Association Between Non-erosive Reflux Disease and High Risk of Obstructive Sleep Apnea in Korean Population

다국어 초록 (Multilingual Abstract)

Background/Aims Obstructive sleep apnea is becoming more important in gastroesophageal reflux disease (GERD) patients. This study investigated the prevalence of high risk for obstructive sleep apnea in GERD patients in comparison with that in healthy controls using the Berlin Questionnaire. We also investigated the risk factors for obstructive sleep apnea in GERD patients.

Methods We enrolled 1,007 subjects: 776 healthy controls, 115 individuals with erosive reflux disease, and 116 with non-erosive reflux disease. GERD was diagnosed and classified using endoscopy and a reflux questionnaire. The Berlin Questionnaire was used to evaluate obstructive sleep apnea.

Results More patients in the GERD group (28.2%) had higher risk for obstructive sleep apnea than healthy controls (20.4%, P = 0.036). More patients with non-erosive disease (32.8%) had higher risk for obstructive sleep apnea (OSA) than patients with erosive disease (20.9%) and controls (20.4%, P = 0.010). On multivariate analysis, non-erosive disease was a high risk factor for obstructive sleep apnea (odds ratio [OR], 1.82; P = 0.011). Age ≥ 55 years (OR, 1.83; P < 0.001) and a high body mass index (≥ 25 kg/m2) (OR, 2.76; P < 0.001) were also identified as risk factors. Nocturnal GERD was related to high risk for OSA in non-erosive disease patients (OR, 2.97; P = 0.019), but not in erosive disease patients.

Conclusions High risk for OSA is more prevalent in GERD patients than in controls. Non-erosive reflux disease, age ≥ 55, and a high BMI are associated with high risk for OSA.

참고문헌 (Reference)

1 Sharma SK, "Validation of the modified Berlin questionnaire to identify patients at risk for the obstructive sleep apnoea syndrome" 124 : 281-290, 2006

2 Netzer NC, "Using the Berlin Questionnaire to identify patients at risk for the sleep apnea syndrome" 131 : 485-491, 1999

3 Kang K, "Usefulness of the Berlin Questionnaire to identify patients at high risk for obstructive sleep apnea: a population-based door-to-door study" 17 : 803-810, 2013

4 Demeter P, "The relationship between gastroesophageal reflux disease and obstructive sleep apnea" 39 : 815-820, 2004

5 Oh JH, "The clinical characteristics of gastroesophageal reflux disease in patients with laryngeal symptoms who are referred to gastroenterology" 26 : 465-469, 2013

6 Ahmadi N, "The Berlin questionnaire for sleep apnea in a sleep clinic population: relationship to polysomnographic measurement of respiratory disturbance" 12 : 39-45, 2008

7 Valipour A, "Symptomatic gastroesophageal reflux in subjects with a breathing sleep disorder" 121 : 1748-1753, 2002

8 Guda N, "Symptomatic gastro-oesophageal reflux, arousals and sleep quality in patients undergoing polysomnography for possible obstructive sleep apnoea" 20 : 1153-1159, 2004

9 Maher MM, "Study of respiratory disorders in endoscopically negative and positive gastroesophageal reflux disease" 16 : 84-89, 2010

10 Yi CH, "Sleep dysfunction in patients with GERD:erosive versus nonerosive reflux disease" 334 : 168-170, 2007

11 Orr WC, "Review article: sleep and its relationship to gastro-oesophageal reflux" 20 (20): 39-46, 2004

12 Gislason T, "Respiratory symptoms and nocturnal gastroesophageal reflux: a population-based study of young adults in three European countries" 121 : 158-163, 2002

13 Wasilewska J, "Respiratory response to proton pump inhibitor treatment in children with obstructive sleep apnea syndrome and gastroesophageal reflux disease" 13 : 824-830, 2012

14 Zamagni M, "Respiratory effort. A factor contributing to sleep propensity in patients with obstructive sleep apnea" 109 : 651-658, 1996

15 Ju G, "Relationships between sleep disturbances and gastroesophageal reflux disease in Asian sleep clinic referrals" 75 : 551-555, 2013

16 Jung-Hwan Oh, "Relationship between Psychological Factors and Quality of Life in Subtypes of Gastroesophageal Reflux Disease" 거트앤리버 발행위원회 3 (3): 259-265, 2009

17 Locke GR 3rd, "Prevalence and clinical spectrum of gastroesophageal reflux: a population-based study in Olmsted County, Minnesota" 112 : 1448-1456, 1997

18 Cho YS, "Prevalence and clinical spectrum of gastroesophageal reflux: a population-based study in Asan-si, Korea" 100 : 747-753, 2005

19 Jung HK, "Overlap of gastro-oesophageal reflux disease and irritable bowel syndrome: prevalence and risk factors in the general population" 26 : 453-461, 2007

20 Ing AJ, "Obstructive sleep apnea and gastroesophageal reflux" 108 (108): 120S-125S, 2000

21 Zimmerman J, "Non-esophageal symptoms cannot differentiate between erosive reflux esophagitis and non-erosive reflux disease in a referred population" 46 : 797-802, 2011

22 Emilsson OI, "Nocturnal gastroesophageal reflux, lung function and symptoms of obstructive sleep apnea: Results from an epidemiological survey" 106 : 459-466, 2012

23 Emilsson ÃsI, "Nocturnal gastro-oesophageal reflux, asthma and symptoms of OSA: a longitudinal, general population study" 41 : 1347-1354, 2013

24 Kerr P, "Nasal CPAP reduces gastroesophageal reflux in obstructive sleep apnea syndrome" 101 : 1539-1544, 1992

25 Green BT, "Marked improvement in nocturnal gastroesophageal reflux in a large cohort of patients with obstructive sleep apnea treated with continuous positive airway pressure" 163 : 41-45, 2003

26 Morse CA, "Is there a relationship between obstructive sleep apnea and gastroesophageal reflux disease?" 2 : 761-768, 2004

27 Harding SM, "Gastroesophageal reflux, asthma, and mechanisms of interaction" 111 (111): 8S-12S, 2001

28 정혜경, "Epidemiology of Gastroesophageal Reflux Disease in Asia: A Systematic Review" 대한소화기 기능성질환∙운동학회 17 (17): 14-27, 2011

29 Lundell LR, "Endoscopic assessment of oesophagitis:clinical and functional correlates and further validation of the Los Angeles classification" 45 : 172-180, 1999

30 De Vries DR, "Concomitant functional dyspepsia and irritable bowel syndrome decrease health-related quality of life in gastroesophageal reflux disease" 42 : 951-956, 2007

31 Jeong JJ, "Chronic gastrointestinal symptoms and quality of life in the Korean population" 14 : 6388-6394, 2008

32 김지연, "Association of Sleep Dysfunction and Emotional Status With Gastroesophageal Reflux Disease in Korea" 대한소화기 기능성질환∙운동학회 19 (19): 344-354, 2013