Abstract
BackgroundNocturnal gastroesophageal reflux (nGER) is associated with respiratory symptoms and sleep-disordered breathing (SDB), but the pathogenesis is unclear. We aimed to investigate the association between nGER and respiratory symptoms, exacerbations of respiratory symptoms, SDB and airway inflammation.MethodsParticipants in the European Community Respiratory Health Survey III in Iceland with nGER symptoms (n = 48) and age and gender matched controls (n = 42) were studied by questionnaires, exhaled breath condensate (EBC), particles in exhaled air (PEx) measurements, and a home polygraphic study. An exacerbation of respiratory symptoms was defined as an episode of markedly worse respiratory symptoms in the previous 12 months.ResultsAsthma and bronchitis symptoms were more common among nGER subjects than controls (54 % vs 29 %, p = 0.01; and 60 % vs 26 %, p < 0.01, respectively), as were exacerbations of respiratory symptoms (19 % vs 5 %, p = 0.04). Objectively measured snoring was more common among subjects with nGER than controls (snores per hour of sleep, median (IQR): 177 (79–281) vs 67 (32–182), p = 0.004). Pepsin (2.5 ng/ml (0.8–5.8) vs 0.8 ng/ml (0.8–3.6), p = 0.03), substance P (741 pg/ml (626–821) vs 623 pg/ml (562–676), p < 0.001) and 8-isoprostane (3.0 pg/ml (2.7–3.9) vs 2.6 pg/ml (2.2–2.9), p = 0.002) in EBC were higher among nGER subjects than controls. Albumin and surfactant protein A in PEx were lower among nGER subjects. These findings were independent of BMI.ConclusionIn a general population sample, nGER is associated with symptoms of asthma and bronchitis, as well as exacerbations of respiratory symptoms. Also, nGER is associated with increased respiratory effort during sleep. Biomarker measurements in EBC, PEx and serum indicate that micro-aspiration and neurogenic inflammation are plausible mechanisms.
Highlights
Nocturnal gastroesophageal reflux is associated with respiratory symptoms and sleep-disordered breathing (SDB), but the pathogenesis is unclear
Respiratory symptoms and spirometry Symptoms of asthma and bronchitis were significantly more common among Nocturnal gastroesophageal reflux (nGER) subjects. Symptoms such as chest tightness, breathlessness, cough and phlegm were more common among nGER subjects (Table 2)
In a general population sample, nGER was significantly associated with symptoms of asthma and bronchitis, as well as exacerbations of respiratory symptoms
Summary
Nocturnal gastroesophageal reflux (nGER) is associated with respiratory symptoms and sleep-disordered breathing (SDB), but the pathogenesis is unclear. Gastroesophageal reflux (GER), and especially nocturnal GER (nGER), is associated with many symptoms from the respiratory tract, often asthma symptoms [1,2,3]. It is not fully known how GER patients with asthma symptoms differ from other asthma patients, and what the pathogenic mechanisms are. Sleep-disordered breathing (SDB) and nGER are closely linked. Persistent nGER seems to be a risk factor for developing symptoms of SDB [2]. Obesity is a significant confounder as it increases the risk of both SDB and nGER [5]
Sign-in/Register to view highlights & summary Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
