Sleep Disorders: Sleep Disorders 2 |

The Presence of OSA Syndrome Is Predicted by Nocturnal Gastroesophageal Reflux FREE TO VIEW

Silvia Dumitru, MD; Spiros Gkatzias, MD; Konstantinos Velentzas, MD; Epaminondas Kosmas, MD
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Metropolitan Hospital, Neo Faliro, Greece

Copyright 2016, American College of Chest Physicians. All Rights Reserved.

Chest. 2016;150(4_S):1278A. doi:10.1016/j.chest.2016.08.1392
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SESSION TITLE: Sleep Disorders 2

SESSION TYPE: Original Investigation Poster

PRESENTED ON: Wednesday, October 26, 2016 at 01:30 PM - 02:30 PM

PURPOSE: It is known that nocturnal gastroesophageal reflux disease (N-GERD) has been observed in patients with obstructive sleep apnea syndrome (OSAS). The responsible mechanisms are not clear as of yet, however obesity, increasing abdominal movements with increasing gastric pressures during apneic events, relaxation of esophageal-gastric sphincter, thoracoabdominal paradox, stimulation of vagal reflexes attributed to acidic esophageal pH, have all been reported. Despite that association, N-GERD has not been included as a question in any of the widely used screening questionnaires for OSAS (such as Berlin, STOP-Bang etc). This study aimed to assess the predictive value of frequent (> 5 times/month) N-GERD as reported by the patient.

METHODS: Full-night polysomnography (PSG) was performed in 284 outpatients referred to our Sleep Laboratory (2013-2014) due to symptoms suggestive of OSAS. Prior to diagnostic PSG, all subjects were asked about symptoms of N-GERD and their estimated frequency per month.

RESULTS: OSAS was diagnosed in 223 patients (75% males; age 49±12 years old; apnea-hypopnea index (AHI) 29±12 events/hour). Frequent N-GERD was reported in 115 of the 223 OSAS patients (prevalence 52%), but in only 8 of the 61 non-apneic patients (13%), with a group-wise odds ratio (OR) of 7.25. When patients are classified as those with severe (77 patients with AHI≥30 events/hour) and those with mild-to-moderate OSAS (146 patients with AHI 5-29 events/hour), frequent N-GERD was reported in 52 (67%) and in 63 (43%) patients respectively, the group-wise OR being 2.69. Furthermore and with respect to the intensity of daytime sleepiness as assessed by the Epworth Sleepiness Scale (ESS), N-GERD was reported in 10 out of the 32 patients (31%) with ESS<10, in 76 out of the 149 patients (51%) with ESS 10-15 and in 29 out of the 42 patients (69%) with ESS≧16. Age or gender were not associated with N-GERD.

CONCLUSIONS: Self-reported frequent (>5 times monthly) nocturnal gastroesophageal reflux is a strong predictor of OSAS irrespective of age or gender. Nocturnal gastroesophageal reflux is more common in severe than in mild and moderate OSAS and it correlates with the intensity of daytime hypersomnolence.

CLINICAL IMPLICATIONS: Nocturnal gastroesophageal reflux should be considered as a question of added value in sleep apnea screening questionnaires.

DISCLOSURE: The following authors have nothing to disclose: Silvia Dumitru, Spiros Gkatzias, Konstantinos Velentzas, Epaminondas Kosmas

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