Upper Esophageal Sphincter and Gastroesophageal Junction Pressure Changes Act to Prevent Gastroesophageal and Esophagopharyngeal Reflux During Apneic Episodes in Patients With Obstructive Sleep Apnea

Kuribayashi, Shiko; Massey, Benson T.; Hafeezullah, Muhammad; Perera, Lilani P.; Hussaini, Syed Q.; Tatro, Linda; Darling, Ronald J.; Franco, Rose; Shaker, Reza

doi:10.1378/chest.09-0913

Cited by 60 publications

(81 citation statements)

References 16 publications

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“…Similar observations were not seen with either the LES relaxation reflex or the peristaltic reflex during awake state. This is supportive of differential processing of afferent and efferent neural signals pertaining to UES and proximal esophagus skeletal muscle functions (3,24) vs. lower esophageal body and LES smooth muscle processing (28,29). Our results indicate that, when the infant is awake, upon provocation with air across maturation, there is an increase in the aerodigestive protective mechanism involving the UES contractile reflex.…”

Section: Aerodigestive Sensitivity and Electro-cortical Arousals: Effsupporting

confidence: 69%

Maturation of upstream and downstream esophageal reflexes in human premature neonates: the role of sleep and awake states

Jadcherla

Chan

Fernández³

et al. 2013

American Journal of Physiology-Gastrointestinal and Liver Physi

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Jadcherla SR, Chan CY, Fernandez S, Splaingard M. Maturation of upstream and downstream esophageal reflexes in human premature neonates: the role of sleep and awake states. Am J Physiol Gastrointest Liver Physiol 305: G649 -G658, 2013. First published September 5, 2013 doi:10.1152/ajpgi.00002.2013.-We tested the hypothesis that the sensory-motor characteristics of aerodigestive reflexes are dependent on stimulus type and volumes, sleep or awake states, and maturation. Thirteen neonates were studied at 33.6 Ϯ 0.5 wk (time 1) and 37.3 Ϯ 0.5 wk (time 2) postmenstrual age using multimodal provocative esophageal manometry concurrent with video polysomnography. Effects of graded volumes (399 infusions at time 1, 430 infusions at time 2) of midesophageal stimulation with air, water, and apple juice on the sensory thresholds and recruitment frequency of upper esophageal sphincter (UES), esophageal body, and lower esophageal sphincter (LES) reflexes were investigated during sleep and awake states. Sensory thresholds for aerodigestive reflexes between maturational stages were similar. Increased frequency recruitment of UES contractile reflex, LES relaxation reflex, and peristaltic reflexes were noted at time 2 (all, P Ͻ 0.05). Graded stimulusresponse relationships were evident at time 1 and time 2 during awake and sleep states (P Ͻ 0.05). Secondary peristalsis vs. esophagodeglutition response proportions during sleep at time 1 vs. time 2 (P ϭ 0.001) and awake vs. sleep at time 2 (P ϭ 0.02) were distinct. We concluded that sensory-motor effects of esophageal mechanosensitivity, osmosensitivity, and chemosensitivity are advanced in sleep with maturation. Sleep further modulates the frequency recruitment and the type of aerodigestive reflexes.sleep; upper esophageal sphincter; lower esophageal sphincter; peristaltic reflex SLEEP IS BOTH A CRUCIAL AND VULNERABLE physiological state for the developing infant. Although it is essential for conservation of energy and growth, the aerodigestive tract also becomes increasingly susceptible to both retrograde and anterograde aspiration during periods of sleep. Aerodigestive adaptation to these provocations must be maintained; however, the effects of such esophageal provocation during sleep are unclear. Compromise of aerodigestive functions may have serious consequences such as apparent life-threatening events (ALTE) or sudden infant death syndrome (SIDS) (1). It is common practice for infants who have experienced such events to undergo evaluation for esophageal and sleep pathology, as there is often a presumed causal connection between ALTE, SIDS, and aerodigestive pathology with respect to aspiration. These infants are often treated empirically for gastroesophageal reflux disease (GERD) and associated sleep disturbance, using treatments such as caffeine, positional changes, modifications of milk type or density, changes in feeding volumes or feeding methods, medical therapy, or even surgical intervention (2, 6, 25, 36). These treatments have aerodigestive consequences, may be expens...

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Section: Aerodigestive Sensitivity and Electro-cortical Arousals: Effsupporting

confidence: 69%

Maturation of upstream and downstream esophageal reflexes in human premature neonates: the role of sleep and awake states

Jadcherla

Chan

Fernández³

et al. 2013

American Journal of Physiology-Gastrointestinal and Liver Physi

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“…OSA was initially postulated to be a cause of GERD by way of increased intrathoracic negative pressure [64]. Manometric studies have shown a synchronous increase in upper and lower sphincter pressure with negative intraesophageal pressure which is protective against reflux events [65]. Transient lower esophageal sphincter relaxation seems to be the primary mechanism for sleep-related GERD [66].…”

Section: Effects Of Sleep Apnoea Upon the Larynxmentioning

confidence: 99%

Adult obstructive sleep apnoea and the larynx

Novakovic

MacKay

2015

Current Opinion in Otolaryngology & Head and Neck Surgery

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The larynx plays an important role in assessment and treatment of adult sleep apnoea. Laryngeal afferent sensory pathways play a critical role in reflexes controlling airway patency during sleep. Airway obstruction at the laryngeal level should be considered and assessed especially in OSA patients nonresponsive to standard therapies. Isolated laryngeal airway obstruction is rare but identification of specific conditions is important as they are amenable to appropriate treatments. OSA can also affect normal laryngeal function. People with OSA exhibit higher levels of laryngeal inflammation, laryngopharyngeal reflux, and chronic cough. Treatment with continuous positive airway pressure has a potential role in improving laryngeal symptomatology in these cases.

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“…Sur le plan physiopathologique, la diminution de la pression intra-oesophagienne lors des apnées pourrait favoriser le reflux. Cependant, l'étude de Kuribayashi et al a montré que la diminution de pression intra-oesophagienne était contrebalancée par une augmentation de pression au niveau du sphincter inférieur de l'oesophage, ce qui prévenait le reflux [62]. Les épisodes de reflux seraient en réalité précédés de manière significative par les éveils et les mouvements nocturnes, responsables d'une relaxation transitoire du sphincter.…”

Section: Syndrome D'apnées Du Sommeil Et Reflux Gastro-oesophagienunclassified

Reflux gastro-œsophagien et pathologies respiratoires chroniques

Dirou

Germaud

Varannes

et al. 2015

Revue des Maladies Respiratoires

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Upper Esophageal Sphincter and Gastroesophageal Junction Pressure Changes Act to Prevent Gastroesophageal and Esophagopharyngeal Reflux During Apneic Episodes in Patients With Obstructive Sleep Apnea

Cited by 60 publications

References 16 publications

Maturation of upstream and downstream esophageal reflexes in human premature neonates: the role of sleep and awake states

Maturation of upstream and downstream esophageal reflexes in human premature neonates: the role of sleep and awake states

Adult obstructive sleep apnoea and the larynx

Reflux gastro-œsophagien et pathologies respiratoires chroniques

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