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Symptomatic Gastroesophageal Reflux in Subjects With a Breathing Sleep Disorder^*

^* From the Department of Thoracic Medicine (Drs. Valipour, Makker, Toma, and Spiro, and Mr. Emegbo), The Middlesex Hospital, University College London Hospitals; and MRC National Survey of Health and Development (Dr. Hardy), Department of Epidemiology and Public Health, Royal Free and University College Medical School, London, UK.

Correspondence to: Stephen G. Spiro, MD; Department of Thoracic Medicine, Middlesex Hospital, Mortimer St, London W1N 8AA, United Kingdom; e-mail: stephen.spiro{at}uclh.org

Study objectives: A link between gastroesophageal reflux (GER) and obstructive sleep apnea (OSA) has been suggested; however, the prevalence and frequency of symptomatic GER and the influence of OSA severity on GER are not known.

Design and patients: Two hundred seventy-one subjects referred for overnight sleep studies were investigated for subjects with a breathing sleep disorder, occurrence of symptomatic GER, potential risk factors for both conditions, and comorbidity using a validated questionnaire.

Results: Overall, 160 of the 228 respondents (73%; 135 subjects with OSA and 93 subjects who snore) reported GER-related symptoms, with heartburn and/or acid regurgitation being the leading symptoms. No evidence of a difference in the occurrence of symptomatic GER between subjects who snore and subjects with OSA was observed (odds ratio [OR], 1.21; 95% confidence interval [CI], 0.7 to 2.1). Furthermore, the occurrence of reflux symptoms was not influenced by the severity of OSA (OR per 10 4% arterial oxygen saturation [SaO₂] dips per hour, 0.98; 95% CI, 0.8 to 1.1). Self-reported comorbidity was higher in subjects with OSA compared with subjects who snore (p = 0.02), but none of the potential risks produced an association with the presence of reflux symptoms in this sample of patients with a breathing sleep disorder.

Conclusion: We conclude that symptomatic GER is common in subjects with a breathing sleep disorder, but there was no difference between those with OSA and subjects who snore.

Key Words: gastroesophageal reflux • obstructive sleep apnea • questionnaire-based survey • subjects with a breathing sleep disorder • subjects who snore

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