, n = 109; placebo, n = 117), of whom 181 were ‘compliant’. The mean Reflux Symptom Index scores at 12 months reduced from baseline in both groups [lansoprazole 16.0 (standard deviation 10.8), placebo 13.6 (standard deviation 9.6), overall 14.7 (standard deviation 10.2)]. A total of 87 (48%) participants achieved a Reflux Symptom Index score in the normal range at 12 months: 33 (40%) in the lansoprazole group and 54 (55%) in the placebo group. Likewise, the Comprehensive Reflux Symptom Score and Laryngopharyngeal Reflux – Health Related Quality of Life total scores and subscales all showed very similar changes in the lansoprazole and placebo cohorts at both 16 weeks and 12 months. Limitations Drop-out rate and compliance are issues in pragmatic clinical trials. The Trial Of Proton Pump Inhibitors in Throat Symptoms (TOPPITS) aimed to detect clinically relevant difference with 90% power. The 346 randomised participants reduced to 283 at the primary end point; 267 completed the primary outcome measure, 220 within the protocol time scale. Despite this, the powers to detect the clinically relevant difference in Reflux Symptom Index score at 16 weeks were 82% (compliant comparison) and 89% (pragmatic comparison). The lack of difference between lansoprazole and placebo is generalisable across NHS clinics. Conclusions Participants on lansoprazole did not report significantly better outcomes than participants on placebo on any of the three patient-reported outcome tools (Reflux Symptom Index, Comprehensive Reflux Symptom Score and Laryngopharyngeal Reflux – Health Related Quality of Life). This multicentre, pragmatic, powered, definitive Phase III trial found no evidence of benefit for patients by treating persistent throat symptoms with lansoprazole. Trial registration Current Controlled Trials ISRCTN38578686 and EudraCT number 2013-004249-17. Funding This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 25, No. 3. See the NIHR Journals Library website for further project information.

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“…Reflux episodes in LPR usually occur in the upright position during the daytime, while reflux episodes in GER occur more often in the supine position at nighttime or during sleep. 11 , 12 Recently, a study by Scott et al 13 reported that LPR occurred exclusively in the supine position. In another earlier study by Beaver et al 14 LPR was found to be more frequently reported in the supine position than upright position.…”

Section: Introductionmentioning

confidence: 99%

Characteristics of upright versus supine reflux pattern in patients with laryngopharyngeal reflux

Mesallam

Baqays

2021

Brazilian Journal of Otorhinolaryngology

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Supraesophageal Reflux: Correlation of Position and Occurrence of Acid Reflux–Effect of Head-of-Bed Elevation on Supine Reflux

Cited by 16 publications

References 39 publications

Effect of CPAP Therapy on Symptoms of Nocturnal Gastroesophageal Reflux among Patients with Obstructive Sleep Apnea

Effect of CPAP Therapy on Symptoms of Nocturnal Gastroesophageal Reflux among Patients with Obstructive Sleep Apnea

Lansoprazole for persistent throat symptoms in secondary care: the TOPPITS RCT

Characteristics of upright versus supine reflux pattern in patients with laryngopharyngeal reflux

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