The Effect of 1 Week of Continuous Positive Airway Pressure Treatment in Obstructive Sleep Apnea Patients With Concomitant Gastroesophageal Reflux

doi:10.1378/chest.130.4.1003

Chest

Volume 130, Issue 4, October 2006, Pages 1003-1008

https://doi.org/10.1378/chest.130.4.1003 Get rights and content

Study objectives

Patients with obstructive sleep apnea (OSA) have a very high incidence of gastroesophageal reflux (GER). Previous studies have shown that the use of continuous positive airway pressure (CPAP) reduces the frequency of reflux events, but these studies only assessed the effect of a single night of treatment. The aim of this study was to assess the effect of 1 week of CPAP treatment on reflux in patients with OSA and GER.

Design

Sixteen patients with OSA and GER were recruited. Polysomnography followed by 24-h, continuous esophageal pH monitoring were performed at baseline. Patients with an apnea-hypopnea index (AHI) > 20/h and 24-h acid contact time (ACT) of at least 6% were included. As part of the polysomnography-qualifying evaluation, all patients underwent CPAP titration to reduce the AHI to < 10/h. Patients were then sent home receiving nasal CPAP for 1 week; after 1 week, esophageal pH monitoring was repeated while receiving CPAP.

Measurements and results

The AHI fell from 63.3 ± 38.5 to 3.2 ± 2.2/h (mean ± SD) [p < 0.001]. Total ACT fell from 13.9 ± 11.6 to 5.6 ± 2.7% (p < 0.001). The upright ACT was reduced from 12.4 ± 6.8 to 6.8 ± 3.8% (p = 0.01), and the supine (during the sleeping interval) ACT was reduced from 16.3 ± 18.8 to 3.8 ± 7.6% (p < 0.01). Eighty-one percent of the patients had a reduction in supine ACT to within the normal range (< 4%).

Conclusions

In OSA patients with significant heartburn complaints, CPAP would appear to be an efficacious approach to the treatment of both disorders.

Section snippets

Subjects

The protocol was reviewed and approved by the Institutional Review Board at The University of Oklahoma Health Sciences Center. Appropriate informed consent was obtained from all patients. Patients were identified as likely to have sleep apnea based on clinical criteria including loud snoring, interrupted sleep at night, and excessive daytime sleepiness. Patients were required to have symptoms of reflux for at least 4 days a week, and awakening from sleep with heartburn at least once a week. The

Results

Forty-three patients were screened, and 16 patients (14 men and 2 women) were enrolled in the study. The others were excluded either because of AHI < 20/h (n = 13) or because of 24-h ACT < 6% (n = 11). Two patients were excluded because of very severe sleep apnea associated with significant oxygen desaturation that required supplemental oxygen during the night. The average use of CPAP was 5.9 ± 1.7/h per night. The mean body mass index (BMI) was 35.1 ± 6.6 kg/m² (Table 1).

Discussion

To our knowledge, this is the first study that has examined the effect of CPAP on GER in patients with sleep apnea beyond 1 single night of therapy. We found a significant reduction in the total 24-h acid contact. This was more impressive in the supine position when the patient was receiving CPAP. To our surprise, this beneficial effect was maintained to a certain extent during the day when the patient was awake and not receiving CPAP.

The coexistence of OSA and GER is common in the obese

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Citation Excerpt :
As an effective and noninvasive treatment for OSA, the mechanism of CPAP is to maintain a certain positive pressure in the upper airway. It has been confirmed that CPAP can completely or partially eliminate the occurrence of GER at night through increasing of esophageal internal pressure rather than reduction of apnea or micro arousal [7,23]. It has been speculated that CPAP may also cause reflex contraction of LES, so as to achieve anti-reflow effect [24].
Obstructive sleep apnea (OSA) is known to be highly associated with reflux diseases. There is evidence that continuous positive airway pressure (CPAP) can decrease the clinical symptoms of gastroesophageal reflux (GER) in OSA patients, but whether CPAP can decrease nocturnal laryngopharyngeal reflux (LPR) episodes is still lack of strong evidence.
To investigate the efficiency of CPAP on LPR and the relationship between LPR, GER and OSA.
retrospective study.
Forty adult patients who had confirmed OSA by polysomnography and suspected LPR were enrolled. Their results of synchronous polysomnography and 24 h esophageal and oropharyngeal Dx-pH monitoring were analyzed. Twenty-seven OSA patients were treated with CPAP on the second night. The nocturnal reflux parameters with and without CPAP treatment were compared.
15.0% and 42.5% of OSA patients were associated with LPR and GER through Dx-pH monitoring respectively. Nevertheless, more than one reflux attack falling below pH6.0 of oropharynx during sleep time was detected in 80.0% patients. There was a significant inverse correlation between the lowest/mean pH values of oropharynx and obstructive apnea index (OAI), so was the lowest pH values of esophagus. Significant positive correlation was calculated between the total number of reflux episodes below pH6.0 of oropharynx and apnea–hypopnea index (AHI)/OAI/hypopnea index (HI). A similar positive correlation was also significant between AHI/OAI and GER parameters. The assessment of the efficacy of CPAP treatment showed significant difference both in GER and LPR related parameter.
OSA patients have a higher incidence of nocturnal LPR and GER. CPAP treatment can effectively reduce both GER and LPR attacks while disordered sleep events reduced in OSA patients.

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Original ResearchThe Effect of 1 Week of Continuous Positive Airway Pressure Treatment in Obstructive Sleep Apnea Patients With Concomitant Gastroesophageal Reflux

Study objectives

Design

Measurements and results

Conclusions

Section snippets

Subjects

Results

Discussion

Am J Med

Chest

Chest

Chest

The occurrence of sleep-disordered breathing among middle-age adults

N Engl J Med

Ancoli-Israel. Epidemiology of sleep disorders

Clin Geriatr Med

Gastroesophageal reflux in patients with sleep apnea syndrome

Z Gastroenterol

Original Research
The Effect of 1 Week of Continuous Positive Airway Pressure Treatment in Obstructive Sleep Apnea Patients With Concomitant Gastroesophageal Reflux