Laryngopharyngeal reflux, upper airway sensory impairment, and obstructive sleep apnea

Abstract

Objectives: Previous studies have demonstrated associations between gastroesophageal reflux disease and obstructive sleep apnea. The goal of this study was to determine whether a correlation exists between laryngopharyngeal reflux (LPR), upper airway (UA) sensory impairment, and obstructive sleep apnea (OSA). Methods: This was a double-blind prospective study involving patients undergoing both polysomnography (PSG) to determine their apnea hypopnea index (AHI), and UA air pulse endoscopic sensory testing (EST) of the laryngeal adductor reflex (LAR) to measure UA sensory impairment. The EST was videotaped and scored by 2 independent investigators for LPR using the reflux finding score (RFS). Results: Preliminary data demonstrates a mean RFS of 11.2 ± 1.7 (range, 5–17) with very close agreement between the 2 scorers. Furthermore, RFS has a direct relationship with the AHI (r = 0.73; P = 0.0008), and there is a highly significant correlation between RFS values and the LAR (r2 = 0.97; P < 0.002). Conclusions: These findings indicate that there is a direct correlation between the extent of OSA and the extent and severity of LPR in this patient population. In addition, UA sensory impairment closely reflects LPR severity. Further research is required to determine whether LPR precedes the development of OSA and contributes to its severity or whether the converse is true. Finally, it is also unknown whether successful treatment of OSA will affect the severity of the LPR.