Gastroesophageal Reflux in Patients with Morbid Obesity: A Role of Obstructive Sleep Apnea Syndrome?
Rent the article at a discountRent now
* Final gross prices may vary according to local VAT.Get Access
Obesity is a risk factor for gastroesophageal reflux disease (GERD) and for obstructive sleep apnea (OSA). Our aim was to evaluate in morbidly obese patients the prevalence of OSA and GERD and their possible relationship.
Morbidly obese patients [body mass index (BMI) >40 or >35 kg/m2 in association with comorbidities] selected for bariatric surgery were prospectively included. Every patient underwent a 24-h pH monitoring, esophageal manometry, and nocturnal polysomnographic recording.
Sixty-eight patients [59 women and 9 men, age 39.1 ± 11.1 years; BMI 46.5 ± 6.4 kg/m2 (mean ± SD)] were included. Fifty-six percent of patients had an abnormal Demester score, 44% had abnormal time spent at pH <4, and 80.9% had OSA [apnea hypopnea index (AHI) >10] and 39.7% had both conditions. The lower esophageal sphincter (LES) pressure was lower in patients with GERD (11.6 ± 3.4 vs 13.4 ± 3.6 mm Hg, respectively; P = 0.039). There was a relationship between AHI and BMI (r = 0.337; P = 0.005). Patients with OSA were older (40.5 ± 10.9 vs 33.5 ± 10.4 years; P = 0.039). GERD tended to be more frequent in patients with OSA (49.1% vs 23.1%, respectively; P = 0.089). There was no significant relationship between pH-metric data and AHI in either the 24-h total recording time or the nocturnal recording time. In multivariate analysis, GERD was significantly associated with a low LES pressure (P = 0.031) and with OSA (P = 0.045) but not with gender, age, and BMI.
- Dent J, El Serag HB, Wallander MA, et al. Epidemiology of gastro-oesophageal reflux disease: a systematic review. Gut. 2005;54:710–7. CrossRef
- Bretagne JF, Richard-Molard B, Honnorat C, et al. Gastroesophageal reflux in the French general population: national survey of 8000 adults. Presse Med. 2006;35:23–31. CrossRef
- Basdevant A. Obesity: epidemiology and public health. Ann Endocrinol (Paris). 2000;61 Suppl 6:6–11.
- Jacobson BC, Somers SC, Fuchs CS, et al. Body-mass index and symptoms of gastroesophageal reflux in women. N Engl J Med. 2006;354:2340–8. CrossRef
- Wajed SA, Streets CG, Bremner CG, et al. Elevated body mass disrupts the barrier to gastroesophageal reflux. Arch Surg. 2001;136:1014–9. CrossRef
- Merrouche M, Sabate JM, Jouet P, et al. Gastro-esophageal reflux and esophageal motility disorders in morbidly obese patients before and after bariatric surgery. Obes Surg. 2007;17:894–900. CrossRef
- Malhotra A, White DP. Obstructive sleep apnoea. Lancet. 2002;360:237–45. CrossRef
- Vgontzas AN, Tan TL, Bixler EO, et al. Sleep apnea and sleep disruption in obese patients. Arch Intern Med. 1994;154:1705–11. CrossRef
- Frey WC, Pilcher J. Obstructive sleep-related breathing disorders in patients evaluated for bariatric surgery. Obes Surg. 2003;13:676–83. CrossRef
- Samelson CF. Gastroesophageal reflux and obstructive sleep apnea. Sleep. 1989;12:475–6.
- Bortolotti M, Gentilini L, Morselli C, et al. Obstructive sleep apnoea is improved by a prolonged treatment of gastrooesophageal reflux with omeprazole. Dig Liver Dis. 2006;38:78–81.
