Mechanism of Gastroesophageal Reflux in Obstructive Sleep Apnea: Airway Obstruction or Obesity?
Open accessAbstract
Study objectives This is the first study to compare reflux events during wake and sleep in obese and non-obese individuals with obstructive sleep apnea (OSA) and obese individuals without OSA. The primary aim of the study was to investigate any additive effect of OSA on gastroesophageal reflux (GER) above that of obesity.Methods Twenty obese individuals (body mass index, BMI > 30 kg/m(2)), 9 non-obese individuals (BMI < 30 kg/m(2)) with moderate-to-severe OSA, and 17 obese control subjects (BMI > 30 kg/m(2)) underwent high-resolution esophageal manometry, 24-h esophageal pH-impedance monitoring, and in-laboratory polysomnography.Results Mean body mass index was 40 ± 6 and 27 ± 4 kg/m(2) for the obese and non-obese OSA groups, respectively, and 34 ± 5 kg/m(2) for the obese control group. Apnea-hypopnea index (AHI) was 50 ± 30 and 30 ± 25 per hour for the obese and non-obese OSA groups (p > 0.05), significantly higher than that of the obese control group (3 ± 3 per hour, p < 0.05). The two obese groups did not show any significant differences in the total number of acidic reflux events (41 ± 20 vs 28 ± 16); however, the obese OSA group had a greater number of acidic reflux events compared to the non-obese OSA group (22 ± 12 events, p < 0.05). In multivariate analysis, BMI significantly predicted number of acidic reflux events (r(2) = 0.16, p = 0.01) during the 24-h period; however, AHI showed no significant association with any measure of GER severity.Conclusions This study confirms an important role for obesity, rather than OSA per se in the relationship between OSA and GER.
The claims and statistics of this paper haven’t been checked yet.
Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.
Integrity signals
Registry
Cites
Statistics
Claims the paper makes
The claims and statistics of this paper haven’t been checked yet.
Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.
Claims other papers make about this one
Each is checked against this paper’s own text: does it say what the citing paper says it does?
Patients with both obstructive sleep apnea and gastroesophageal reflux have a higher body mass index than patients with obstructive sleep apnea alone.
“While patients with OSA and gastroesophageal reflux have been shown to have a higher BMI than patients with OSA alone”
From International Consensus Statement on Obstructive Sleep Apnea (2023) · cites this paper as [941]
The Abstract reports that BMI predicted the number of acidic reflux events, and the Discussion says BMI was associated with reflux severity in patients with OSA. But the study compares obese and non-obese OSA groups, not OSA patients with reflux against OSA patients without reflux; it does not establish the stated between-group BMI difference. (LLM, conf=0.84)
Experimental — accuracy not yet measuredIn that cohort, obese patients with obstructive sleep apnea had significantly more reflux events than non-obese patients with obstructive sleep apnea.
“However, obese patients with OSA had a significantly greater number of reflux events compared to the non-obese group with OSA.”
From International Consensus Statement on Obstructive Sleep Apnea (2023) · cites this paper as [941]
In a prospective cohort study on obstructive sleep apnea and gastroesophageal reflux disease in obesity, there was no significant difference in total objective reflux events between obese patients with and without obstructive sleep apnea.
“There was no significant difference in the total number of objective reflux events among obese patients with and without OSA.”
From International Consensus Statement on Obstructive Sleep Apnea (2023) · cites this paper as [941]
In multivariate analysis, body mass index significantly predicted the number of objective reflux events, but apnea-hypopnea index showed no significant association with gastroesophageal reflux disease severity.
“In multivariate analysis, BMI was a significant predictor of the number of objective reflux events, but AHI showed no significant association with GERD severity.941”
From International Consensus Statement on Obstructive Sleep Apnea (2023) · cites this paper as [941]
Self-check
Percentages, sums and reported differences re-computed from the paper’s own numbers.
The self-check needs the paper’s full text.
