[The relationship between obstructive sleep apnea and gastroesophageal reflux and the effect of antireflux therapy]

To evaluate the relationship between gastroesophageal reflux (GER) and obstructive sleep apnea (OSA) and the effect of combined therapy with cisapride and omeprazole.

24-hour esophageal pH and manometric monitoring and polysomnography (PSG) were performed in 18 patients with snoring, daytime sleepiness and acid reflux, heartburn and regurgitation. Cisapride 10 mg qid and omeprazole 20 mg q12h were given to patients with GER and OSA. these tests were repeated on the 7th day.

7 of the 18 patients with OSA had severe GER. All except one had daytime GER as well as nocturnal GER. Nocturnal recordings were analyzed and it was found that esophageal pH below 4.0 was frequently followed by swallow action (58.6%, control = 20.6%, P < 0.05), gross body movement (18.6%, control = 4.8%, P < 0.05) and arousal (26.8%, control = 16.8%, P < 0.05). The mean lowest esophageal pressure [(-15.2 +/- 9.6) mmHg] before and [(-18.6 +/- 10.1) mmHg] after the drops of pH were significantly lower than that during control periods [(-10.6 +/- 8.1) mmHg, P < 0.005]. After antireflux therapy, there was dramatically improvement in total apnea time [from (52.7 +/- 27.1) to (21.6 +/- 21.2) minutes, P < 0.002)] and apnea hypopnea index (AHI) [from (38.9 +/- 17.6) to (15.2 +/- 12.3) No./h, P < 0.002].

GER is a predisposing factor for OSA, they may coexist and aggravate each other. Combined therapy with cisapride and omeprazole is a new, simple and effective method for GER with OSA.