- Orr WC, Heading R, Johnson LF, et al. Review article: sleep and its relationship to gastro-oesophageal reflux. Aliment Pharmacol Ther. 2004;20 Suppl 9:39–46. CrossRef
- Chitturi S, Abeygunasekera S, Farrell GC, et al. NASH and insulin resistance: insulin hypersecretion and specific association with the insulin resistance syndrome. Hepatology. 2002;35:373–9. CrossRef
- Armstrong D, Bennett JR, Blum AL, et al. The endoscopic assessment of esophagitis: a progress report on observer agreement. Gastroenterology. 1996;111:85–92. CrossRef
- Johnson LF, DeMeester TR. Development of the 24-hour intraesophageal pH monitoring composite scoring system. J Clin Gastroenterol. 1986;8 Suppl 1:52–8. CrossRef
- Lavie P, Herer P, Hoffstein V. Obstructive sleep apnoea syndrome as a risk factor for hypertension: population study. BMJ. 2000;320:479–82. CrossRef
- Suter M, Dorta G, Giusti V, et al. Gastro-esophageal reflux and esophageal motility disorders in morbidly obese patients. Obes Surg. 2004;14:959–66. CrossRef
- O’Keeffe T, Patterson EJ. Evidence supporting routine polysomnography before bariatric surgery. Obes Surg. 2004;14:23–6. CrossRef
- Jouet P, Sabate JM, Maillard D, et al. Relationship between obstructive sleep apnea and liver abnormalities in morbidly obese patients: a prospective study. Obes Surg. 2007;17:478–85. CrossRef
- Spitzer AR, Boyle JT, Tuchman DN, et al. Awake apnea associated with gastroesophageal reflux: a specific clinical syndrome. J Pediatr. 1984;104:200–5. CrossRef
- Valipour A, Makker HK, Hardy R, et al. Symptomatic gastroesophageal reflux in subjects with a breathing sleep disorder. Chest. 2002;121:1748–53. CrossRef
- Kim HN, Vorona RD, Winn MP, et al. Symptoms of gastro-oesophageal reflux disease and the severity of obstructive sleep apnoea syndrome are not related in sleep disorders center patients. Aliment Pharmacol Ther. 2005;21:1127–33. CrossRef
- Graf KI, Karaus M, Heinemann S, et al. Gastroesophageal reflux in patients with sleep apnea syndrome. Z Gastroenterol. 1995;33:689–93.
- Penzel T, Becker HF, Brandenburg U, et al. Arousal in patients with gastro-oesophageal reflux and sleep apnoea. Eur Respir J. 1999;14:1266–70. CrossRef
- Morse CA, Quan SF, Mays MZ, et al. Is there a relationship between obstructive sleep apnea and gastroesophageal reflux disease? Clin Gastroenterol Hepatol. 2004;2:761–8. CrossRef
- Senior BA, Khan M, Schwimmer C, et al. Gastroesophageal reflux and obstructive sleep apnea. Laryngoscope. 2001;111:2144–6. CrossRef
- Kerr P, Shoenut JP, Millar T, et al. Nasal CPAP reduces gastroesophageal reflux in obstructive sleep apnea syndrome. Chest. 1992;101:1539–44. CrossRef
- Green BT, Broughton WA, O’Connor JB. 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. 2003;163:41–5. CrossRef
- Ing AJ, Ngu MC, Breslin AB. Obstructive sleep apnea and gastroesophageal reflux. Am J Med. 2000;108 Suppl 4a:120S–5S. CrossRef
- Demeter P, Visy KV, Magyar P. Correlation between severity of endoscopic findings and apnea–hypopnea index in patients with gastroesophageal reflux disease and obstructive sleep apnea. World J Gastroenterol. 2005;11:839–41.
- Ozturk L, Pelin Z. Is the severity of obstructive sleep apnea or the magnitude of respiratory effort associated with gastroesophageal reflux? World J Gastroenterol. 2005;11:4769.
- Grunstein RR, Stenlof K, Hedner JA, et al. Two year reduction in sleep apnea symptoms and associated diabetes incidence after weight loss in severe obesity. Sleep. 2007;30:703–10.
- Haines KL, Nelson LG, Gonzalez R, et al. Objective evidence that bariatric surgery improves obesity-related obstructive sleep apnea. Surgery. 2007;141:354–8. CrossRef
- Gastroesophageal Reflux in Patients with Morbid Obesity: A Role of Obstructive Sleep Apnea Syndrome?
Volume 18, Issue 11 , pp 1479-1484
- Cover Date
- Print ISSN
- Online ISSN
- Additional Links
- Morbid obesity
- 24-h pH monitoring
- Industry Sectors
- Author Affiliations
- 1. Assistance Publique - Hôpitaux de Paris (AP-HP), Hôpital Louis Mourier, Service d’Hépato-Gastroentérologie, Université Paris 7, 178 rue des Renouillers, 92700, Colombes Cedex, France
- 2. Assistance Publique - Hôpitaux de Paris (AP-HP), Hôpital Louis Mourier, Service des Explorations Fonctionnelles, Université Paris 7, 178 rue des Renouillers, 92700, Colombes Cedex, France
- 3. Assistance Publique - Hôpitaux de Paris (AP-HP), Hôpital Louis Mourier, Service de Chirurgie viscérale, Université Paris 7, 178 rue des Renouillers, 92700, Colombes Cedex, France