Cites
Locke, G. R., Talley, N. J., Fett, S. L., ZINSMEISTER, A. R., & Melton, L. J. (1997) · Gastroenterology · doi:10.1016/s0016-5085(97)70025-8 · Cited by 2,090 · see citing works
Symptoms in gastro-oesophageal reflux disease
Klauser, A. G., Schindlbeck, N. E., & Müller-Lissner, S. A. (1990) · The Lancet · doi:10.1016/0140-6736(90)90287-f · Cited by 747 · see citing works
Obesity: A Challenge to Esophagogastric Junction Integrity
Pandolfino, J. E., El‐Serag, H. B., Zhang, Q., Shah, N. K., Ghosh, S. K., & Kahrilas, P. J. (2006) · Gastroenterology · doi:10.1053/j.gastro.2005.12.016 · Cited by 556 · see citing works
A New Questionnaire for Gastroesophageal Reflux Disease
Locke, G. R., Talley, N. J., Weaver, A. L., & Zinsmeister, A. R. (1994) · Mayo Clinic Proceedings · doi:10.1016/s0025-6196(12)62245-9 · Cited by 427 · see citing works
Obesity Is Associated With Increased Transient Lower Esophageal Sphincter Relaxation
Wu, J. C. Y., MUI, L., Cheung, C. M., Chan, Y., & Sung, J. J. �. (2006) · Gastroenterology · doi:10.1053/j.gastro.2006.12.032 · Cited by 310 · see citing works
Obstructive sleep apnea and gastroesophageal reflux
Ing, A., Ngu, M., & Breslin, A. B. X. (2000) · The American Journal of Medicine · doi:10.1016/s0002-9343(99)00350-2 · Cited by 272 · see citing works
Respiratory Symptoms and Nocturnal Gastroesophageal Reflux
Gíslason, Þ., Janson, C., Vermeire, P. A., Plaschke, P. P., Bjornsson, E. H., Gíslason, D., & Boman, G. (2002) · CHEST Journal · doi:10.1378/chest.121.1.158 · Cited by 240 · see citing works
Obesity Is Associated With Increased Transient Lower Esophageal Sphincter Relaxation
Katzka, D. A. (2008) · Yearbook of Gastroenterology · doi:10.1016/s0739-5930(08)79152-9 · Cited by 238 · see citing works
Green, B. T., Broughton, W. A., & O’Connor, J. B. (2003) · Archives of Internal Medicine · doi:10.1001/archinte.163.1.41 · Cited by 211 · see citing works
Clinical and in vitro analysis of determinants of gastroesophageal competence
DeMeester, T. R., Wernly, J. A., Bryant, G. H., Little, A. G., & Skinner, D. B. (1979) · The American Journal of Surgery · doi:10.1016/0002-9610(79)90008-4 · Cited by 210 · see citing works
Predictors of Heartburn During Sleep in a Large Prospective Cohort Study
Fass, R., Quan, S. F., O’Connor, G. T., Ervin, A., & Iber, C. (2005) · CHEST Journal · doi:10.1378/chest.127.5.1658 · Cited by 182 · see citing works
Chiocca, J. C., Olmos, J. A., Salis, G., Soifer, L., HIGA, R., Marcolongo, M. M., & THE ARGENTINEAN GASTRO‐OESOPHAGEAL REFLUX STUDY GROUP (2005) · Alimentary Pharmacology & Therapeutics · doi:10.1111/j.1365-2036.2005.02565.x · Cited by 131 · see citing works
O’Sullivan, G. C., DeMeester, T. R., Joelsson, B. E., Smith, R. B., Blough, R. R., Johnson, L. F., & Skinner, D. B. (1982) · The American Journal of Surgery · doi:10.1016/0002-9610(82)90127-1 · Cited by 127 · see citing works
Arousal in patients with gastro-oesophageal reflux and sleep apnoea
Penzel, T., Becker, H. F., Brandenburg, U., Labunski, T., Pankow, W., & Peter, J. H. (1999) · European Respiratory Journal · doi:10.1183/09031936.99.14612669 · Cited by 125 · see citing works
Symptomatic Gastroesophageal Reflux in Subjects With a Breathing Sleep Disorder
Valipour, A., Makker, H. K., Hardy, R., Emegbo, S., Toma, T., & Spiro, S. G. (2002) · CHEST Journal · doi:10.1378/chest.121.6.1748 · Cited by 113 · see citing works
Is there a relationship between obstructive sleep apnea and gastroesophageal reflux disease?
