Introduction: A temporal association between gastroesophageal reflux (GER) and apnea episodes has been demonstrated in infants (Wenzl et al., Pediatr Pulmonol 2001, 31: 144–9). Aim of this study was to analyze the coincidence of retrograde (GER) and antegrade (swallow) esophageal bolus movement with apnea. Methods: 15 infants (age 97 ± 52 days) with recurrent apnea episodes were investigated with simultaneous intraesophageal impedance measurement (IMP), pH-metry and polygraphy during a total measuring time of 115.5 hours. IMP patterns, pH, oronasal airflow and chest wall movement were recorded and analyzed. Apnea was defined as a breathing arrest >= 5s. The occurence of an apnea episode during 30s preceding or following the beginning of a GER or swallow was defined as temporal association. Statistical analysis was performed using Fishers exact test. Results: At the time of abstract submission data analysis from four infants was complete. 166 GER and 1482 swallowing-episodes were registered by IMP in these infants. Most GER were non-acidic (pH >= 4) and reached the hypopharynx. 136 episodes of apnea were documented by polygraphy. 7 GER (4.2%) and 72 swallows (4.8%) were associated with an apnea. The mean time spent apneic during both GER and swallowing was significantly greater than the mean time spent apneic without esophageal bolus movement (p <0.01). However, there was no difference between the directions of bolus movement in this respect (p = 0.85). Conclusion: There is a temporal association between episodes of apnea and esophageal bolus movement even in this small group of infants. This is true not only for acidic and non-acidic GER, but also for episodes of swallowing. Apparently, hypopharyngeal bolus presence is more important than direction or pH of the bolus regarding apneic events. Short apneas during bolus passage are considered as physiologic airway protection. Alterations of autonomic nervous control, e.g. due to immaturity, may induce prolonged pathologic airway obstruction. The pH-independent intraluminal impedance technique in combination with polygraphy has proven to be a sensitive diagnostic tool for this approach.