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Sleep phase and gastro-oesophageal reflux in infants at possible risk of SIDS
J Y Paton1, U M MacFadyen, H Simpson
1Department of Child Health, University of Leicester.
Insights
Gastro-oesophageal reflux in infants frequently occurs during active sleep, not quiet sleep. This finding may explain why reflux during sleep is a risk factor for pulmonary disease in infants.
Area of Science:
- Pediatric Gastroenterology
- Sleep Medicine
- Neonatal Physiology
Background:
- Gastro-oesophageal reflux (GOR) is a common concern in infants.
- The relationship between sleep state and GOR events requires further elucidation.
- Understanding this association is crucial for managing potential complications like pulmonary disease.
Purpose of the Study:
- To investigate the association between gastro-oesophageal reflux and specific sleep states in infants.
- To determine the timing and frequency of GOR events relative to sleep patterns.
Main Methods:
- Simultaneous monitoring of esophageal pH and polysomnography during overnight sleep in 24 infants.
- Analysis of pH drops and their correlation with sleep stages (active, indeterminate, quiet) and body movements.
Main Results:
- Gastro-oesophageal reflux was confirmed in 20 out of 24 infants.
- Most reflux events (48%) initiated during active sleep, with another significant portion (47%) during indeterminate sleep often linked to body movements.
- Reflux episodes rarely began (4%) or occurred during quiet sleep.
Conclusions:
- Gastro-oesophageal reflux episodes in infants predominantly occur during active or indeterminate sleep, not quiet sleep.
- The association of GOR with active sleep and body movements may contribute to its role as a risk factor for pulmonary complications.
Abstract:
The association between gastro-oesophageal reflux and sleep state in 24 infants with confirmed or suspected gastro-oesophageal reflux was studied by monitoring both the pH in the lower oesophagus and polygraphic tracings made during sleep at night. Gastro-oesophageal reflux during the night was confirmed in 20 infants. Three hundred and sixteen precipitous drops of more than one unit of pH were recorded during the studies, 186 during periods of wakefulness. Of 130 drops in pH during sleep, 62 (48%) began during active sleep and 62 during indeterminate sleep. Of the latter, 56 (90%) were associated with brief gross body movements. Only five of the drops in pH (4%) began during quiet sleep. Gastro-oesophageal reflux stopped during active sleep on 56 occasions (43%), in indeterminate sleep in 62 (47%), and in quiet sleep in 12 (9%). Episodes of gastro-oesophageal reflux starting or ending in quiet sleep were uncommon. The occurrence of gastro-oesophageal reflux during active sleep may partly explain why reflux during sleep is a risk factor for pulmonary disease.