We attempted to determine whether the different physiology of REM and non-REM sleep affect gastroesophageal reflux (GER). Our hypothesis is that GER occurs less frequently in REM sleep.
We reviewed 26 nocturnal polysomnograms (NPSG) with esophageal pH monitoring. Inclusion criteria for this study were (1) age over 18 years, (2) completed NPSG with esophageal pH measurement and (3) at least 15 minutes of REM sleep. All studies were performed in an accredited sleep disorders center and scored according to the criteria of Rechstschaffen and Kales. Acid gastroesophageal reflux (GER) was defined as a pH < 4 for > 30 seconds. Gastroesophageal reflux disease (GERD) was defined as > 4% of sleep period time with pH < 4. Acid contact time (ACT) was defined as the number of minutes with pH < 4. Acid contact time index (ACTI) was defined as the percentage of sleep time in each stage with pH<4.
Seventeen subjects met study criteria. There were 10 men and 7 women with a mean age of 48.27±11.55 years, mean Epworth sleepiness scale of 11.7±4.23, and a mean BMI OF 32.69±7.71 kg/m2. There was a significantly greater ACTI during NREM sleep (9.7±3.2 vs. 2.9±1.8, p=0.039). Eight of these subjects had GERD. In this sample, there was a significantly greater ACTI during NREM compared to REM(20.1±4.7 vs 6.1±3.5, p=0.016).
Sleep-related GER occurs predominantly during NREM sleep and is characterized by longer ACT compared to REM sleep.
REM sleep does not have to be present in order to exclude sleep-related GER.
F.H. Shaib, None.