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Correlation of sleep-disordered breathing and laryngopharyngeal reflux: a two-channel triple-sensor pHmetry catheter study

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Abstract

Purpose

To investigate the relationship between sleep-disordered breathing with gastroesophageal reflux (GER) and laryngopharyngeal reflux (LPR) using a two-channel triple-sensor pHmetry catheter.

Methods

The study was carried out on a total of 34 people with complaints of snoring, witnessed apnea and daytime sleepiness. 24-h pH monitoring with a two-channel, triple-sensor antimony pH catheter was applied to individuals simultaneously with polysomnography (PSG) on the day they would sleep in the sleep laboratory. Obstructive sleep apnea syndrome (OSAS) severity and reflux grade were compared with each other. Data obtained from PSG and pHmetry results were numerically compared with each other. The relationship between apnea, hypopnea, and arousal periods and reflux episodes was then examined by overlaying pHmetry graphics for each patient.

Results

A total of 34 individuals (18 males—52.9% and 16 females—47.1%), age ranging from 27 to 71 years (mean 50.5 ± 11.0) participated in the study. GER was detected in 52.9% and LPR in 85.3% of the patients. In 35.3% of cases, pathologic GER was not observed despite LPR detection. No statistically significant relationship was found between the numerical values of apnea–hypopnea index (AHI) and arousal numbers and reflux parameters of individuals and between OSAS severity and LPR and GER (p > 0.05). There was no statistically significant correlation between respiratory events and reflux episodes with regard to timing (p > 0.05).

Conclusion

The prevalence of GER and LPR is found to be high in patients with sleep-disordered breathing. There is no significant relationship between OSAS severity and GER and LPR grade or respiratory events and reflux episodes with regard to timing.

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References

  1. Epstein LJ, Kristo D, Strollo PJ, Friedman N, Malhotra A, Patil SP, Ramar K, Rogers R, Schwab RJ, Weaver EM, Weinstein MD (2009) Adult Obstructive Sleep Apnea Task Force of the American Academy of Sleep Medicine. Clinical guideline for evaluation, management and long term care of obstructive sleep apnea in adults. J Clin Sleep Med 5(3):263–276

    PubMed  Google Scholar 

  2. Chand N, Johnson DA, Tabangin M, Ware JC (2004) Sleep dysfunction in patients with gastro-esophageal reflux disease: prevalence and response to GERD therapy, a pilot study. Aliment Pharmacol Ther 20:969–974

    Article  PubMed  CAS  Google Scholar 

  3. Berry RB, Budhiraja R, Gottlieb DJ, Gozal D, Iber C, Kapur VK, Marcus CL, Mehra R, Parthasarathy S, Quan SF, Redline S, Strohl KP, Davidson Ward SL, Tangredi MM (2012) American Academy of Sleep Medicine. Rules for scoring respiratory events in sleep: update of the 2007 AASM Manual for the Scoring of Sleep and Associated Events. Deliberations of the Sleep Apnea Definitions Task Force of the American Academy of Sleep Medicine. J Clin Sleep Med 8(5):597–619

    PubMed  PubMed Central  Google Scholar 

  4. Koufman JA (1991) The otolaryngologic manifestations of gastroesophageal reflux disease (GERD): a clinical investigation of 225 patients using ambulatory 24-h pH monitoring and an experimental investigation of the role of acid and pepsin in the development of laryngeal injury. Laryngoscope 101:1–78

    Article  PubMed  CAS  Google Scholar 

  5. Lee JS, Heo SJ, Kim JS, Ahn D, Sohn JH, Kim H (2018) Relationship between the severity of laryngopharyngeal reflux and sleep apnea: using drug-induced sleep endoscopy (DISE). Eur Arch Otorhinolaryngol 275(1):219–224

    Article  PubMed  Google Scholar 

  6. Koufman JA, Belafsky PC, Daniel E et al (2002) Prevalence of esophagitis in patients with pH documented laryngopharyngeal reflux. Laryngoscope 112:1606–1609

    Article  PubMed  CAS  Google Scholar 

  7. Mel- SA (2008) Laryngopharyngeal reflux: diagnosis and treatment of a controversial disease. Curr Opin Allergy Clin Immunol 8(1):28–33

    Article  Google Scholar 

  8. Harrell S, Evans B, Goudy S, Winstead W, Lentsch E, Koopman J, Wo JM (2005) Design and implementation of an ambulatory pH monitoring protocol in patients with suspected laryngopharyngeal reflux. Laryngoscope 115(1):89–92

    Article  PubMed  Google Scholar 

  9. Basoglu OK, Vardar R, Tasbakan MS, Ucar ZZ, Ayik S, Kose T, Bor S (2015) Obstructive sleep apnea syndrome and gastroesophageal reflux disease: the importance of obesity and gender. Sleep Breath 19(2):585–592

    Article  PubMed  Google Scholar 

  10. Eryılmaz A, Erişen L, Demir UL, Kasapoglu F, Ozmen OA, Ursavas A, Kıyıcı M, Hızalan I (2012) Management of patients with coexisting obstructive sleep apnea and laryngopharyngeal reflux disease. Eur Arch Otorhinolaryngol 269(12):2575–2580

    Article  PubMed  Google Scholar 

  11. Johnson LF, DeMeester TR (1974) 24 h pH monitoring of the distal esophagus. A quantitive measure of gastroesophgeal reflux. Am J Gastroenterol 62:325–332

    PubMed  CAS  Google Scholar 

  12. Müderris T, Gökcan K, Yorulmaz İ (2009) The clinical value of pharyngeal pH monitoring using a double-probe, triple sensor catheter in patients with laryngopharyngeal reflux. Arch Otolaryngol Head Neck Surg 135:163–166

