Temporal Association Between Respiratory Events and Reflux in Patients With Obstructive Sleep Apnea and Laryngopharyngeal Reflux
Open accessAbstract
The aim of the current study was to test the hypothesis that there is a temporal correlation between reflux episodes and respiratory events in patients with laryngopharyngeal reflux and obstructive sleep apnea. Adults with clinically diagnosed laryngopharyngeal reflux confirmed by two validated instruments (reflux symptom index ≥ 13 and reflux finding score ≥ 7) and obstructive sleep apnea (OSA) underwent full polysomnography with concomitant and synchronized multichannel intraluminal impedance-pH esophageal monitoring. The apnea-hypopnea and arousal indexes that occurred 15, 30, and 45 minutes before and after each reflux episode were recorded and compared to full-night apnea and hypopnea and arousal index. We studied 27 patients (14 males, age 51.7 ± 9.1 years, body mass index 32.4 ± 4.2 kg/m2) with laryngopharyngeal reflux (reflux symptom index 16 ± 2 and reflux finding score 12 ± 3) and OSA (apnea-hypopnea index = 32.3 ± 28.4 events/h). We evaluated 102 reflux episodes. Almost half of the reflux episodes occurred while awake (43.1%) and only five reflux episodes (4.9%) occurred during an obstructive respiratory event. The apnea and hypopnea and arousal indexes 15, 30, and 45 minutes before and after reflux episodes were lower than full-night apnea and hypopnea and arousal indexes, respectively. Among patients with well-established laryngopharyngeal reflux and OSA, there is no temporal association between reflux and obstructive respiratory events. Even though the data comprised a small sample size, it seems that a more complex mechanism is involved with these two highly prevalent diseases. Xavier SD, Eckley CA, Duprat AC, de Souza Fontes LH, Navarro-Rodriguez T, Patrocínio J, Tridente D, Lorenzi-Filho G. Temporal association between respiratory events and reflux in patients with obstructive sleep apnea and laryngopharyngeal reflux. J Clin Sleep Med. 2019;15(10):1397–1402.
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Nocturnal reflux symptoms in obstructive sleep apnea are associated with sleep fragmentation and poor sleep quality.
“which have been associated with sleep fragmentation and overall poor sleep quality.927,930,936”
From International Consensus Statement on Obstructive Sleep Apnea (2023) · cites this paper as [936]
The Results (page not provided) report that arousal indexes in the 15-, 30-, and 45-minute periods around reflux episodes were lower than the full-night arousal index, contrary to the attributed association with sleep fragmentation. The paper does not report a measure of overall sleep quality, so it cannot establish that part of the claim. (LLM, conf=0.84)
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Experimental — accuracy not yet measuredMore than 75% of patients with obstructive sleep apnea in population-based studies report nocturnal reflux symptoms.
“Population-based studies have demonstrated that greater than 75% of patients with OSA report nocturnal reflux symptoms”
From International Consensus Statement on Obstructive Sleep Apnea (2023) · cites this paper as [936]
The Introduction (page unavailable) reports that laryngopharyngeal reflux is more prevalent in patients with OSA than in the general population, at 60% versus 20%. It does not report that more than 75% of patients with OSA have nocturnal reflux symptoms, or attribute that figure to population-based studies. The Methods describe recruitment from a reflux outpatient clinic rather than a population-based sample. (LLM, conf=0.82)
Experimental — accuracy not yet measuredLaryngopharyngeal reflux is associated with sleep-disordered breathing.
“has also been associated with SDB.923,924,926–930,932,933,936,937”
From International Consensus Statement on Obstructive Sleep Apnea (2023) · cites this paper as [936]
Experimental — accuracy not yet measuredIn 27 adults with reflux confirmed by validated instruments and obstructive sleep apnea, no temporal association was found between reflux and obstructive respiratory events on polysomnography with multichannel intraluminal impedance-pH monitoring.
“no temporal association between reflux and obstructive respiratory events was identified on PSG with concomitant multichannel intraluminal impedance (MCII)-pH esophageal monitoring.936”
From International Consensus Statement on Obstructive Sleep Apnea (2023) · cites this paper as [936]
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References 43 · Cited by 8
Research works printed but not linked: 2
- [22]22. Jecker P, Rassouli S, Selivanova O, Lippold W, Mann WJ. [No correlation between reflux of gastric contents and obstructive sleep apnea]. HNO. 2008;56(11):1122-1128.
- [42]42. Tardif C, Denis P, Verdure-Poussin A, Hidden F, Pasquis P, Samson-Dollfus D. Gastroesophageal reflux during sleep in obese patients. Neurophysiol Clin. 1988;18(4):323-332.
- Authors
- Xavier, S. D., Eckley, C. A., Duprat, A. C., de Souza Fontes, L. H., Navarro-Rodriguez, T., Patrocínio, J., Tridente, D., & Lorenzi-Filho, G.
- Affiliations
- Faculdade de Ciências Médicas da Santa Casa de São Paulo (BR)
- Otolaryngology Department,Santa Casa São Paulo, São Paulo, Brazil
- Esophagus and Digestive Motility of Gastroenterology, Department of Hospital Clínicas, São Paulo University, São Paulo, Brazil
- Irmandade da Santa Casa de Misericórdia de São Paulo (BR)
- Beth Israel Deaconess Medical Center (US)
- InCor Sleep Center Laboratory Director, São Paulo, Brazil
- Corresponding author
- Xavier, Sandra Doria
- ORCID
- Xavier, Sandra Doria
- Venue
- Journal of Clinical Sleep Medicine
- Published
- 2019-10-15
- Volume
- 15
- Issue
- 10
- Pages
- 1397-1402
- ISSN
- 1550-9389 (ISSN-L)
- 1550-9397
- PMC
- PMC6778358
- OpenAlex
- W2980776898
- Semantic Scholar
- 3141b209709617d3e1bef3a969e1e9f9131f7325
- Cited by
- 8
- References
- 43
- Citations by year
- 2024: 1 · 2023: 1 · 2022: 3 · 2021: 3
- FWCI
- 1.36
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Journal of Clinical Sleep Medicine (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
- laryngopharyngeal reflux, obstructive sleep apnea, reflux episodes, respiratory events, apnea-hypopnea index, arousal index, esophageal pH monitoring, impedance-pH monitoring, temporal association, polysomnography
- MeSH terms
- Esophagus, Female, Humans, Male, Middle Aged, Time, Polysomnography, Sleep Apnea, Obstructive, Laryngopharyngeal Reflux
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