Abstract
BackgroundIt has been suggested that disturbed activity of the autonomic nervous system is one of the factors involved in gastroesophageal reflux (GER) in adults. We sought to establish whether transient ANS dysfunction (as assessed by heart rate variability) is associated with the occurrence of GER events in neonates during sleep and wakefulness.MethodsNineteen neonates with suspected GER underwent simultaneous, synchronized 12-hour polysomnography and esophageal multichannel impedance-pH monitoring. We compared changes in HRV parameters during three types of periods (control and prior to and during reflux) with respect to the vigilance state.ResultsThe vigilance state influenced the distribution of GER events (P<0.001), with 53.4% observed during wakefulness, 37.6% observed during active sleep and only 9% observed during quiet sleep. A significant increase in the sympathovagal ratio (+32%, P=0.013) was observed in the period immediately prior to reflux (due to a 15% reduction in parasympathetic activity (P=0.017)), relative to the control period. This phenomenon was observed during both wakefulness and active sleep.ConclusionOur results showed that GER events were preceded by a vigilance-state-independent decrease in parasympathetic tone. This suggests that a pre-reflux change in ANS activity is one of the factors contributing to the mechanism of reflux in neonates.
Highlights
Gastroesophageal reflux (GER) is defined as the physiologic passage of gastric contents into the esophagus
It has further been hypothesized that disturbances in autonomic nervous system (ANS) activity could impair contraction of the lower esophageal sphincter and may be involved in transient lower esophageal sphincter relaxation [6,7]
To assess the changes in ANS activity in relation to gastroesophageal reflux (GER), we examined the changes in Heart rate variability (HRV) parameters during three periods of three minutes defined with regard to each GER event's time of occurrence: (i) a control period, (ii) a period immediately prior to the GER and (iii) a period during the GER
Summary
Gastroesophageal reflux (GER) is defined as the physiologic passage of gastric contents into the esophagus. GER has been linked to disturbances in autonomic nervous system (ANS) activity. It has been suggested that disturbed activity of the autonomic nervous system is one of the factors involved in gastroesophageal reflux (GER) in adults. A significant increase in the sympathovagal ratio (+32%, P=0.013) was observed in the period immediately prior to reflux (due to a 15% reduction in parasympathetic activity (P=0.017)), relative to the control period This phenomenon was observed during both wakefulness and active sleep. Conclusion: Our results showed that GER events were preceded by a vigilance-state-independent decrease in parasympathetic tone. This suggests that a pre-reflux change in ANS activity is one of the factors contributing to the mechanism of reflux in neonates
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