Potential Therapeutic Effect of Continuous Positive Airway Pressure on Laryngopharyngeal Reflux in Obstructive Sleep Apnea Patients

Jae Hyuk Choi,Sang Duk Hong,Eunkyu Lee,Hyo Yeol Kim,Yong Gi Jung,Seung Kyu Chung

doi:10.3390/jcm10132861

Abstract

To investigate the potential therapeutic effect of continuous positive airway pressure (CPAP) treatment on laryngopharyngeal reflux in obstructive sleep apnea (OSA) patients, we performed a retrospective analysis of data prospectively collected from patients who underwent CPAP therapy after being diagnosed with moderate to severe OSA between January 2019 and May 2020. Subjects were asked to complete the reflux symptom index (RSI) questionnaire before and after CPAP. Additionally, a laryngoscopic examination was performed to evaluate objective endoscopic findings and determine reflux finding score (RFS). A total of 46 patients were included in the analysis. Overall, significant decreases in mean RSI score (10.85 ± 6.40 vs. 8.80 ± 7.99, p < 0.001) and RFS (7.41 ± 3.32 vs. 4.65 ± 2.12, p < 0.001) were observed after CPAP treatment. Within subdomains of the RSI, throat clearing, postnasal drip, breathing difficulty, troublesome cough, and foreign body sensation were significantly improved by CPAP treatment. All subdomains of RFS, with the exception of posterior commissure hypertrophy and granuloma, showed significant differences after CPAP treatment. There were no differences between subgroups according to body mass index or severity of OSA. CPAP treatment in OSA potentially reduces laryngeal reflux symptoms and improves laryngeal examination findings.

Highlights

Accepted: 24 June 2021Obstructive sleep apnea (OSA) is a sleep-related disorder associated with upper airway collapse and reduction of airway flow [1]
obstructive sleep apnea (OSA) is related to liver injury, fatty liver disease, peptic ulcer, and reflux diseases such as gastroesophageal reflux and laryngopharyngeal reflux (LPR) [3]
LPR is a disease in which leakage of gastric acid from the upper esophageal sphincter damages the laryngopharyngeal mucosa

Summary

Introduction

Obstructive sleep apnea (OSA) is a sleep-related disorder associated with upper airway collapse and reduction of airway flow [1]. OSA increases the risk of hypertension, cardiovascular events, cerebrovascular accidents, cognitive deterioration, and motor vehicle accidents [2]. OSA is related to liver injury, fatty liver disease, peptic ulcer, and reflux diseases such as gastroesophageal reflux and laryngopharyngeal reflux (LPR) [3]. LPR is a disease in which leakage of gastric acid from the upper esophageal sphincter damages the laryngopharyngeal mucosa. The main symptoms of LPR include hoarseness, throat clearing, dysphagia, and globus sensation. On endoscopy in patients with LPR, diffuse laryngeal edema, erythema, posterior commissure hypertrophy, and granuloma are generally observed [4]. Diagnosis of LPR is usually based on reflux symptom index (RSI)

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