Sleep disorders in patients with gastroesophageal reflux disease: an open clinical and pH metric prospective study

ABSTRACT

Sleep disorders are frequent in patients with GERD. Severity of sleep disorders could be related to occurrence of nighttime symptoms, but the relationship between severity of GERD and the severity of sleep disorders is not well established. To identify the frequency of sleep disorders in patients with suspected GERD and the correlation between the severity of sleep disorders and pH metric parameters in these patients. We studied prospectively 50 patients with esophageal and supra-esophageal symptoms of GERD. 24-hour esophageal pH monitoring examination was performed in all patients. Standard survey was applied to determine the frequency and the severity of sleep disorders in these patients. We included 50 patients [10 men, 40 women], mean age 43.7 years [18-70]. Nighttime symptoms were present in 26 patients [52%]. Pathological acid gastro-esophageal reflux was diagnosed by 24-hour esophageal pH recording in 18 patients [36%], with nocturnal acid reflux in 19 patients [38%]. Sleep disorders were reported by 29 patients [58%]. Mean number of hours of sleep was 6.8 hours by night [4-9 hours]. Clinical factors associated with higher frequency of sleep disorders were occurrence of nighttime symptoms [p<0.0001] and duration of symptoms of GERD [53.2 +/- 41.4 months vs 26.0 +/- 18.1 months; p = 0.007], with no association with BMI, age and sex. pHmetric parameters associated with sleep disorders were pathological acid reflux [p<0.0001; OR [C195%]28.3 [3.3-240.8]] and nocturnal acid reflux p<0.0001; OR[C195%132.7 [3.8-279.2]]. Patients with sleep disorders had significant changes of pHmetric parameters compared to those without sleep disorders Acid exposition time, numbers of reflux episodes, number of episodes longest than five minutes, duration of longest reflux episode and DeMeester score [respectively 6.1 +/- 8.8 vs 1.3 +/- 1.5 p = 0.01; 59.2 +/- 52.0 vs 20.7 +/- 21.6 p = 0.001; 3.1 +/- 6.1 vs 0.1 +/- 0.3 p = 0.03; 8.9 +/- 9.3 minutes vs 3.4 +/- 4.0 minutes p = 0.01; 24.0 +/- 33.2 vs 4.8 +/- 4.9 p = 0.01]. Number of hours of sleep was significantly lower in patients with pathological acid reflux [5.3 +/- 1.2 hours vs 7.6 +/- 1.7 hours, p<0.0001] and in patients with nocturnal acid reflux [5.2 +/- 1.1 hours vs 7.8 +/- 1.5 hours, p<0.0001]. Number of hours of sleep was strongly correlated with esophageal pH parameters Sleep disorders are frequent in patients with GERD symptoms. Severity of sleep disorders are strongly correlated with severity of global and nocturnal acid reflux as attested by 24-hour esophageal pH monitoring