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Arousals induced by proximal esophageal reflux in infants
A Kahn1, E Rebuffat, M Sottiaux
1Pediatric Sleep and Development Unit, University Children's Hospital, Free University of Brussels, Belgium, Austria.
Insights
Acid reflux in the proximal esophagus triggers arousal from sleep in infants. This study shows proximal gastroesophageal reflux is a significant arousal stimulus during infant sleep.
Area of Science:
- Pediatric Sleep Medicine
- Gastroenterology
Background:
- Infant sleep disturbances are common.
- The role of proximal acid reflux in infant arousal is not well understood.
Purpose of the Study:
- To investigate if proximal esophageal acid reflux can induce arousal from sleep in infants.
Main Methods:
- Fifty infants (8 weeks old) underwent overnight polygraphic monitoring.
- Proximal esophageal pH monitoring and behavioral arousal assessment were performed.
- Data analysis was conducted blind to pH changes.
Main Results:
- 97 reflux episodes (pH < 4) were recorded in 41 infants.
- Reflux was associated with wakefulness (41%) and REM sleep (39%).
- A significant increase in arousals occurred before, during, and after reflux events, particularly in the minutes following pH drops.
Conclusions:
- Proximal gastroesophageal reflux is a potent arousal stimulus in sleeping infants.
- Reflux-induced arousals are concentrated in the immediate period following pH drops.
- This finding has implications for understanding infant sleep disturbances and potential interventions.
Abstract:
We investigated whether acid reflux in the proximal esophagus can induce arousal from sleep in infants. Fifty normal infants with occasional regurgitations were studied at the age of 8 weeks (range 4-26 weeks). In each child a pH probe was placed in the proximal portion of the thoracic esophagus, in front of the third vertebra, under radiologic control. Polygraphic monitoring of state of alertness and of proximal esophageal pH changes was recorded continuously during one night. The data were analyzed blind. For 41 of the 50 infants, a total of 97 drops below pH 4 was computed. Reflux was more frequently associated with wakefulness (41% of the episodes), or rapid eye movement (REM) sleep (39%), than with nonREM (19%) or indeterminate sleep (1%). Comparing the fifth and the last minutes preceding the pH drops, a significant increase in the number of behavioral arousals was observed (p = 0.003). In comparison with the minute before the drop in esophageal pH, a further significant increase in the number of arousals occurred during the first minutes following the pH drop (p = 0.001). Although the first minutes following the 97 episodes of reflux represented only 0.4% of the total sleep time, 76% of all arousals (74 out of 97) took place during this time period (p = 0.001). Five minutes after the pH drops, the behavioral changes tended to return to prereflux values. It is concluded that in infants, during sleep, proximal gastroesophageal reflux can act as a strong arousal stimulus.