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Gastroesophageal reflux incidence and respiratory dysfunction during sleep in infants: treatment with cisapride
Y Vandenplas1, M Deneyer, M Verlinden
1Academic Children's Hospital, Free University of Brussels, Belgium.
Insights
Positional treatment and cisapride effectively reduced gastroesophageal reflux in infants. This treatment also significantly improved disrupted sleep patterns, suggesting a link between reflux and poor sleep quality in infants.
Area of Science:
- Pediatric Gastroenterology
- Neonatal Sleep Studies
- Gastrointestinal Motility Disorders
Background:
- Gastroesophageal reflux is common in infants and can be associated with sleep disturbances.
- Infants often present with disrupted sleep patterns alongside reflux symptoms.
- Understanding the interplay between reflux and sleep is crucial for effective infant care.
Purpose of the Study:
- To evaluate the efficacy of positional treatment combined with cisapride in managing gastroesophageal reflux in infants.
- To assess the impact of this combined treatment on infant sleep patterns and associated symptoms.
- To determine if cisapride causes any adverse reactions in the study population.
Main Methods:
- 22 infants (4-26 weeks) with gastroesophageal reflux and disrupted sleep underwent 24-h esophageal pH monitoring and cardiopneumography.
- Treatment involved positional adjustments and cisapride for 13-16 days.
- Data were compared before and after treatment, with reflux and sleep parameters analyzed.
Main Results:
- Combined treatment significantly reduced overall gastroesophageal reflux (p < 0.001).
- Reflux reduction was most pronounced during sleep and fasted periods.
- Disrupted sleep patterns significantly improved or resolved in all infants (p < 0.001).
- No adverse reactions to cisapride were reported.
- Clinical symptoms associated with reflux also improved.
Conclusions:
- A combination of positional treatment and cisapride is effective in reducing gastroesophageal reflux and improving sleep in infants.
- Gastroesophageal reflux may be a contributing factor to disturbed infant sleep, characterized by abnormal breathing patterns.
- Cisapride appears safe and effective for treating reflux-associated sleep issues in infants.
Abstract:
We studied the effects of positional treatment and cisapride (a new prokinetic agent) on the incidence and duration of gastroesophageal reflux in 22 infants (4-26 weeks old) in asleep, awake, fasted, and postcibal periods. In addition to gastroesophageal reflux (assessed by 24-h continuous esophageal pH monitoring), all infants presented with a disrupted irregular sleep pattern ("respiratory dysfunction") (assessed by a simultaneously performed cardiopneumogram). Reflux was particularly prominent during the sleep and fasted periods. Investigations (cardiopneumogram and esophageal pH monitoring) in the study population were repeated under treatment conditions (cisapride) after 13-16 days. All pH monitoring data with regard to the total investigation time decreased significantly (p less than 0.001). The treatment-related differences were largest in the asleep and fasted periods, but treatment data were not completely within normal ranges (established in age-matched asymptomatic infants), as they were for the awake periods. Associated symptoms of gastroesophageal reflux (belching, cough, nocturnal wheezing, irritability, and restlessness at night) were evaluated before and during treatment by history. A combination of positional treatment and cisapride seemed effective (objectivated by pH monitoring data and clinical improvement); cisapride did not cause adverse reactions. The disrupted sleep pattern improved significantly or disappeared (p less than 0.001) in all infants. These data suggest that in a number of young infants, gastroesophageal reflux may be associated with a disturbed, irregular sleep of poor quality, which is characterized by a typical breathing pattern (multiple, irregularly repeated, short apneas).