Morse, C. A., Quan, S. F., Mays, M. Z., Green, C., Stephen, G., & Fass, R. (2004) · Clinical Gastroenterology and Hepatology · doi:10.1016/s1542-3565(04)00347-7 · Cited by 95 · see citing works
Mechanisms of nocturnal gastroesophageal reflux events in obstructive sleep apnea
Shepherd, K., Hillman, D. R., Holloway, R. H., & Eastwood, P. R. (2010) · Sleep And Breathing · doi:10.1007/s11325-010-0404-x · Cited by 87 · see citing works
Self-citationShepherd, K., JAMES, A. L., Musk, A. W., Hunter, M. L., Hillman, D. R., & Eastwood, P. R. (2010) · Journal of Sleep Research · doi:10.1111/j.1365-2869.2010.00843.x · Cited by 84 · see citing works
Self-citationGastroesophageal reflux in patients with sleep apnea syndrome.
Ki, G., Karaus, M., Heinemann, S., Körber, S., Dorow, P., & Hampel, K. E. (1995) · PubMed · Cited by 77 · see citing works
Anggiansah, R., Sweis, R., Anggiansah, A., Wong, T., Cooper, D., & Fox, M. R. (2013) · Alimentary Pharmacology & Therapeutics · doi:10.1111/apt.12208 · Cited by 73 · see citing works
Kuribayashi, S., Massey, B. T., Hafeezullah, M., Perera, L. P., Hussaini, S. Q., Tatro, L., Darling, R. J., Franco, R., & Shaker, R. (2009) · CHEST Journal · doi:10.1378/chest.09-0913 · Cited by 72 · see citing works
Mechanism of gastroesophageal reflux in patients with obstructive sleep apnea syndrome
Kuribayashi, S., Kusano, M., Kawamura, O., Shimoyama, Y., Maeda, M., Hisada, T., Ishizuka, T., Dobashi, K., & Mori, M. (2010) · Neurogastroenterology & Motility · doi:10.1111/j.1365-2982.2010.01485.x · Cited by 70 · see citing works
Derakhshan, M. H., Robertson, E. V., Fletcher, J., Jones, G., Lee, Y. Y., Wirz, A. A., & McColl, K. E. L. (2011) · Gut · doi:10.1136/gutjnl-2011-300633 · Cited by 63 · see citing works
Gastroesophageal Reflux in Patients with Morbid Obesity: A Role of Obstructive Sleep Apnea Syndrome?
Sabaté, J., Jouët, P., Merrouche, M., Pouzoulet, J., Maillard, D., Harnois, F., Msika, S., & Coffin, B. (2008) · Obesity Surgery · doi:10.1007/s11695-008-9508-9 · Cited by 59 · see citing works
Kim, H. ‐., Vorona, R. D., Winn, M. P., DOVIAK, M. J., Johnson, D. A., & Ware, J. C. (2005) · Alimentary Pharmacology & Therapeutics · doi:10.1111/j.1365-2036.2005.02447.x · Cited by 54 · see citing works
Impact of Treatment of Gastroesophageal Reflux on Obstructive Sleep Apnea-Hypopnea Syndrome
Friedman, M., Gürpınar, B., Lin, H., Schalch, P., & Joseph, N. J. (2007) · Annals of Otology Rhinology & Laryngology · doi:10.1177/000348940711601103 · Cited by 53 · see citing works
Demeter, P. (2005) · World Journal of Gastroenterology · doi:10.3748/wjg.v11.i6.839 · Cited by 50 · see citing works
Teramoto, S., Ohga, E., Matsui, H., Ishii, T., Matsuse, T., & Ouchi, Y. (1999) · Journal of the American Geriatrics Society · doi:10.1111/j.1532-5415.1999.tb05216.x · Cited by 43 · see citing works
Variables affecting the occurrence of gastroesophageal reflux in obstructive sleep apnea patients
�zt�rk, L., �zdogan, A., �ktem, F., �zt�rk, �., & Pelin, Z. (2004) · European Archives of Oto-Rhino-Laryngology · doi:10.1007/s00405-003-0658-z · Cited by 40 · see citing works
