Symptomatic gastro-oesophageal reflux, arousals and sleep quality in patients undergoing polysomnography for possible obstructive sleep apnoea

Abstract

Introduction: Nocturnal acid reflux is common and could disturb sleep by causing arousals that fragment sleep. Aim: To determine the prevalence of gastro-oesophageal reflux symptoms and their association with arousals, stages of sleep and quality of life in patients undergoing evaluation for excessive daytime sleepiness and obstructive sleep apnoea. Methods: Ninety-four consecutive patients with excessive daytime sleepiness were prospectively studied. Patients completed the gastrointestinal symptom rating scale, a validated symptom questionnaire for reflux disease and a disease-specific quality of life questionnaire, the sleep apnoea quality of life index and then underwent overnight polysomnography, which was read in a blinded manner. Results: There were 40 males and 54 females with a mean age of 47 ± 13 years. Reflux symptoms were present in 63 of the 94 (67%) patients. Patients with reflux symptoms had significantly more arousals from sleep 43 ± 70/h than those without (20 ± 24/h; P = 0.03). The sleep duration during the second stage of sleep was shorter (44 ± 21%) for those with reflux symptoms than those without (52 ± 12%; P = 0.03). Patients with reflux spent significantly shorter periods in stage II sleep (44 ± 21%) than those without (52 ± 12%; P = 0.03). The sleep-related quality of life score in patients with gastro-oesophageal reflux (3.1 ± 1.1) was significantly lower than in patients without reflux (3.7 ± 1.0; P = 0.02). Regression analysis demonstrated a significant inverse correlation between quality of life and reflux symptom score (P = 0.002) and total spontaneous arousals (P = 0.04). Conclusions: Gastro-oesophageal reflux is common in patients with sleep disorders, is associated with increased arousal, decreased durations spent in the deeper stages of sleep and poorer sleep-related quality of life.