The Relationship Between Obstructive Sleep Apnea (OSA) and Gastroesophageal Reflux Disease (GERD) in Inpatient Settings: A Nationwide Study

Abstract

Introduction: Several studies identified a link between gastroesophageal reflux disease (GERD) and obstructive sleep apnea (OSA). GERD is a condition in which acid reflux from the stomach to the esophagus causes troublesome symptoms. On the other hand, OSA is defined as a sleep-related breathing disorder in which airflow significantly decreases or ceases due to upper airway obstruction, leading to arousal from sleep. OSA was found to be associated with GERD. In this study, we aim to study the characteristics and concurrent risk factors associated with GERD and OSA in a large population-based study.Methods: Patients with the diagnosis of GERD were extracted from the National Inpatient Database (NIS) for the years 2016 to 2019. Patients' age, gender, race, and hospital information, including region and bed size, were extracted and considered as baseline characteristics. The comorbidities included are hypertension (HTN), atrial fibrillation (AFib), congestive heart failure (CHF), chronic obstructive pulmonary disease (COPD), pulmonary hypertension (PHTN), obesity, and smoking. Patients younger than 18 years old were excluded from this study.Results: Out of 22,677,620 patients with the diagnosis of GERD, 12.21% had a concurrent diagnosis of OSA (compared to 4.79% in patients without GERD, p-value <0.001). The mean age of patients with GERD and OSA was 64.47 years vs 65.42 years in patients without OSA (p-value <0.001). The GERD and OSA group had almost identical gender distribution compared to the GERD only group, as it was predominantly female patients. The white and black races were slightly more prevalent in the GERD and OSA group compared to the GERD only group. Regarding comorbidities, the prevalence of obesity was more clear in the GERD and OSA group. It was noted that the group of patients who carry a diagnosis of GERD and OSA have more prevalence of diabetes (DM), hypertension (HTN), obesity, atrial fibrillation (Afib), congestive heart failure (CHF), and pulmonary hypertension (PHTN). Patients with GERD and OSA were 21% less likely to be older than 65 years rather than younger (95% CI: 0.79-0.8, p-value <0.001), 35% less likely to be females (95% CI: 0.65-0.65, p-value <0.001), and 22% less likely to be non-white (95% CI: 0.77-0.8, p-value <0.001). Obesity was found to be the strongest association with this population, followed by PHTN, CHF, DM, HTN, Afib, and lastly smoking.Conclusion: Patients with GERD and OSA were found more likely to be female, white, living in the southern part of the United States, obese, diabetes mellitus type 2, and being active smokers.

Association of Dry Eye Diseases and Auditory Sensitivity

“…Second, sleep disturbance due to the fact of tinnitus may have caused dry eye, because sleep disorders are an important risk factor for dry eye [ 48 , 49 , 50 ]. Sleep apnea accompanied with laryngopharyngeal reflux also may affect to dry eye [ 43 , 51 ]. Sleep disorders are associated with both tinnitus and dry eye [ 48 , 49 , 50 , 52 , 53 ].…”

The Differences between Gastroesophageal and Laryngopharyngeal Reflux

“…GERD and psychosocial disorders often occur together and can affect each other [11]. Obstructive sleep apnea (OSA), obstructive sleep apnea syndrome (OSAS), and GERD have a strong relationship and share several common risk factors: approximately 40-60% of patients with OSA also suffer from GERD [12].…”

Pathophysiologie der Schlafapnoe

“…Es konnte gezeigt werden, dass bei 12% der Refluxpatienten gleichzeitig ein OSAS vorlag, wohingegen dies nur bei 5% der Patienten ohne Reflux der Fall war. Weiter erwies sich in dieser Untersuchung, dass Adipositas die stärkste Assoziation mit Reflux ist [26]. Eine weitere Studie berichtet in 45% der Fälle mit OSAS über sauren Reflux [27].…”