Obese Patients Have Stronger Peristalsis and Increased Acid Exposure in the Esophagus
Fornari, F., Callegari-Jacques, S. M., Dantas, R. O., Scarsi, A. L., Ruas, L. O., & de Barros, S. G. S. (2010) · Digestive Diseases and Sciences · doi:10.1007/s10620-010-1454-4 · Cited by 35 · see citing works
Heinemann, S., Graf, K. I., Karaus, M., & Dorow, P. (1995) · PubMed · Cited by 16 · see citing works
Predictors of Heartburn During Sleep in a Large Prospective Cohort Study
Barkin, J. S. (2006) · Yearbook of Medicine · doi:10.1016/s0084-3873(08)70555-8 · Cited by 6 · see citing works
Impact of Treatment of Gastroesophageal Reflux on Obstructive Sleep Apnea-Hypopnea Syndrome
Keefe, M. A. (2008) · Yearbook of Otolaryngology-Head and Neck Surgery · doi:10.1016/s1041-892x(08)79222-9 · Cited by 1 · see citing works
Flagged first, then by citations
Cited by
Sorted by citations
International Consensus Statement on Obstructive Sleep Apnea
Chang, J. L., Goldberg, A. N., Alt, J. A., Mohammed, A., Ashbrook, L., Auckley, D., Ayappa, I., Bakhtiar, H., Barrera, J. E., Bartley, B. L., et al. (2023) · International Forum of Allergy & Rhinology · doi:10.1002/alr.23079 · Cited by 350 · see citing works
Sleep and Nocturnal Gastroesophageal Reflux
Lim, K. G., Morgenthaler, T. I., & Katzka, D. A. (2018) · CHEST Journal · doi:10.1016/j.chest.2018.05.030 · Cited by 84 · see citing works
Dominguez, J. E., Krystal, A. D., & Habib, A. S. (2018) · Anesthesia & Analgesia · doi:10.1213/ane.0000000000003335 · Cited by 84 · see citing works
Gruden, J. F., Green, D. B., Legasto, A. C., Jensen, E. A., & Panse, P. M. (2017) · American Journal of Roentgenology · doi:10.2214/ajr.17.18063 · Cited by 48 · see citing works
Gastroesophageal reflux disease: recent advances and its association with sleep
Oh, J. H. (2016) · Annals of the New York Academy of Sciences · doi:10.1111/nyas.13143 · Cited by 41 · see citing works
Tamanna, S., Campbell, D., Warren, R., & Ullah, M. I. (2016) · Journal of Clinical Sleep Medicine · doi:10.5664/jcsm.6126 · Cited by 37 · see citing works
Dominguez, J. E., Cantrell, S. E., Habib, A. S., Izci‐Balserak, B., Lockhart, E., Louis, J. M., Miskovic, A., Nadler, J. W., Nagappa, M., O'Brien, L. M., et al. (2023) · Obstetrics and Gynecology · doi:10.1097/aog.0000000000005261 · Cited by 32 · see citing works
Kim, Y., Lee, Y. J., Park, J. S., Cho, Y.-J., Yoon, H. I., Lee, J. H., Lee, C.-T., & Kim, S. J. (2018) · Sleep and Breathing · doi:10.1007/s11325-017-1533-2 · Cited by 30 · see citing works
The Prevalence of Gastroesophageal Reflux in Patients With Excessive Central Airway Collapse
Majid, A., Kheir, F. M., Alape, D., Kent, M. S., Lembo, A. J., Rangan, V., Carreiro, M., & Gangadharan, S. P. (2018) · CHEST Journal · doi:10.1016/j.chest.2018.09.021 · Cited by 25 · see citing works
Health Consequences of Obstructive Sleep Apnea
Espiritu, J. R. D. (2021) · Springer eBooks · doi:10.1007/978-3-030-54146-0_3 · Cited by 21 · see citing works
Temporal Relationship Between Night-Time Gastroesophageal Reflux Events and Arousals From Sleep
