GERD (acid reflux) and Sleep Apnea

The following is an article on acid reflux, date and link no longer available:

'Silent' Nighttime Acid Reflux Symptoms Can Cause Poor Sleep And Sleep Apnea

Patients with sleep complaints but no heartburn symptoms suffered episodes of nighttime acid reflux according to research presented at the 70th Annual Scientific Meeting of the American College of Gastroenterology. In a separate study, researchers found that symptoms of gastroesophageal reflux (GER) are common and frequently severe in patients with obstructive sleep apnea.

Patients with gastroesophageal reflux commonly report poor sleep, waking at night because of acid reflux. Some individuals who have respiratory problems exacerbated by acid reflux may frequently be without symptoms of heartburn. In a study of 81 patients with documented sleep complaints at least three nights per week who underwent polysomnographic sleep evaluations, 26 percent had acid reflux. Of those who suffered with reflux, 94 percent of the recorded reflux events were associated with arousal from sleep or awakening.

"These are patients without significant heartburn symptoms, who are experiencing acid reflux during sleep," explained William C. Orr, Ph.D. of Lynn Health Science Institute in Oklahoma City, OK. "'Silent reflux' may be the cause of sleep disturbances in patients with unexplained sleep disorders."

In another study on GERD and sleep presented by researchers at Duke University Medical Center at the ACG Annual Scientific Meeting, GER symptoms were common and frequently severe in 168 patients undergoing sleep studies who reported symptoms consistent with sleep apnea. These patients had frequent daytime and nighttime heartburn symptoms. Those with sleep apnea reported much lower quality of life on a self-administered questionnaire. Those patients with sleep apnea who also reported moderate to severe nighttime GER reported even worse quality of life.

"All patients with sleep apnea should be evaluated for gastroesophageal reflux," said J. Barry O'Connor, M.D., of Duke University Medical Center, one of the investigators.

Link to Medical News Today article
The following is an excerpt from a September 19, 2004 article in Medical News Today. For full article, click on above link:

Sleep Apnea Associated with Stomach Acid Backflow into Throat

Medical researchers have long suspected a relationship between gastro-esophageal reflux disease (GERD) and obstructive sleep apnea (OSA), two medical conditions which can have a deleterious effect on a patient’s quality of life. Now, a team of Canadian researchers has determined that there are significant relationships between laryngopharyngeal reflux (LPR), OSA, and upper airway sensory impairment.

Laryngopharyngeal reflux, or LPR, is the backflow of stomach contents up the esophagus and into the upper airway, whereas GERD includes backflow only into the esophagus. The refluxed stomach contents (refluxate) are primarily composed of acid and activated pepsin, a proteolytic enzyme needed to digest food in the stomach. The damage from this disorder can be extensive. Symptoms of laryngopharyngeal reflux include altered voice, throat clearing, vocal fatigue, and cough, and have been linked to more substantial illnesses including laryngospasm , tightening of the larynx, and glottic carcinoma. This disorder is common in the North American adult population, estimated to affect up to 35 percent of the population 40 years or older.

Obstructive sleep apnea (OSA) affects 4-9 percent of males and 1-4 percent of females in the general population. The authors of this study have identified airway inflammation, a mucosal sensory impairment in the oropharynx (pharynx posterior to the mouth), velopharynx (soft palate), and larynx (voice box) of OSA patients, using endoscopic sensory testing. Correlations between the level of laryngeal sensory impairment and apnea severity strongly suggest that this sensory impairment plays a role in the functioning of OSA.