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The Association Between Sleep-Related Respiratory Events and Nocturnal Gastroesophageal Reflux Events in Patients With Coexistence of Obstructive Sleep Apnea and Gastroesophageal Reflux Disease: A Case-Crossover Study
October 2015, Vol 148, No. 4_MeetingAbstracts
Sleep Disorders | October 2015
The Association Between Sleep-Related Respiratory Events and Nocturnal Gastroesophageal Reflux Events in Patients With Coexistence of Obstructive Sleep Apnea and Gastroesophageal Reflux Disease: A Case-Crossover Study Nattapong Jaimchariyatam, MD; Warangkana Tantipornsinchai, MD; Tayard Desudchit, MD; Sutep Gonlachanvit, MD Division of Pulmonary and Critical Care Medicine, Department of Medicine, Faculty of Medicine, Chulalongkorn University, and Excellence Center for Sleep Disorders, King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand Chest. 2015;148(4_MeetingAbstracts):1029A. doi:10.1378/chest.2272479
Abstract SESSION TITLE: Aftermath of OSA and Its Treatment SESSION TYPE: Original Investigation Slide PRESENTED ON: Tuesday, October 27, 2015 at 08:45 AM - 10:00 AM PURPOSE: Gastroesophageal reflux disease (GERD) and obstructive sleep apnea (OSA) are both common health problem, and the increased prevalence of nocturnal reflux in patients with OSA has been well described. The literature has addressed significant improvement of GERD after OSA treatment, and sometimes vice versa. However, the precise mechanism underlying this correlation remains unclear. We aim to examine the association between gastroesophageal reflux (GER) and sleep events in patients with coexistence of OSA and GERD. METHODS: A case-crossover study among 12 patients with coexisting OSA and GERD was conducted. All participants underwent simultaneous polysomnography and esophageal manometry along with pH monitoring. Subtypes of GER (i.e. acid, non-acid and gas reflux) and sleep events (i.e. arousal, awakening, hypopnea/apnea, and respiratory effort related arousals [RERA]) were defined as outcome in turn. Respective control time points were selected in all eligible control periods. When GER was outcome, each sleep event was assessed as the exposure individually, and when sleep event was outcome, each GER was also assessed as the exposure individually. Estimated odds ratios (ORs) and 95% confidence intervals (CIs) were analyzed. P-value<0.05 was defined as significance. RESULTS: The patients were determined as moderate to severe OSA (respiratory disturbance index of 41.7 [range, 21.26-95.19]). A hundred and sixteen GER episodes were found during the study, accompanied by 12% acid reflux, 4.4% non-acid reflux, 71.6% gas reflux, 6% mixed non-acid with gas reflux, and 6% mixed acid with gas reflux. The arousals and awakenings were found to be significantly
associated with the subsequent GER events. The OR for a GER following an arousal was 2.31 (95%CI 1.39-3.68; p<0.001) and following an awakening was 3.71 (95%CI 1.81-7.63; p<0.001). Other respiratory events, including apnea, hypopneas and RERA, did not appear significantly correlated with any types of the subsequent GERs (p>0.05). No sleep events followed GER events (p>0.05).
CONCLUSIONS: In patients with coexixtence of GERD and moderate to severe OSA, both awakening and arousal appear to be associated with, or perhaps responsible for, any subtypes of the subsequent GER event. There is no correlation between other sleep events (apnea, hypopnea, or RERA) and any types of GER. GER did not appear to precipitate any sleep events. CLINICAL IMPLICATIONS: Normalization of sleep fragmentation in patients with coexistence of OSA and GERD may be helpful in improving GERD control. DISCLOSURE: The following authors have nothing to disclose: Nattapong Jaimchariyatam, Warangkana Tantipornsinchai, Tayard Desudchit, Sutep Gonlachanvit No Product/Research Disclosure Information
Sleep Disorders | October 2015
The Association Between Sleep-Related Respiratory Events and Nocturnal Gastroesophageal Reflux Events in Patients With Coexistence of Obstructive Sleep Apnea and Gastroesophageal Reflux Disease: A Case-Crossover Study Nattapong Jaimchariyatam, MD; Warangkana Tantipornsinchai, MD; Tayard Desudchit, MD; Sutep Gonlachanvit, MD Division of Pulmonary and Critical Care Medicine, Department of Medicine, Faculty of Medicine, Chulalongkorn University, and Excellence Center for Sleep Disorders, King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand Chest. 2015;148(4_MeetingAbstracts):1029A. doi:10.1378/chest.2272479
Abstract SESSION TITLE: Aftermath of OSA and Its Treatment SESSION TYPE: Original Investigation Slide PRESENTED ON: Tuesday, October 27, 2015 at 08:45 AM - 10:00 AM PURPOSE: Gastroesophageal reflux disease (GERD) and obstructive sleep apnea (OSA) are both common health problem, and the increased prevalence of nocturnal reflux in patients with OSA has been well described. The literature has addressed significant improvement of GERD after OSA treatment, and sometimes vice versa. However, the precise mechanism underlying this correlation remains unclear. We aim to examine the association between gastroesophageal reflux (GER) and sleep events in patients with coexistence of OSA and GERD. METHODS: A case-crossover study among 12 patients with coexisting OSA and GERD was conducted. All participants underwent simultaneous polysomnography and esophageal manometry along with pH monitoring. Subtypes of GER (i.e. acid, non-acid and gas reflux) and sleep events (i.e. arousal, awakening, hypopnea/apnea, and respiratory effort related arousals [RERA]) were defined as outcome in turn. Respective control time points were selected in all eligible control periods. When GER was outcome, each sleep event was assessed as the exposure individually, and when sleep event was outcome, each GER was also assessed as the exposure individually. Estimated odds ratios (ORs) and 95% confidence intervals (CIs) were analyzed. P-value<0.05 was defined as significance. RESULTS: The patients were determined as moderate to severe OSA (respiratory disturbance index of 41.7 [range, 21.26-95.19]). A hundred and sixteen GER episodes were found during the study, accompanied by 12% acid reflux, 4.4% non-acid reflux, 71.6% gas reflux, 6% mixed non-acid with gas reflux, and 6% mixed acid with gas reflux. The arousals and awakenings were found to be significantly
associated with the subsequent GER events. The OR for a GER following an arousal was 2.31 (95%CI 1.39-3.68; p<0.001) and following an awakening was 3.71 (95%CI 1.81-7.63; p<0.001). Other respiratory events, including apnea, hypopneas and RERA, did not appear significantly correlated with any types of the subsequent GERs (p>0.05). No sleep events followed GER events (p>0.05).
CONCLUSIONS: In patients with coexixtence of GERD and moderate to severe OSA, both awakening and arousal appear to be associated with, or perhaps responsible for, any subtypes of the subsequent GER event. There is no correlation between other sleep events (apnea, hypopnea, or RERA) and any types of GER. GER did not appear to precipitate any sleep events. CLINICAL IMPLICATIONS: Normalization of sleep fragmentation in patients with coexistence of OSA and GERD may be helpful in improving GERD control. DISCLOSURE: The following authors have nothing to disclose: Nattapong Jaimchariyatam, Warangkana Tantipornsinchai, Tayard Desudchit, Sutep Gonlachanvit No Product/Research Disclosure Information