Overnight Esophageal Peristaltic Activity Is Predictive of States of Wakefulness and Sleep

Abstract

Purpose: Previous studies have shown that patients with GERD swallow more frequently than healthy controls. Overnight combined multichannel intraluminal impedance (MII-pH) detects esophageal peristaltic activity (PA) at night. Portable sleep monitoring using Zeo allows distinction between periods of wakefulness and various stages of sleep (REM, light, or deep) by utilizing dry fabric sensors which are integrated into a headband which continuously detect neural activity of patients wearing the headband device. There is no information comparing these techniques in GERD patients as an indicator of sleep stages. We evaluated the use of PA (both primary and secondary contractions) as detected by MII-pH as a marker to identify stages of wake/sleep. Methods: 21 patients (13 male, 8 female) were studied. All patients were referred for evaluation of GERD. Each patient was monitored using a Zeo Personal Sleep Coach (Zeo, Inc, Newton, MA) during the overnight recumbent portion of 24 h-MII-pH testing. Both Zeo and MII-pH analysis software allowed for precise time synchronization so that overnight MII-pH swallow activity and Zeo sleep staging data were analyzed independently, then correlated. Impedance allowed analysis of PA/min which were matched with the patients' stage of sleep/wake (wake, REM, light, deep) as assessed by the Zeo device. STATISTICS: Peristaltic activity frequency (PAF) between sleep/wake stages were compared by ANOVA. Results: During overnight analysis, 3485 PA were detected by MII-pH spanning 1328 sleep/wake periods over 9215.5 minutes as detected by Zeo. PAF was significantly higher (p<0.01) during periods of wakefulness (mean ± SD = 0.72 ± 0.30 PA/min) than during all periods of sleep (0.25-0.39 PA/min). Although the difference in PAF between all stages of sleep/wake were found to be statistically significant, the inter-sleep stage (REM - light - deep) differences were not significant. Conclusion: Peristaltic activity frequency detected by MII-pH reliably predicts wakefulness as shown by Zeo. Although PA frequency during REM sleep is higher than that experienced during light and deep sleep, it did not delineate differences in sleep stages. Disclosure: Erick Singh - Consultant: Takeda Pharmaceuticals; Daniel Pohl - No conflicts of interest; Fernando Arevalo - No conflicts of interest; Janice Freeman - Consultant: Sandhill Scientific Inc.; Christopher Rife - No conflicts of interest; Donald Castell - consultant:Sandhill Scientific Inc and Takeda Pharmaceuticals, Speakers Bureau: Sandhill Scientific Inc, Xenoport Inc, and Takeda Pharmaceuticals.Table: Table. Esophageal peristaltic activity detected during sleep/wake stagesFigure: No Caption available.