Indian Journal of Sleep Medicine

Register      Login

VOLUME 13 , ISSUE 2 ( April-June, 2018 ) > List of Articles


Nocturnal Gastroesophageal Reflux Disease and Microarousals in Obstructive Sleep Apnea

Armaan Mishra, Arpita Priyadarshini

Keywords : Microarousals, nGER, OSAS

Citation Information : Mishra A, Priyadarshini A. Nocturnal Gastroesophageal Reflux Disease and Microarousals in Obstructive Sleep Apnea. Indian Sleep Med 2018; 13 (2):21-24.

DOI: 10.5005/jp-journals-10069-0019

License: NA

Published Online: 01-10-2018

Copyright Statement:  NA


Introduction: Obstructive sleep apnea syndrome (OSAS) is associated with a high frequency of gastroesophageal reflux and arousals. Nocturnal gastroesophageal reflux (nGER) is strongly associated with sleep disturbances and disturbed sleep results in increased nocturnal gastroesophageal reflux. Objectives: It was aimed to study the prevalence of nocturnal gastroesophageal reflux in obstructive sleep apnea (OSA). In our study, we sought to evaluate the correlation between the frequency and type of arousals and episodes of nGER in OSA cases. Materials and Methods: We conducted an observational study among sixty patients already diagnosed with OSA on the basis of standard sleep criteria. Demographic data, anthropometric measurements, and detailed medical history were recorded. All subjects underwent polysomnography study and filled out the validated Gastroesophagal disease-health related quality of life questionnaire (GERD-HRQL). Statistical analysis was done by the multivariate regression model. Results: There was a strong significant correlation between apnea-hypopnea index (AHI) and GERD score. (r = 0.544, p = 0.002). Moreover, respiratory arousal index was also significantly correlated with GERD score (r = 0.370, p = 0.040). It was found that AHI was a strong predictor of GERD with a significant regression model (p < 0.002, r2 = 0.0272). Respiratory arousal index (RAI) was responsible for 13.7% (r2 = 0.137) variance which was statistically significant p = 0.040 (p < 0.05). Desaturation index (DI) also predicted significantly about the gastroesophageal reflux (p = 0.005). Conclusion: The present results suggest that the occurrence of arousals was related to episodes of nGER in OSA. Funding: This study was part of Short Term Research Studentship (STS) program of the Indian Council of Medical Research (ICMR).

