Association between respiratory events and nocturnal gastroesophageal reflux events in patients with coexisting obstructive sleep apnea and gastroesophageal reflux disease

Abstract

Background and Rationale: The literatures have addressed the increased prevalence of Gastroesophageal reflux disease (GERD) in obstructive sleep apnea (OSA). Likewise, significant improvement of GERD has been found after OSA treatment. However, the precise mechanism underlying this correlation remains unclear. We examined the association between nocturnal gastroesophageal reflux (GER) and sleep events in patients with coexisting OSA and GERD. Materials and methods: A case-crossover study among 12 patients with coexisting moderate-severe OSA and GERD was conducted. Participants underwent simultaneous polysomnography and esophageal manometry with pH monitoring. Subtypes of GER (i.e. acid reflux, nonacid reflux, and gas reflux) were defined as outcome. Respective control time points were selected in all eligible control periods. Each sleep event was assessed as the exposure individually. Estimated odds ratios (ORs) and 95% confidence intervals (CIs) were analyzed. P-value Results: 116 GER episodes were found during the study (12% acid-reflux, 4.4% nonacid-reflux, 71.6% gas-reflux, 12% mixed-type). The OR for a GER following an arousal was 2.31 (95%CI 1.39-3.68; p 0.05). Discussion: Both awakening and arousal appear to precipitate GER event in patients with coexisting GERD and moderate-severe OSA. However, other respiratory events did not cause GER to happen.