Associations between obstructive sleep apnea severity and endoscopically proven gastroesophageal reflux disease

Abstract

Obstructive sleep apnea (OSA) is believed to be an important risk factor for gastroesophageal reflux disease (GERD). However, the association between OSA and GERD is not straightforward and has been incompletely characterized. The aim of this study was to assess the relationship between OSA and GERD by performing both polysomnography (PSG) and esophagogastroduodenoscopy (EGD). The enrolled patients underwent both PSG and EGD from October 2003 to July 2015 at Seoul National University Bundang Hospital. All patients were checked for the presence of mucosal injury in the EGD findings and divided into a no-GERD group and a GERD group according to the Los Angeles (LA) classification. In addition, the GERD symptoms of heartburn, acid regurgitation, and reflux-related cough were recorded. A total of 216 patients were enrolled. Ninety-nine patients (45.8%) were in the GERD group, 68 (31.5%) were the minimal-change GERD group, and 49 (22.7%) were in the GERD LA-A/B group. The OSA-related findings were worse in the GERD LA-A/B group than in the no-GERD group: the apnea-hypopnea index was 33.6 +/- 25.5 versus 22.0 +/- 17.2 (p = 0.01), the longest apnea duration was 50.7 +/- 24.0 versus 41.6 +/- 23.3 s (p = 0.03), the lowest oxygen saturation was 80.2 +/- 7.9 versus 83.2 +/- 7.5% (p = 0.02), and the oxygen desaturation index was 25.1 +/- 22.4 versus 16.1 +/- 15.5 (p = 0.01), respectively. Sleep efficiency was significantly worse in patients with GERD symptoms (81.2 +/- 10.8%) than in those without GERD symptoms (85.1 +/- 11.4%) (p = 0.03). Endoscopically proven GERD was associated with more severe OSA. GERD symptoms were also associated with deteriorated sleep quality.