PDF Share
  1. Reddy EV, Kadhivaran T, Mishra HK, Sreenivas V, Handa KK, Sinha S, Sharma SK. Prevalence and risk factors of obstructive sleep apnoea among middle-aged urban Indians: A community based study. Sleep Med 2009 Sep 1;10(8): 913-918.
  2. Yang YX, Spencer G, Schutte-Rodin S, Brensinger C, Metz DC. Gastroesophageal reflux and sleep events in obstructive sleep apnea. Eur J Gastroenterol Hepatol 2013 Sep; 25(9):1017–1023.
  3. Jung HK, Choung RS, Talley NJ. Gastroesophageal reflux disease and sleep disorders: evidence for a causal link and therapeutic implications. J Neurogastroenterol Motil 2010 Jan; 16(1):22-29.
  4. Zanation AM, Senior BA. The relationship between extraesophageal reflux (EER) and obstructive sleep apnea (OSA). Sleep Med Rev 2005 Dec 1; 9(6):453-458.
  5. Vakil N, van Zanten SV, Kahrilas P, Dent J, Jones R, Global Consensus Group. The Montreal definition and classification of gastroesophageal reflux disease: A global evidencebased consensus. AmJGastroenterol. 2006 Aug; 101(8):1900– 1920.
  6. Hai-Yun Wang, Kondarapassary Balkumaran Leena. Prevalence of gastro-esophageal reflux disease and its risk factors in a community-based population in southern India. BMC Gasteroenterol. 2016 Mar 15; 16(1):36.
  7. Bajaj JS, Bajaj S, Dua KS, Joradeh S, Ritmann T, Hofmann C, Sheker R. Influence of sleep stages on upper esophageal sphincter contractile reflex and secondary esophageal peristalsis. Gastroenterology 2006 Jan;130(1):17-25.
  8. Allen L, Poh CH, Gasiorowzka A, Malagon I, Navarro- Rodriguez T, Cui H, Powers J, Moty B, Willis MR, Ashpole N. Increased oeophageal acid exposure at the beginning of the recumbent period is primarily a recumbent-awake phenomenon. Ailment Pharmacol Ther 2010; 32:787- 794.
  9. DiMarino AJ, Banwait KS, Eschinger E, Greenberg A, Dimarino M, Doghramji K, Cohen S. The effect of gastrooesophageal reflux and omeprazole on key sleep parameters. Aliment Pharmacol Ther 2005; 22:325-329.
  10. Dent J, Dodds WJ, Friedman RH, Sekiguchi T, Hogan WJ, Andorfer RC, Petrie DJ. Mechanism of gastroesophageal reflux in recumbent asymptomatic human subjects. J Clin Invest 1980 Feb 1; 65(2): 256–267.
  11. Schneider JH, Küper MA, Königsrainer A, Brücher BL. Transient lower esophageal sphincter relaxation and esophageal motor response. J Surg Res. 2010 Apr; 159(2):714-719.
  12. Kuribayashi S1, Kusano M, Kawamura O, Shimoyama Y, Maeda M, Hisada T, Ishizuka T, Dobashi K, Mori M. Mechanism of gastroesophageal reflux in patients with obstructive sleep apnea syndrome. Neurogastroenterol Motil 2010 Jun; 22 (6): 611–e172.
  13. Fujiwara Y, Arakawa T, Fass R. Gastroesophageal reflux disease and sleep disturbances. J Gasroenterol 2012 Jul 1; 47(7):760-769.
  14. Nakahara K, Fujiwara Y, Tsukahara T, Yamagami H, Tanigawa T, Shiba M, Tominaga K, Watanabe T, Urade Y, Arakawa T. Acid reflux directly causes sleep disturbances in rat with chronic esophagitis. PloS one. 2014 Sep 12;9(9):e106969.
  15. Mody R, Bolge SC, Kannan H, Fass R. Effects of gastroesophageal reflux disease on sleep and outcomes. Clin Gastroenterol Hepatol 2009 Sep 1; 7(9): 953-959.
  16. Dubois RW, Aguilar D, Fass R, Orr WC, Elfant AB, Dean BB, Harper AS, YU HT, Melmed GY, Lynn R, Singh A. Consequences of frequent nocturnal gastro oesophageal reflux disease among employed adults: symptom severity, quality of life and work productivity. Alimentary pharmacology & therapeutics. 2007 Feb;25(4):487-500.
  17. Schey R, Dickman R, Parthasarathy S, Quan SF, Wendel C, Merchant J, Powers J, Han B, Van Handel D, Fass R. Sleep deprivation is hyperalgesic in patients with gastroesophageal reflux disease. Gastroenterology. 2007 Dec 1;133(6):1787-95.
  18. American Academy of Sleep Medicine International classification of sleep disorders, 3rd edition: Diagnostic and coding manual. Westchester, Illinois: American Academy of Sleep Medicine 2014.
  19. Iber, C.; Ancoli-Israel, S.; Chesson, AL., et al. The AASM Manual for the Scoring of Sleep and Associated Events. American Academy of Sleep Medicine; West Chester, IL: 2007.
  20. Madan K, Ahuja V, Gupta DS, Sharma MP, Bal C, Kapoor A. Impact of 24-hr oesophageal pH monitoring on the diagnosis of gastroesophageal reflux disease: defining the gold standard. J Gastroenterol Hepatol. 2005; 20:30–37.
  21. Velanovich V. The development of the GERD-HRQL symptom severity instrument. Dis Esophagus 2007 Apr 1; 20(2):130-134.
  22. Ozen K. Basoglu, Rukiye Vardar, Serhat bor Tazbakan MS, Ucar ZZ, Ayik S, Kose T. Obstructive sleep apnea syndrome and gastroesophageal reflux disease: the importance of obesity and gender. Sleep and Breathing, 2015, 19(2):585-592.
  23. Yu Xiao Yang, Spencer G, Schulte-Rodin S, Brensinger C, Mtz TC. Gatroesophageal reflux and sleep events in OSA; European Journal of gasteroenerology and hepatology, 2013;25:1017-1023.
PDF Share
PDF Share

© Jaypee Brothers Medical Publishers (P) LTD.