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Predictors of Heartburn During Sleep in a Large Prospective Cohort Study^*

^* From the Sections of Gastroenterology (Dr. Fass), Department of Medicine, and Pulmonary and Critical Care Medicine (Dr. Quan), Department of Medicine, and the Arizona Respiratory Center, University of Arizona College of Medicine, Tucson, AZ; the Department of Medicine (Dr. O’Connor), Boston University, Boston, MA; the Johns Hopkins University (Ms. Ervin), Baltimore, MD; and the Department of Medicine (Dr. Iber), University of Minnesota, Minneapolis, MN.

Correspondence to: Ronnie Fass, MD, Southern Arizona VA Health Care System, Gastroenterology Section (1–111G-1), Tucson, AZ 85723-0001; e-mail: Ronnie.Fass{at}med.Va.gov

Background and aims: Nocturnal gastroesophageal reflux, which may result in nocturnal heartburn, has been demonstrated to be associated with a more severe form of gastroesophageal reflux disease (GERD). The aim of this study was to determine the clinical predictors of heartburn during sleep in a large prospective cohort study.

Methods: Study subjects were members of the parent cohorts from which the Sleep Heart Health Study (SHHS) recruited participants. SHHS is a multicenter, longitudinal, cohort study of the cardiovascular consequences of sleep-disordered breathing. As part of the recruitment process, parent cohort members completed a questionnaire that permitted an assessment of the relationships between heartburn during sleep, and patient demographics, sleep abnormalities, medical history, and social habits in nine community-based parent cohorts across the United States. All variables, significant at the p < 0.05 level, were included as independent variables in multivariate logistic regression models with heartburn during sleep status included as the dependent variable

Results: A total of 15,314 subjects completed the questions about heartburn during sleep, and of these, 3,806 subjects (24.9%) reported having this symptom. In four increasingly comprehensive multivariate models, increased body mass index (BMI), carbonated soft drink consumption, snoring and daytime sleepiness (Epworth sleepiness scale score), insomnia, hypertension, asthma, and usage of benzodiazepines were strong predictors of heartburn during sleep. In contrast, college education decreased the risk of reporting heartburn during sleep.

Conclusions: Heartburn during sleep is very common in the general population. Reports of this type of symptom of GERD are strongly associated with increased BMI, carbonated soft drink consumption, snoring and daytime sleepiness, insomnia, hypertension, asthma, and usage of benzodiazepines. Overall, heartburn during sleep may be associated with sleep complaints and excessive daytime sleepiness.

Key Words: cohort studies • gastroesophageal reflux • heartburn • sleep

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