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Relationships Between Sleep Quality and pH Monitoring Findings in Persons with Gastroesophageal Reflux Disease

Posted Sep 11 2009 4:58pm

Gastroesophageal reflux disease (GERD) is very common, affecting up to 44% of the adult U.S. population monthly and 20% weekly. Classic GERD symptoms include heartburn and acid regurgitation; these symptoms are common during the day and may also awaken subjects from sleep during the night.

Nocturnal GERD symptoms have been shown to affect quality of sleep and subsequent daytime function. Quality of sleep in persons with GERD may also be affected by acid reflux-related short arousals, for which the person is commonly amnestic, but these arousals lead to sleep fragmentation.

Heartburn that awakens patients during sleep affects approximately 25% of the general U.S. population >40 years of age. A recent national survey in subjects with heartburn symptoms demonstrated that 79% of the respondents reported having symptoms at night. Of those, 63% reported that their symptoms affected their ability to get a good night's sleep, 75% reported that symptoms kept them from falling asleep or woke them up during sleep, and 40% indicated that heartburn had some effect on their ability to function well at work the next day.

Daytime reflux events tend to be more frequent and of shorter duration than those during sleep. Reflux events during sleep differ from those during the day as the result of physiological changes that occur with the onset of sleep. These physiological changes include marked decline in the frequency of swallowing events resulting in reduced primary peristalsis and consequently in reduced delivery of saliva to the distal portion of the esophagus, loss of gravitational drainage, slower gastric emptying, and diminished conscious perception of gastroesophageal reflux events.

These sleep related changes may lead to delayed esophageal acid clearance and as a result, increased acid-mucosal contact time. Thus, there is considerable evidence to indicate that GERD can affect normal sleep physiology, and cause sleep disturbances and poor quality of sleep. Conversely, it is also possible that disturbed sleep enhances perception of intra-esophageal reflux events, perhaps through centrally-mediated mechanisms. However, evidence supporting such a hypothesis is lacking. Read More.......

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