Very preliminary research conducted by Dr. Brian Mulhall appears to indicate that people that suffer from gastroesophageal reflux disease (GERD) frequently experience sleep disorders. 48 million of the 60 million Americans that have been diagnosed with GERD report that their symptoms get worse in the evening and that it interferes with their sleep.
The exact relationship between sleep apnea and GERD is not yet understood, but there are some theories. One is that obstructive sleep apnea causes changes in airway pressure that can cause reflux to occur. Another is that the reflux acids result in vocal cord spasms that can lead to sleep apnea.
Dr. Mulhall, from the Gastroenterology Service at Walter Reed Army Medical Center in Washington, D.C. recently presented his findings at the 68th annual scientific meeting of the American College of Gastroenterology.
To date his team has studied 50 adults, 30 of whom had been diagnosed with sleep apnea, 10 of which also have GERD. Using a chi-squared test and intraclass correlation coefficients, the researchers found that a third of the patients with sleep apnea experienced “substantial” nighttime reflux.
Dr. Mulhall plans to study 280 patients in the next phase of is research. He will include evaluations that measures all of the contents that flow into the esophagus including non-acidic liquids that may produce fewer symptoms.
This is important because if the next phase of his research does show a stronger association between sleep apnea and any type of refluxed material, doctors may be better able to help prevent possible esophageal damage in patients not previously recognized to be at increased risk. For instance, it could be the amount of liquids that are regurgitated, not necessarily its acidity level.
Those patients with GERD will then be put into a randomized study to receive either antireflux medication such as a proton pump inhibitor or placebo, as well as continuous positive airway pressure (CPAP), to see if symptoms improve.
“Many patients with obstructive sleep apnea have no symptoms of heartburn,” said Dr. Mulhall. “In the next phase of this study, we will be evaluating whether these patients are having more esophageal injuries than other people with reflux.”
“Many patients with obstructive sleep apnea have no symptoms of heartburn,” Mulhall says. “What we will be doing is to evaluate whether these patients are having more esophageal injuries than are expected. It may turn out that if you have obstructive sleep apnea, you need to be examined for reflux — even if you have no symptoms of GERD.”
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