Abstract
Background & AimsPrevious studies indicate an association between sleep problems and gastroesophageal reflux disease (GERD). Although both these conditions separately have moderate heritabilities, confounding by genetic factors has not previously been taken into account. This study aimed to reveal the association between sleep problems and GERD, while adjusting for heredity and other potential confounding factors.MethodsThis cross-sectional population-based study included all 8,014 same-sexed twins of at least 65 years of age and born in Sweden between 1886 and 1958, who participated in telephone interviews in 1998–2002. Three logistic regression models were used 1) external control analysis, 2) within-pair co-twin analysis with dizygotic (DZ) twin pairs discordant for GERD, and 3) within-pair co-twin analysis with monozygotic (MZ) twin pairs discordant for GERD. Odds ratios (ORs) with 95% confidence intervals (CIs) were calculated and adjusted for established risk factors for GERD, i.e. sex, age, body mass index (BMI), tobacco smoking, and educational level.ResultsA dose-response association was identified between increasing levels of sleep problems and GERD in the external control analysis. Individuals who often experienced sleep problems had a two-fold increased occurrence of GERD compared to those who seldom had sleep problems (OR 2.0, 95% CI 1.8–2.4). The corresponding association was of similar strength in the co-twin analysis including 356 DZ pairs (OR 2.2, 95% CI 1.6–3.4), and in the co-twin analysis including 210 MZ pairs (OR 1.5, 95% CI 0.9–2.7).ConclusionA dose-dependent association between sleep problems and GERD remains after taking heredity and other known risk factors for GERD into account.
Highlights
Gastroesophageal reflux disease (GERD), defined as recurrent regurgitation of stomach contents into the esophagus which causes troublesome symptoms or complications [1], is a public health problem in the Western world, affecting up to 20% of adult populations [2,3]
Twin studies have shown that 31–43% of the variation in liability to gastroesophageal reflux disease (GERD) could be explained by genetic factors [8,9], and the gene collagen type III alpha 1 has been associated with GERD and hiatus hernia [10]
Previous research indicates that sleep problems are associated with GERD [15,16], but both these conditions are associated with a moderate heritability, confounding by genetic factors has not been adjusted for in existing studies
Summary
Gastroesophageal reflux disease (GERD), defined as recurrent regurgitation of stomach contents into the esophagus which causes troublesome symptoms or complications [1], is a public health problem in the Western world, affecting up to 20% of adult populations [2,3]. Twin studies have shown that 31–43% of the variation in liability to GERD could be explained by genetic factors [8,9], and the gene collagen type III alpha 1 has been associated with GERD and hiatus hernia [10]. Sleep problems are another common health concern, affecting about one-third of the adult population in industrialized countries [11]. Previous studies indicate an association between sleep problems and gastroesophageal reflux disease (GERD) Both these conditions separately have moderate heritabilities, confounding by genetic factors has not previously been taken into account. This study aimed to reveal the association between sleep problems and GERD, while adjusting for heredity and other potential confounding factors
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