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Mechanisms of nocturnal gastroesophageal reflux events in obstructive sleep apnea

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Abstract

Purpose

Obstructive sleep apnea (OSA) is associated with increased nocturnal gastroesophageal reflux (nocturnal GER) events and symptoms. Treatment of OSA with continuous positive airway pressure (CPAP) reduces nocturnal GER in patients with OSA. This study sought to determine the: (1) relationship of nocturnal GER events with apnea/hypopnea and arousal, (2) effect of upper airway obstruction on the barrier function of the lower esophageal sphincter (LES), (3) mechanism of LES failure for each nocturnal GER event and (4) effect of CPAP on LES function during sleep.

Methods

Eight patients with OSA and nocturnal GER underwent polysomnography with esophageal manometry and pH monitoring. The first half of the night was spent without CPAP and the second half with 10 cmH2O CPAP.

Results

Baseline LES barrier pressure (P b) was low in these patients. When patients were off CPAP, there were 2.7 ± 1.8 nocturnal GER events per hour and 70 ± 39 obstructive respiratory events per hour. There was no direct relationship between the occurrence of GER and obstructive events. While upper airway obstruction did not alter P b, CPAP tended to increase the nadir P b during LES relaxation (LESR) and decreased the duration of LESR.

Conclusions

Upper airway obstructive and nocturnal GER events are not directly related. The relatively low P b in these OSA patients raises the possibility of weakening of the gastroesophageal junction from repetitive strain associated with obstructed breathing events. The favourable effect of CPAP on nocturnal GER is possibly due to an increase in nadir P b and decrease in the duration for which the LES relaxes during swallow-induced and transient LESR.

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Acknowledgements and disclosures

The authors would like to thank the staff of the Respiratory Sleep Disorders Clinic at Sir Charles Gairdner Hospital for their assistance in this study. In particular, Sue Tanner and Marie-Therese Hunter are thanked for their help in polysomnographic analysis. Peter Eastwood is supported by a National Health and Medical Research Council Fellowship (No. 513705). This project was supported by the Sir Charles Gairdner Hospital Research Foundation.

Conflicts of interest

The authors declare that they have no conflict of interest.

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Authors and Affiliations

  1. West Australian Sleep Disorders Research Institute, Department of Pulmonary Physiology, Sir Charles Gairdner Hospital, Nedlands, 6009, Australia

    Kelly Shepherd, David Hillman & Peter Eastwood

  2. School of Anatomy and Human Biology, University of Western Australia, Crawley, 6009, Australia

    Kelly Shepherd & Peter Eastwood

  3. Department of Gastroenterology and Hepatology, Royal Adelaide Hospital, Adelaide, 5000, Australia

    Richard Holloway

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  1. Kelly Shepherd
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Correspondence to Peter Eastwood.

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Shepherd, K., Hillman, D., Holloway, R. et al. Mechanisms of nocturnal gastroesophageal reflux events in obstructive sleep apnea. Sleep Breath 15, 561–570 (2011). https://doi.org/10.1007/s11325-010-0404-x

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  • DOI: https://doi.org/10.1007/s11325-010-0404-x

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