Temporal Association Between Respiratory Events and Reflux in Patients With Obstructive Sleep Apnea and Laryngopharyngeal Reflux

Abstract

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. Methods: 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. Results: We studied 27 patients (14 males, age 51.7 ± 9.1 years, body mass index 32.4 ± 4.2 kg/m 2 ) 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. Conclusions: 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.

Impedance‐pH monitoring profile of patients with reflux and obstructive sleep apnea syndrome: A controlled study

“…The association between pH study and PSG findings was investigated in many studies, 14‐20 which reported controversial results. Some authors observed that patients with severe OSAS had a significant higher number of nocturnal proximal or distal oesophageal events compared with patients with mild OSAS, 14,16,17 while others did not find any association between reflux and OSAS findings 15,18,19,21‐23 . The inconsistencies may result from methodological differences across studies.…”

“…Some authors used dual‐ or triple‐probe pH monitoring to evaluate reflux events and did not consider non‐acid HREs 18,19 . Others only included patients with GERD (distal probe findings) 14,20,23 or oesophagitis 21 . Among studies reporting gastrointestinal findings, the prevalence of patients with GERD or GERD and LPR varied from 38.9% to 100% of cases 14,15,18,20,21 .…”

“…Third, the severity of LPR was evaluated through different patient‐reported outcome questionnaires including different GERD‐related 5,7,15 or laryngopharyngeal 6,14,17,21,22 symptoms. Thus, the comparison of our results with the literature remains limited regarding the use of different clinical outcomes.…”

“…The primary limitations of our study are the low number of patients and the lack of investigation of laryngopharyngeal signs. To date, only a few studies prospectively investigated the relationship between LPR and OSAS through simultaneous pH study and PSG 15,16,18,21,27 . This methodological point is particularly important because the reproducibility of the HEMII‐pH results from one day to the other is not guaranteed.…”

“…compared with patients with mild OSAS, 14,16,17 while others did not find any association between reflux and OSAS findings. 15,18,19,[21][22][23] The inconsistencies may result from methodological differences across studies.…”