Association Between Non-erosive Reflux Disease and High Risk of Obstructive Sleep Apnea in Korean Population

Abstract

Background/AimsObstructive sleep apnea is becoming more important in gastroesophageal reflux disease (GERD) patients. This study investigated the prevalence of high risk for obstructive sleep apnea in GERD patients in comparison with that in healthy controls using the Berlin Questionnaire. We also investigated the risk factors for obstructive sleep apnea in GERD patients. MethodsWe enrolled 1,007 subjects: 776 healthy controls, 115 individuals with erosive reflux disease, and 116 with non-erosive reflux disease. GERD was diagnosed and classified using endoscopy and a reflux questionnaire. The Berlin Questionnaire was used to evaluate obstructive sleep apnea. ResultsMore patients in the GERD group (28.2%) had higher risk for obstructive sleep apnea than healthy controls (20.4%, P = 0.036). More patients with non-erosive disease (32.8%) had higher risk for obstructive sleep apnea (OSA) than patients with erosive disease (20.9%) and controls (20.4%, P = 0.010). On multivariate analysis, non-erosive disease was a high risk factor for obstructive sleep apnea (odds ratio [OR], 1.82; P = 0.011). Age ≥ 55 years (OR, 1.83; P < 0.001) and a high body mass index (≥ 25 kg/m 2 ) (OR, 2.76; P < 0.001) were also identified as risk factors. Nocturnal GERD was related to high risk for OSA in non-erosive disease patients (OR, 2.97; P = 0.019), but not in erosive disease patients. ConclusionsHigh risk for OSA is more prevalent in GERD patients than in controls. Non-erosive reflux disease, age ≥ 55, and a high BMI are associated with high risk for OSA.

Gastroesophageal reflux disease: recent advances and its association with sleep

“…When controlling for variables, the risk of poor sleep quality was significantly increased for individuals with GERD compared with controls . A study performed in Korea indicated that individuals with GERD were likely to be at high risk for OSA compared to the control group (28.2% vs. 20.4%; P = 0.036) …”

“…Among 33,391 patients with symptomatic GERD, 64% of them had nGER symptoms that were associated with sleep disturbances . In a study performed in Korea that compared GERD ( n = 231) defined by upper endoscopy and/or frequent typical symptoms and controls ( n = 776), the prevalence of nGER symptoms was higher in GERD patients than in controls (23.4% vs. 4.1%; P < 0.001) . Among 9322 patients with heartburn or regurgitation, 84% reported sleep disturbances because of nGER reflux, including reflux in the supine position (72%), typical reflux disturbing sleep (39%), and waking because of reflux (45%) …”

“…16 A study performed in Korea indicated that individuals with GERD were likely to be at high risk for OSA compared to the control group (28.2% vs. 20.4%; P = 0.036). 17 A few studies have shown an association between GERD and subjective sleep disturbances, such as sleep shortage and short sleep duration. Matsuki et al 18 performed a case-control study in Japan that indicated that GERD patients were more likely to address subjective sleep shortage and short sleep duration (<5 h) than were controls.…”

“…25 Another study suggested nocturnal symptoms as high risk factors for OSA in GERD patients, especially in NERD patients (OR, 2.97). 17 Therefore, OSA and nGER symptoms could be strongly related.…”

Association Between Obstructive Sleep Apnea and Gastroesophageal Reflux Adjusted for Obesity in Patients With Sleep Disorders: a Case-control Study

“…Several studies have reported a high prevalence of RE in patients with OSAS, including some which used questionnaires to diagnose it [23,29]. However, many studies have reported no association between OSA severity and GER.…”