Effect of Gastroesophageal Reflux Disorder on Sleep Architecture in Patients With Obstructive Sleep Apnea

Abstract

PURPOSE: Obstructive sleep apnea (OSA) and gastro-esophageal reflux disorder (GERD) adversely affect sleep quality. Increased upper airway resistance and cyclic obstruction is the proposed mechanism for OSA. Since GERD is also associated with uncontrolled asthma by increasing upper airway resistance, it is plausible that GERD with an underlying obstructive sleep apnea may worsen sleep quality more than what is explained by OSA alone. METHODS: Patients who underwent polysomnography and were found to have OSA during last 3 years were included. Patients who had clinical documentation of GERD constituted cases, while others were classified as controls. Demographics [age, gender, BMI], clinical factors affecting sleep [chronic pain, post-traumatic stress disorder (PTSD), benign prostatic hypertrophy (BPH), asthma], medications affecting sleep [rapid eye movement (REM) suppressants and stimulants] and polysomnographic parameters [total sleep time (TST), sleep efficiency (SE), sleep stages, REM onset, apnea-hypopnea index (AHI), arousal index, periodic leg movement disorder (PLMD) index] were recorded. Linear regression was performed to compare the primary sleep variables of TST and SE while adjusting for all significant confounding factors. All statistical analyses were performed using software R. RESULTS: There were 196 subjects; 98 cases (OSA and GERD) and 98 controls (OSA alone). The sample consisted of obese (33.1+/-5.2), older (61.8+/-10.7), and male (95.9%) subjects. There was no significant difference for the demographic variables age, BMI or gender between the GERD and non-GERD groups (p>0.05). There was also no significant difference between the groups for any sleep characteristics. Specifically no significant difference in either TST (283.4+/-64.1 vs. 284.2+/-58.1 minutes, p=0.8), or sleep efficiency (75.1+/-15.3 vs. 75.8+/-14.5 %, p=0.69) was noted. The only parameter found to be significant was sleep onset, as it was significantly delayed for the GERD group compared to the non-GERD group (28.5+/-32.2 vs. 21.2 +/-23.2 minutes, p=0.0443). CONCLUSIONS: Gastro-esophageal reflux disorder in patients with underlying obstructive sleep apnea may cause a delay in sleep onset.