The Effect of Poor Quality of Sleep On Esophageal Acid Exposure

Abstract

Background: Gastroesophageal reflux disease (GERD) has been shown to cause various sleep disturbances. Recent studies demonstrated that poor quality of sleep suppresses satiety hormones, leading to increase in food consumption and obesity. The latter may lead to increase in gastroesophageal reflux. Aim: To determine if poor quality of sleep can result in increase in gastroesophageal reflux in GERD patients, by correlating the level of quality of sleep with esophageal acid exposure. Methods: Patients with typical GERD symptoms at least 3 times a week underwent an upper endoscopy and pH testing. Prior to the pH test patients completed a validated sleep quality questionnaire to assess the level of quality of sleep the morning of the pH probe placement. At baseline patients were evaluated by the validated Sleep Habits Questionnaire. Patients with psychological abnormalities or those who consume medications that may affect sleep or reflux were excluded from the study. Results: 48 (M/F 33/15, mean age 48.8 ± 17.1) patients were recruited into the study. Of those, 26 had erosive esophagitis (Grade A - 8, B - 10, C - 7 and D - 1), 4 Barrett's esophagus and 18 non-erosive reflux disease. Overall, poorer sleep quality was related to longer acid reflux events during the total (r = −0.36, p < 0.05) and supine (r = −0.38, p < 0.01) time of the pH test. When individual items assessing sleep quality were investigated, more perceived awakenings during the night before were correlated with a greater number of acid reflux events that were longer than 5 minutes in the supine position (r = 0.28, p < 0.05), a greater number of minutes of the longest acid reflux event (r = 0.3, p < 0.05), and a greater number of minutes of the longest acid reflux event while supine during the 24-hour pH test (r = 0.31, p < 0.05). Conclusions: Poor quality of sleep prior to the pH test correlated with duration of acid reflux events, primarily in the supine position. Thus, poor quality of sleep appears to increase duration of acid reflux events.