Nocturnal reflux and sleep disturbances: An overlooked link in the past

Abstract

Gastro-oesophageal reflux disease (GORD) is highly prevalent n western countries. The main clinical manifestations are repreented by heartburn and regurgitation and they are commonly used or the diagnosis of GORD, although their accuracy is far from optial [1]. The above symptoms can occur during the daytime and lso throughout the nocturnal period. In the past, the progressively idespread use of 24-h oesophageal pH-metry showed that the ajority of reflux events belong to the post-prandial periods, whilst hey are much less frequent during the night time [2]. This temporal istribution of abnormal reflux episodes provided the rationale to xplain, at least in part, the benefit of proton pump inhibitors (PPIs) n patients with GORD. In fact, these drugs are more effective durng the daytime, when proton pumps are activated by fractionated eals, than through the night time, when their main pharmacoogical target does not work because of sleep [3]. Despite the above ndings, in the last decade we have witnessed a mounting evidence f the role of night time GORD in provoking a decreased quality of ife, a variety of sleep disorders and diminished work performances 4]. Several epidemiological surveys have confirmed that nocturnal eflux symptoms, in particular heartburn and regurgitation, can be eported by 2 out of 3 patients with GORD [5] and the relationship etween GORD and sleep disorders has been recently established y many studies which have clearly demonstrated that 47–57% of he GORD patients and approximately 25% of the US adult genral population report having heartburn that awakens them from leep during the night [6,7]. Of the GORD patients, 63% report that hey are unable to sleep well, 42% are unable to sleep during a ull night, 39% have to take naps during the day and 34% have to leep in a seated position because of night time heartburn [7]. It as also been shown that sleep deprivation per se can adversely nfluence GORD, in that the inability to have a complete rest during he night is a potential mechanism for increasing the perception of ymptoms in patients with GORD [8]. Another important issue is he still poorly understood role of nocturnal reflux in determining xtra-oesophageal and particularly respiratory symptoms because f the well-known longer-lasting duration and the slower clearing f supine refluxes compared with the daytime ones [9]. Finally, the se of impedance-pH monitoring has shown that nocturnal weakly