Shepherd, K., Ockelford, J., Ganasan, V., Holloway, R. H., Hillman, D. R., & Eastwood, P. R. (2020) · The American Journal of Gastroenterology · doi:10.14309/ajg.0000000000000627 · Cited by 20 · see citing works
Self-citationSinclair, A. J., & Abdelhafiz, A. H. (2025) · Metabolites · doi:10.3390/metabo15010049 · Cited by 20 · see citing works
Zhu, Q., Hua, L., Chen, L., Mu, T., Dong, D., Xu, J., & Shen, C. (2023) · Frontiers in Genetics · doi:10.3389/fgene.2023.1111144 · Cited by 17 · see citing works
Li, C., Wu, Z., Pan, X., & Yuan, K. (2020) · Sleep And Breathing · doi:10.1007/s11325-020-02224-9 · Cited by 16 · see citing works
Obstructive sleep apnea and 19 gastrointestinal diseases: a Mendelian randomization study
Yan, W., Zhou, J., Jiang, M., Kong, Y., Qin, H., Qi, Y., Wang, S., & Tai, J. (2024) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2024.1256116 · Cited by 15 · see citing works
Parekh, P. J., Oldfield, E. C., & Johnson, D. A. (2017) · Journal of Clinical Gastroenterology · doi:10.1097/mcg.0000000000000963 · Cited by 13 · see citing works
Chronic Cough and Obstructive Sleep Apnea
Sundar, K. M., Stark, A., & Dicpinigaitis, P. V. (2024) · Sleep Medicine Clinics · doi:10.1016/j.jsmc.2024.02.004 · Cited by 10 · see citing works
Hung, J., Wong, M., Liu, T., Yi, C., Lei, W., & Chen, C. (2018) · Journal of Clinical Gastroenterology · doi:10.1097/mcg.0000000000001147 · Cited by 9 · see citing works
Gastroesophageal Reflux Disease: A Cause for Eustachian Tube Dysfunction in Obstructive Sleep Apnea
Yan, S., Wei, Y., Zhan, X., Yao, L., Li, X., Fang, F., & Xu, J. (2020) · Ear Nose & Throat Journal · doi:10.1177/0145561320931219 · Cited by 8 · see citing works
Wang, X., Wright, Z., Wang, J., & Song, G. (2023) · Journal of Respiration · doi:10.3390/jor3020008 · Cited by 6 · see citing works
Sleep Disturbances in General Medical Disorders
Chokroverty, S. (2017) · Springer eBooks · doi:10.1007/978-1-4939-6578-6_47 · Cited by 3 · see citing works
Feng, Z., Wu, S., Wang, M., Wang, H., Hou, Y., Yi, H., Xiao, F., Xu, L., Dong, X.-S., & Han, F. (2025) · Sleep Medicine · doi:10.1016/j.sleep.2025.03.004 · Cited by 4 · see citing works
Peng, C.-K., Tsao, C., Sung, W., Wang, S., Chen, W.-J., Hsieh, T.-Y., Yang, M.-H., Lee, T., & Chen, S. (2022) · Healthcare · doi:10.3390/healthcare10091633 · Cited by 3 · see citing works
Sleep Disturbances and Functional Gastrointestinal Diseases
Kumar, A., Sharan, K., & Gupta, R. K. (2022) · Springer eBooks · doi:10.1007/978-981-16-0123-1_29 · Cited by 2 · see citing works
Sleep apnoea syndrome and gastroesophageal reflux disease in clinical and pathophysiological context
Genzor, S., Gregar, J., & Hobzová, M. (2018) · Interní medicína pro praxi · doi:10.36290/int.2018.002
Kryvenko, V. I., & Svitlytska, O. A. (2020) · Zaporozhye Medical Journal · doi:10.14739/2310-1210.2020.2.200580
Murghuzov, M. A. (2020) · Problems of Uninterrupted Medical Training and Science · doi:10.31071/promedosvity2020.03.072
L. T. hobhouse’s new liberalism and the reformulation of ideology
