Extra‐Esophageal Reflux (EER) and Sleep Disorders

Abstract

Objective: GERD is associated with sleep disorders, but how other reflux related disorders affect sleep is unknown. This study’s goal is to evaluate the interaction of extra-esophageal reflux (EER) using subjective and objective (salivary pepsin) measures and sleep disorders including insomnia, hypersomnia, and sleep disordered breathing (SDB). Method: A prospective cohort of sleep and non-sleep adult patients were evaluated for insomnia, hypersomnia, SDB, sleep quality of life, nasal symptoms, and EER using validated questionnaires (PSQI, ESS, STOP BANG, FOSQ10 RSI, NOSE). Simultaneous pharyngeal saliva samples obtained in clinic underwent Western blot immunoassay for pepsin. Results: Prevalence of pepsin (+) and elevated Reflux Symptom Index (RSI) in 70 adult subjects (54 assay complete) was 26% and 46.3%, respectively. Significant heartburn symptoms were reported in 14.8%. Pepsin (+) was not associated with any measure of sleep or non-sleep outcomes ( P > .05). In contrast, a significant correlation ( P < .001) was observed between RSI and insomnia ( r = 0.47), sleep QOL ( r = 0.45), and nasal symptoms (0.54) but not SDB ( r = 0.03, ns). Nasal symptoms were strongly correlated with sleep disorders ( r = 0.54, P < .001). Conclusion: Despite a low prevalence of GER in this population, a strong association between measures of EER and multiple measures of sleep quality as well as nasal obstruction was observed. Findings support that patient symptoms related to EER are associated with sleep disorders and sleep quality independent of GER.