Chest
Volume 121, Issue 6, June 2002, Pages 1748-1753
Journal home page for Chest

Clinical Investigations
Sleep and Breathing
Symptomatic Gastroesophageal Reflux in Subjects With a Breathing Sleep Disorder

https://doi.org/10.1378/chest.121.6.1748Get rights and content

Study objectives

A link between gastroesophageal reflux (GER) and obstructive sleep apnea (OSA) has been suggested; however, the prevalence and frequency of symptomatic GER and the influence of OSA severity on GER are not known.

Design and patients

Two hundred seventy-one subjects referred for overnight sleep studies were investigated for subjects with a breathing sleep disorder, occurrence of symptomatic GER, potential risk factors for both conditions, and comorbidity using a validated questionnaire.

Results

Overall, 160 of the 228 respondents (73%; 135 subjects with OSA and 93 subjects who snore) reported GER-related symptoms, with heartburn and/or acid regurgitation being the leading symptoms. No evidence of a difference in the occurrence of symptomatic GER between subjects who snore and subjects with OSA was observed (odds ratio [OR], 1.21; 95% confidence interval [CI], 0.7 to 2.1). Furthermore, the occurrence of reflux symptoms was not influenced by the severity of OSA (OR per 10 4% arterial oxygen saturation [Sao2] dips per hour, 0.98; 95% CI, 0.8 to 1.1). Self-reported comorbidity was higher in subjects with OSA compared with subjects who snore (p = 0.02), but none of the potential risks produced an association with the presence of reflux symptoms in this sample of patients with a breathing sleep disorder.

Conclusion

We conclude that symptomatic GER is common in subjects with a breathing sleep disorder, but there was no difference between those with OSA and subjects who snore.

Section snippets

Materials and Methods

The reflux questionnaire was administered to 271 consecutive and previously untreated patients with a suspected breathing sleep disorder, referred for sleep studies between October 1998 and April 2000 just before their initial sleep study. The GERQ was a self-reported instrument designed to measure symptoms experienced during the last year, and was comprised of 80 questions as well as a psychosomatic symptom checklist for a measure of somatization. The first section (30 questions) inquired into

Results

Of 271 eligible participants, 228 subjects (84%) were included in the analysis. Of the other 43 participants, 24 subjects did not complete the questionnaire, 12 subjects were unable to speak or read English, 6 subjects refused to participate, and 1 subject was mentally handicapped. Anthropometric data and results of the sleep investigations for the 228 eligible participants with complete information are shown in Table 1. The 4% Sao2 dip rate, body mass index, Epworth sleepiness scale score, and

Discussion

We have shown that GER is common in subjects with a breathing sleep disorder. Typical symptoms include heartburn and acid regurgitation, which were intermittently noted by almost 60% of the respondents, of which 23% reported frequent (at least weekly) episodes of GER. A subset of patients presented with atypical symptoms, and we observed a high prevalence of potential risk factors for GER and self-reported comorbidity, with hypertension and cardiovascular disease reported more frequently in

ACKNOWLEDGMENT

We thank K.Y. Wong and A.D. McGown for their help in data collection.

References (33)

  • JP Claussen

    Gastroesophageal reflux disease

    Clin Rev

    (1999)
  • M Ruth et al.

    The prevalence of symptoms suggestive of esophageal disorders

    Scand J Gastroenterol

    (1991)
  • OT Nebel et al.

    Symptomatic gastroesophageal reflux: incidence and precipitating factors

    Am J Dig Dis

    (1976)
  • JF Johanson

    Epidemiology of esophageal and supraesophageal reflux injuries

    Am J Med

    (2000)
  • C Janson et al.

    Daytime sleepiness, snoring and gastro-oesophageal reflux amongst young adults in three European countries

    J Intern Med

    (1995)
  • CF Samuelson

    Gastroesophageal reflux and obstructive sleep apnea

    Sleep

    (1989)
  • Cited by (102)

    • Asthma and Three Colinear Comorbidities: Obesity, OSA, and GERD

      2021, Journal of Allergy and Clinical Immunology: In Practice
    • Association between respiratory events and nocturnal gastroesophageal reflux events in patients with coexisting obstructive sleep apnea and gastroesophageal reflux disease

      2016, Sleep Medicine
      Citation Excerpt :

      GERD and OSA frequently occur together. GERD has been shown to be prevalent in patients with OSA on the basis of studies recording symptoms and esophageal pH [2–5], but data on non-acid reflux have been rarely reported. Patients with OSA are at a significant risk for nocturnal gastroesophageal reflux (GER).

    • Prevention of Postoperative Pulmonary Complications

      2015, Surgical Clinics of North America
      Citation Excerpt :

      Intraoperatively, several techniques have been shown to improve outcomes in patients with OSA. The pharyngeal dysfunction of OSA predisposes to higher rates of aspiration pneumonia; this can be partially countered by the use of short-acting neuromuscular blockers and acid-reducing medications.104,113,114 General anesthesia should be avoided when possible, and shorter operative times lead to better outcomes.115

    View all citing articles on Scopus
    View full text