Gomes, C. L. (2014) · Portuguese National Funding Agency for Science, Research and Technology (RCAAP Project by FCT)
Medical Comorbidities of Obstructive Sleep Apnea
Kim, J., Demerjian, G. G., Patel, M., & Barkhordarian, A. (2022) · Springer eBooks · doi:10.1007/978-3-031-10646-0_5
Sanner, B. M. (2020) · Springer Reference Medizin · doi:10.1007/978-3-642-54672-3_73-1
Diet Pemakanan Menurut Perspektif Halal Dan Sunnah Terhadap Penyakit Gerd
Yahaya, A. M., & Ismail, M. N. (2022) · Journal of Fatwa Management and Research · doi:10.33102/jfatwa.vol27no2-se.496
Obstructive Sleep Apnea (OSA) and Gastroenterology
Cortéz-Hernández, C. A., & Cessa-Zanatta, J. C. (2023) · Springer eBooks · doi:10.1007/978-3-031-35225-6_13
Asthma and Other Respiratory Disorders Associated with Obesity
Abu‐Hasan, M., & Fedele, D. A. (2023) · American Academy of PediatricsItasca, IL eBooks · doi:10.1542/9781610026536-43
Crosstalk between gastrointestinal tract disorders and obstructive sleep apnea
Jian, S., Liu, J., He, M., Liu, B., Liu, K., Zang, C., Su, X., Zhang, Y., & Yi, M. (2024) · Sleep And Breathing · doi:10.1007/s11325-024-03082-5
Sleep and Gastroesophageal Reflux
Troxler, R., & Harding, S. M. (2024) · Elsevier eBooks · doi:10.1016/b978-0-323-75566-5.00010-1
Баировна, Д. Б., & Onuchina, E. V. (2025) · Zabajkalʹskij medicinskij vestnik · doi:10.52485/19986173_2025_1_33
Sanner, B. M. (2025) · Springer Reference Medizin · doi:10.1007/978-3-662-65186-5_73
The Obese Snorer: Obstructive Sleep Apnoea and the Obesity Hypoventilation Syndrome
Hasan, A. (2025) · Springer eBooks · doi:10.1007/978-981-96-7810-5_29
- Authors
- Shepherd, K., & Orr, W.
- Affiliations
- Lynn Health Science Institute (US)
- Corresponding author
- Shepherd, Kelly
- Venue
- Journal of Clinical Sleep Medicine
- Published
- 2016-01-15
- Volume
- 12
- Issue
- 1
- Pages
- 87-94
- ISSN
- 1550-9389 (ISSN-L)
- 1550-9397
- PMC
- PMC4702204
- OpenAlex
- W2339343292
- Semantic Scholar
- 2e3adcfb6c369a4ff170a50db540577ef7aaa702
- Cited by
- 38
- References
- 33
- Citations by year
- 2025: 5 · 2024: 4 · 2023: 5 · 2022: 5 · 2021: 1 · 2020: 6 · 2018: 5 · 2017: 4 · 2016: 2 · 2014: 1
- FWCI
- 4.00
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Journal of Clinical Sleep Medicine (publishedVersion)
- Europe PMC (PubMed Central) (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Gastroenterology › Gastroesophageal reflux and treatments
- Health Sciences › Medicine › Physiology › Obstructive Sleep Apnea Research
- Health Sciences › Health Professions › Speech and Hearing › Dysphagia Assessment and Management
- Keywords
- gastroesophageal reflux, obstructive sleep apnea, obesity, body mass index, airway obstruction, reflux events, esophageal manometry, apnea-hypopnea index
- MeSH terms
- Adult, Airway Obstruction, Female, Gastroesophageal Reflux, Humans, Male, Middle Aged, Obesity, Polysomnography, Sleep Apnea, Obstructive
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
Are you an author, or do you see a problem with this page? Request a review
