Clinical and polysomnographic predictors of laryngopharyngeal reflux in obstructive sleep apnea syndrome

Fábio Azevedo Caparroz,Milena De Almeida Torres Campanholo,Caroline Gomez Regina,Sung Woo Park,Leonardo Haddad,Luís Carlos Gregório,Fernanda Louise Martinho Haddad

doi:10.1016/j.bjorl.2018.03.007

Fábio Azevedo Caparroz, Milena De Almeida Torres Campanholo + Show 5 more

Open Access

https://doi.org/10.1016/j.bjorl.2018.03.007

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Abstract

IntroductionObstructive sleep apnea syndrome and laryngopharyngeal reflux are diseases with a high prevalence in the overall population; however, it remains unclear whether they are diseases with the same risk factors present in the same populations or if there is any association between them. ObjectivesTo evaluate and determine the prevalence of laryngopharyngeal reflux in patients with moderate and severe obstructive apnea syndrome and also to determine its predictive factors. MethodsHistorical cohort, cross-sectional study of patients aged 18–70 years, referred to a tertiary service Otorhinolaryngology outpatient clinic with a polysomnographic diagnosis of moderate or severe obstructive sleep apnea syndrome. The reflux symptom index questionnaire and the reflux finding score at indirect videolaryngoscopy were applied to the assessed population, considering the inclusion and exclusion criteria. ResultsFifty-six patients were evaluated, of which 64.3% had a positive laryngopharyngeal reflux (positive reflux symptom index and/or positive endolaryngeal reflux finding score). Body mass index was a predictor of reflux presence in this group of patients with moderate to severe obstructive sleep apnea syndrome. In patients with positive score for endoscopic findings and reflux symptom index (12.3%), there was a trend toward significance for a higher mean apnea–hypopnea index and a higher percentage of sleep time with oxyhemoglobin saturation below 90% (p=0.05). ConclusionThe prevalence of laryngopharyngeal reflux was higher in this group of patients with moderate to severe obstructive sleep apnea syndrome, and the body mass index was a predictor of laryngopharyngeal reflux in these patients. There was a trend toward greater oxyhemoglobin desaturation in patients with a positive score for reflux symptoms index (RSI) and reflux finding score (RFS).

Highlights

Obstructive sleep apnea syndrome (OSAS) and laryngopharyngeal reflux (LPR) are conditions with high prevalence in the general population, affecting 2---4% and 20---40% of the adult population, respectively.[1,2] Both have a significant impact on quality of life and lead to increased morbidity in affected individuals.[1,2] their association has been suggested in the literature, it is unclear whether this association exists or whether they are conditions with the same risk factors, coexisting in the same populations.3---5There are several theories supporting the association between laryngopharyngeal reflux and OSAS, with the main ones based on inflammation and decrease in the upper airway caliber due to prolonged contact of the gastroduodenal content with the pharynx and larynx.[4]
Three patients were excluded from the statistical analyses due to lack of data
Considering as a criterion of positivity for laryngopharyngeal reflux, the score >13 in the reflux symptom index (RSI) tool or score >7 in the reflux finding score (RFS), according to the classification of the original study descriptions, we observed that 64.3% of the patients can be considered as having laryngopharyngeal reflux

Summary

Introduction

There are several theories supporting the association between laryngopharyngeal reflux and OSAS, with the main ones based on inflammation and decrease in the upper airway caliber due to prolonged contact of the gastroduodenal content with the pharynx and larynx.[4] both diseases share obesity as an important risk factor, which may justify apnea and reflux in the same individual due to the reduction in upper airway permeability and increasing intraabdominal pressure.[4]. The pressure of the lower esophageal sphincter (LES), on the other hand, is minimal during expiration, but is not affected by the sleep stages.[6]

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