Chest
Clinical InvestigationsNasal CPAP Reduces Gastroesophageal Reflux in Obstructive Sleep Apnea Syndrome
Section snippets
Methods
Our study group was composed of six OSAS patients who complained of regular nocturnal heartburn and/or regurgitation of gastric contents into the pharynx. Five were men and age ranged from 33 to 56 years (mean = 38.7). Body mass index ranged from 29.4 to 40.6 kg/m2 (mean = 32.5). None of the patients had previously undergone more than symptomatic treatment for their GER. The subjects were not receiving any medication for the treatment of reflux during the study.
Each subject underwent two days
Results
All patients had normal esophageal peristalsis, and normal LES and UES resting pressures. LES resting pressures ranged from 10 to 30 mm Hg (mean = 14.1, normal ≥10).
Discussion
Many patients with OSAS have symptoms suggesting the presence of nocturnal GER. We studied six such patients and confirmed the presence of pathologic nocturnal reflux in five. All six had pathologic degrees of reflux when the entire 24-h period was analyzed. This in itself does not prove that GER is associated with OSAS. However, given the frequency of GER symptoms in the OSAS population and the apparent specificity of these complaints, we believe nocturnal GER is a prevalent disorder in OSAS
Conclusions
Obstructive sleep apnea syndrome may predispose patients to GER. Possible pathophysiologic explanations for this association include the prevalence of obesity in the OSA population, abnormally large drops in intrathoracic pressure during upper airway obstruction, and frequent arousals and movement during sleep. The use of CPAP significantly reduced mean reflux frequency and duration in five of six OSA patients. The single patient who continued to have abnormal amounts of reflux while receiving
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Manuscript received June 24; revision accepted September 24.