Sleep Apnea Treatment Also Effective for Gastroesophageal Reflux
A device that helps people who have the obstructive breathing disorder sleep apnea also helps people who suffer from acid reflux, a painful stomach disorder
Tuesday, January 14, 2003
Nocturnal gastroesophageal reflux is a common condition
characterized by disturbance of sleep due to severe heartburn and
regurgitation of acidic stomach fluid into the esophagus. Patients
with OSA repeatedly stop breathing for periods of 10 seconds or
longer while sleeping.
Experts estimate that 10 percent of the general population
experiences nGER. However, studies have shown that a much larger
percentage of OSA patients -- between 54 and 76 percent -- also
suffer from nGER.
“This is the first long-term, prospective study of the
relationship between obstructive sleep apnea and nocturnal
gastroesophageal reflux, and specifically the efficacy of a proven
sleep apnea treatment in reducing reflux symptoms,” said John
O’Connor, M.D., assistant professor of medicine in the division of
gastroenterology at Duke University Medical Center and senior
author of the study.
Researchers studied 331 patients diagnosed with OSA at the
University of South Alabama Sleep Disorders Clinic.
OSA is diagnosed through polysomnography, a procedure performed
overnight in a sleep lab to evaluate sleep disruption. While the
patient sleeps, the machine tallies the total number of times the
patient’s breathing either stops or slows, to come up with a
measure of the severity of the patient’s OSA.
In the study, patients arriving to be tested for OSA were asked
to report the frequency with which their sleep was disturbed by
“severe heartburn and choking.”
Of the 331 patients surveyed, 61 percent reported symptoms of
nGER. The researchers followed 189 of those patients who were
treated with nasal continuous positive airway pressure (CPAP) to
relieve OSA.
CPAP is the standard treatment for sleep apnea and is
administered through a mask fitted over the nose worn during sleep.
The mask is attached to a machine that delivers pressurized air
through the patient’s nostrils. The pressure maintains an open
airway, thus preventing any interruptions in breathing. Although
CPAP relieves sleep apnea, it does not cure the disorder and must
be used every night to be most effective.
Physicians believe CPAP also prevents nGER symptoms by
increasing pressure in the thorax and thus preventing acid from
coming back up the esophagus.
The Duke researchers followed up with each patient to assess the
frequency of his or her nGER symptoms while using CPAP treatment.
CPAP treatment resulted in a 48 percent overall decrease in the
frequency of patients’ nGER symptoms.
Of the 165 patients in this study who adhered to CPAP treatment,
74.5 percent showed improvement in their nGER symptoms. Sixteen
patients who discontinued CPAP treatment served as a control group,
with only 31.3 percent reporting improvements in their nGER
symptoms.
“Nocturnal reflux problems can be quite disturbing to patients
who suffer from this disorder,” said O’Connor. “And we know that
nighttime reflux is even more detrimental to patient quality of
life than daytime heartburn. Although our study demonstrated that
CPAP treatment relieved both sleep apnea and GERD symptoms, there
needs to be further research to determine the optimal treatment
combination including CPAP, dietary modifications and acid
suppressing medications.”
There was no external funding for this study.
Joining O’Connor on this study were Bryan Green, M.D., a fellow in the division of gastroenterology at Duke University Medical Center and William Broughton, M.D., professor of medicine at the University of South Alabama College of Medicine.