    Article  PubMed  Google Scholar 

  13. Green BT, Broughton WA, O’Connor BJ (2003) Marked improvement in nocturnal gastroesophageal reflux in a large cohort of patients with obstructive sleep apnea treated with continuous positive airway pressure. Arch Intern Med 163:41–45

    Article  PubMed  Google Scholar 

  14. Morse CA, Quan SF, Mays MZ, Green C, Stephen G, Fass R (2004) Is there a relationship between obstructive sleep apnea and gastroesophageal reflux disease. Clin Gastroenterol Hepatol 2:761–768

    Article  PubMed  Google Scholar 

  15. Zanation AM, Senior BA (2005) The relationship between extraesophageal reflux (EER) and obstructive sleep apnea (OSA). Sleep Med Rev 9:453–458

    Article  PubMed  Google Scholar 

  16. Mizuta Y, Takeshima F, Shikuwa S, Ikeda S, Kohno S (2006) Is there a specific linkage between obstructive sleep apnea syndrome and gastroesophageal reflux disease? Dig Endosc 18:88–97

    Article  Google Scholar 

  17. Wise SK, Wise JC, DelGaudio JM (2006) Gastroesophageal reflux and laryngopharyngeal reflux in patients with sleep-disordered breathing. Otolaryngol Head Neck Surg 135:253–257

    Article  PubMed  Google Scholar 

  18. Harding SM (2007) Gastroesophageal reflux during sleep. Sleep Med Clin 2:41–50

    Article  Google Scholar 

  19. Kusano M, Kouzu T, Kawano T, Ohara S (2008) Nationwide epidemiological study on gastroesophageal reflux disease and sleep disorders in the Japanese population. J Gastroenterol 43:833–841

    Article  PubMed  Google Scholar 

  20. Penzel T, Becker HF et al (1999) Arousal in patients with gastro-esophageal reflux and sleep apnea. Eur Respir J 14:1266–1270

    Article  PubMed  CAS  Google Scholar 

  21. Öztürk Ö, Öztürk L, Özdoğan A, Öktem F, Pelin Z (2004) Variables affecting the occurance of gastroesophageal reflux in obstructive sleep apnea patients. Eur Arch Otorhinolaryngol 261:229–232

    Article  PubMed  Google Scholar 

  22. Berg S, Hoffstein V, Gislason T (2004) Acidification of distal esophagus and sleep-related breathing disturbances. Chest 125:2101–2106

    Article  PubMed  Google Scholar 

  23. Eskiizmir G, Kezirian E (2009) Is there a vicious cycle between obstructive sleep apnea and laryngopharyngeal reflux disease? Med Hypotheses 73:706–708

    Article  PubMed  Google Scholar 

  24. Celik M, Ercan İ (2006) Diagnosis and management of laryngopharyngeal reflux disease. Curr Opin Otolaryngol Head Neck Surg 14:150–155

    PubMed  Google Scholar 

  25. Vaezı MF (2006) Review article: the role of pH monitoring in extraoesophageal gastro oesophageal reflux disease. Aliment Pharmacol Ther 23:40–49

    Article  PubMed  Google Scholar 

  26. Shimazu R, Kusano K, Kuratomi Y, Inokuchi A (2008) Histological changes of the pharynx and larynx in rats with chronic acid reflux esophagitis. Acta Otolaryngol 18:1–7

    Google Scholar 

  27. Dickman R, Green C, Fass SS et al (2007) Relationships between sleep quality and pH monitoring findings in persons with gastroesophageal reflux disease. J Clin Sleep Med 3:505–513

    PubMed  PubMed Central  Google Scholar 

  28. Graf KI, Karaus M, Heinemann S, Kober S, Dorow P, Hampel KE (1995) Gastroesophageal reflux in patients with sleep apnea syndrome. Z Gastroenterol 33:689–693

    PubMed  CAS  Google Scholar 

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Funding

The authors did not take any funding or financial support from any drug manufacturer or anyone else.

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Authors and Affiliations

  1. Department of Otorhinolaryngology, Faculty of Medicine, Bülent Ecevit University, Zonguldak, Turkey

    Duygu Erdem

  2. Department of Otorhinolaryngology, Health Sciences University, Gülhane Faculty of Medicine, Ankara, Turkey

    Yavuz Fuat Yılmaz

  3. Department of Otorhinolaryngology, Numune Training and Research Hospital, Health Sciences University, Ankara, Turkey

    Müge Özcan

  4. Department of Otorhinolaryngology, Acibadem Ankara Hospital, Ankara, Turkey

    Ali Titiz

  5. Department of Otorhinolaryngology, Health Sciences University, Dr. Abdurrahman Yurtaslan Oncology Training and Research Hospital, Ankara, Turkey

    Samet Özlügedik

  6. Department of Otorhinolaryngology, Ekol Hospitals, İzmir, Turkey

    Adnan Ünal

Authors
  1. Duygu Erdem
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  2. Yavuz Fuat Yılmaz
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  3. Müge Özcan
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  4. Ali Titiz
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  5. Samet Özlügedik
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  6. Adnan Ünal
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Correspondence to Duygu Erdem.

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Erdem, D., Yılmaz, Y.F., Özcan, M. et al. Correlation of sleep-disordered breathing and laryngopharyngeal reflux: a two-channel triple-sensor pHmetry catheter study. Eur Arch Otorhinolaryngol 275, 2585–2592 (2018). https://doi.org/10.1007/s00405-018-5107-0

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  • DOI: https://doi.org/10.1007/s00405-018-5107-0

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