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Obstructive sleep apnea and gastroesophageal reflux
A J Ing1, M C Ngu, A B Breslin
1Respiratory Investigation Unit, Concord Hospital, NSW, Australia.
The American Journal of Medicine
|March 16, 2000
Summary
Patients with obstructive sleep apnea (OSA) experience more gastroesophageal reflux (GER) than healthy individuals. While OSA therapy reduced GER, the link between OSA and GER remains unclear, though GER may cause arousals.
Area of Science:
- Gastroenterology and Pulmonology
- Sleep Medicine
Background:
- Gastroesophageal reflux (GER) is increasingly recognized in patients with obstructive sleep apnea (OSA).
- The potential causal relationship and impact of treating one condition on the other require further investigation.
Purpose of the Study:
- To determine the prevalence of GER in a controlled OSA population.
- To investigate the causal relationship between OSA and GER by assessing the effects of treating OSA on GER and vice versa.
Main Methods:
- Simultaneous polysomnography and distal esophageal pH monitoring were performed on 63 OSA patients and 41 controls.
- Therapeutic interventions included nasal continuous positive airway pressure (nCPAP) for OSA and antireflux medication (nizatidine) for GER.
Main Results:
- OSA patients exhibited significantly higher GER events and time spent at pH <4.0 compared to controls.
- 53.4% of GER episodes in OSA patients were temporally related to apneas/hypopneas, but only 46.8% of apneas related to reflux.
- nCPAP non-specifically reduced GER parameters; nizatidine reduced arousals but not the apnea-hypopnea index (AHI).
Conclusions:
- Patients with OSA have a higher prevalence of GER.
- The role of OSA in GER pathogenesis is unclear, as nCPAP's effect on GER appears non-specific.
- GER is likely implicated in arousal pathogenesis, but not in apnea pathogenesis.