Abstract
Obstructive sleep apnea (OSA) leads to upper respiratory tract obstruction, causing increased abdominal-gastric pressure and decreased lower esophageal sphincter (LES) pressure and thus gastroesophageal reflux (GER). Continuous positive airway pressure (CPAP) is known to be an effective method for OSA treatment, but its effect on GER is still controversial. There are a very few studies investigating CPAP and GER relationship and performed based on pre- and post-treatment objective parameters of GER in patients with OSA. The study investigated the effect of CPAP treatment in patients with moderate and severe OSA without GER complaints on pre- and post-treatment objective GER parameters. The study included 25 patients with respiratory disturbance indices >15 without reflux symptoms who had undergone polysomnography at sleep laboratory. Age, sex, body mass index (BMI), waist, and neck circumference of the patients were documented. DeMeester score, LES pressure, and polysomnography parameters were evaluated pre- and post-CPAP. The results were statistically evaluated, and p value <0.05 is considered significant. Out of 25 patients, 21 were male (84 %) and mean age was 49.2 ± 8.6 (range 31–66). At the pre-CPAP phase, mean sphincter pressure was 22.2 ± 1.2 (range 8–73), and mean DeMeester score was 18 ± 15.5 (range 0.2–57). At the post-CPAP, mean sphincter pressure was 22.9 ± 1.6 (range 9–95), and mean DeMeester score was 16.3 ± 14.8 (range 0.2–55). No significant difference (p > 0.05) was found comparing pre-CPAP and post-CPAP measurements. Objective criteria show that CPAP treatment does not cause reflux in patients with OSA. Unlike studies reported in the literature, this conclusion has been reached by pre- and post-CPAP assessments.
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References
Liu Y, Su C, Liu R et al (2011) NREM-AHI greater than REM-AHI versus REM-AHI greater than NREM-AHI in patients with obstructive sleep apnea: clinical and polysomnographic features. Sleep Breath 15(3):463–470
Zanation AM, Senior BA (2005) The relationship between extraesophageal reflux and obstructive sleep apnea. Sleep Med Rev 9(6):453–458
Morse CA, Quan SF, Mays MZ et al (2004) Is there a relationship between obstructive sleep apnea and gastroesophageal reflux disease? Clin Gastroenterol Hepatol 2(9):761–768
Bor S, Mandiracioglu A, Kitapcioglu G et al (2005) Gastroesophageal reflux disease in a low-income region in Turkey. Am J Gastroenterol 100(4):759–765
Vakil N, Van Zanten SV, Kahrilas P et al (2006) Global Consensus Group th Montreal definition and classification of gastroesophageal reflux disease: a global evidence-based consensus. Am J Gastroenterol 101:1900–1920
Shepherd K, Hillman D, Holloway R et al (2011) Mechanisms of nocturnal gastroesophageal reflux events in obstructive sleep apnea. Sleep Breath 15(3):561–570
Dickman R, Green C, Fass SS et al (2007) Relationships between sleep quality and pH monitoring findings in persons with gastroesophageal reflux disease. J Clin Sleep Med 3(5):505–513
Green BT, Broughton WA, O’Connor JB (2013) Marked improvement in nocturnal gastroesophageal reflux in a large cohort of patients with obstructive sleep apnea treated with continuous positive airway pressure. Arch Intern Med 163(1):41–45
Kerr P, Shoenut JP, Millar T et al (1992) Nasal CPAP reduces gastroesophageal reflux in obstructive sleep apnea syndrome. Chest 101(6):1539–1544
Kerr P, Shoenut JP, Steens RD et al (1993) Nasal continuous positive airway pressure. A new treatment for nocturnal gastroesophageal reflux? J Clin Gastroenterol 17(4):276–280
Criner GJ, Brennan K, Travaline JM et al (1999) Efficacy and compliance with noninvasive positive pressure ventilation in patients with chronic respiratory failure. Chest 116(3):667–675
Ing AJ, Ngu MC, Breslin AB (2000) Obstructive sleep apnea and gastroesophageal reflux. Am J Med 108(Suppl 4a):120–125
Tawk M, Goodrich S, Kinasewitz G, Orr W (2006) The effect of 1 week of continuous positive airway pressure treatment in obstructive sleep apnea patients with concomitant gastroesophageal reflux. Chest 130(4):1003–1008
Epstein LJ, Kristo D, Strollo PJ Jr, et al; Adult Obstructive Sleep Apnea Task Force of the American Academy of Sleep Medicine (2009) Clinical guideline for the evaluation, management and long-term care of obstructive sleep apnea in adults. J Clin Sleep Med 5(3):263–276
Locke GR, Talley NJ, Weaver AL et al (1994) A new questionairre for gastroesophageal reflux disease. Mayo Clin Proc 69(3):539–547
Berry RB, Budhiraja R, Gottlieb DJ et al (2012) Rules for scoring respiratory events in sleep: update of the 2007 AASM Manual for the Scoring of Sleep and Associated Events. Deliberations of the Sleep Apnea Definitions Task Force of the American Academy of Sleep Medicine. J Clin Sleep Med 8(5):597–619
Spechler SJ, Castell DO (2001) Classification of oesophageal motility abnormalities. Gut 49(1):145–151
Graf KI, Karaus M, Heinemann S et al (1995) Gastroesophageal reflux in patients with sleep apnea syndrome. Z Gastroenterol 33:689–693
Jung HK, Choung RS, Talley NJ (2010) Gastroesophageal reflux disease and sleep disorders: evidence for a causal link and therapeutic implications. J Neurogastroenterol Motil 16(1):99–100
Katz PO (1998) Gastroesophageal reflux disease. J Am Geriatr Soc 46:1558–1565
Johnson LF, DeMeester TR (1986) Development of the 24-hour intraesophageal pH monitoring composite scoring system. J Clin Gastroenterol 8(Suppl 1):52–58
Wise SK, Wise JC, DelGaudio JM (2006) Gastroesophageal reflux and laryngopharyngeal reflux in patients with sleep-disordered breathing. Otolaryngol Head Neck Surg 135(2):253–257
Watson NF, Mystkowski SK (2008) Aerophagia and gastroesophageal reflux disease in patients using continuous positive airway pressure: a preliminary observation. J Clin Sleep Med 4(5):434–438
Shepherd K, Hillman D, Eastwood P (2013) Symptoms of aerophagia are common in patients on continuous positive airway pressure therapy and are related to the presence of nighttime gastroesophageal reflux. J Clin Sleep Med 9(1):13–17
Ozturk O, Ozturk L, Ozdogan A et al (2004) Variables affecting the occurrence of gastroesophageal reflux in obstructive sleep apnea patients. Eur Arch Otorhinolaryngol 261(4):229–232
Berg S, Hoffstein V, Gislason T (2004) Acidification of distal esophagus and sleep-related breathing disturbances. Chest 125(6):2101–2106
Suzuki M, Saigusa H, Kurogi R et al (2010) Arousals in obstructive sleep apnea patients with laryngopharyngeal and gastroesophageal reflux. Sleep Med 11(4):356–360
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Ozcelik, H., Kayar, Y., Danalioglu, A. et al. Does CPAP treatment lead to gastroesophageal reflux in patients with moderate and severe OSA?. Eur Arch Otorhinolaryngol 274, 1223–1229 (2017). https://doi.org/10.1007/s00405-016-4116-0
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DOI: https://doi.org/10.1007/s00405-016-4116-0