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 17 January 2018

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News

Acid suppression improves sleep in minimally symptomatic GERD patients

This month's Digestive Diseases and Sciences examines GERD as an etiology of sleep disturbance in subjects with insomnia and minimal reflux symptoms.

News image

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Gastroesophageal reflux disease (GERD) is a well-recognized cause of impaired sleep in patients with frequent GERD symptoms, as well as those with sleep apnea.

GERD's role in sleep disturbance of minimally symptomatic patients with poor sleep quality is less clear.

After 2 weeks of treatment, 19% had normalization of sleep efficiency
Journal Digestive Diseases and Sciences

Dr Nicholas Shaheen and colleagues from North Carolina, USA explored the prevalence of GERD-related sleep disturbance in minimally-symptomatic subjects with demonstrated insomnia.

The research team assessed the changes in sleep efficiency in these subjects after vigorous acid suppression.

The team recruited subjects aged 18 to 75 years reporting at least 6 months of insomnia, and sleep difficulty at least 3 nights per week.

Subjects with a body mass index over 30, a history of snoring or ongoing use of proton pump inhibitor or H2 receptor antagonist were excluded.

The team reported that subjects underwent concurrent a sleep study with a dual channel 24-hour pH study.

Sleep efficiency was defined as the percentage of time after sleep initiation that the subject actually slept.

Spontaneous arousal index, defined as the number of arousals per hour, were calculated.

Patients demonstrating poor sleep quality had a sleep efficiency of less than 83%, and more than 10 arousals per hour for those aged under 45 years, and more than 15 for those who were 45 or older.

Patients with poor sleep quality and no obstructive sleep apnea were treated with oral rabeprazole 20 mg BID for 14 days.

The researchers reported that after 14 days, the subjects underwent repeat sleep study with pH monitoring.

The GERD Symptom Assessment Scale, the Epworth Sleepiness Scale, and the Functional Outcomes of Sleep Questionnaire were administered to subjects at study inception and after 2 weeks of therapy.

The researchers enrolled 24 subjects reporting insomnia, and 20 met criteria for disordered sleep and no obstructive sleep apnea.

The team noted that 17 patients completed both the first and second studies, and 16 were adequate for analysis.

Baseline Symptom Assessment Scale demonstrated trivial or no reflux symptoms in the cohort.

No subject scored more than 8 out of 45 on Symptom Assessment Scale, corresponding to a median rating of reflux symptoms of ‘not at all'.

The research team observed that 25% of patients demonstrated abnormal pH studies at baseline.

All of these patients had normalization of acid exposures on proton pump inhibitor.

The team noted that after 2 weeks of treatment, 19% had normalization of sleep efficiency.

However, 33% of patients with normal Johnson-DeMeester scores had normalization of sleep efficiency after 2 weeks of treatment.

Repeated measures analysis showed significant improvement in spontaneous arousal index between the first and second study for the whole group.

Pre- and post-therapy Epworth Sleepiness Scale, and Functional Outcomes of Sleep Questionnaire scores were not significantly different.

Dr Shaheen's team concluded, "Despite the lack of GERD symptoms, a significant minority of subjects with sleep disturbance have abnormal acid exposures."

"These preliminary data suggest that aggressive treatment of GERD in such patients may result in improvement in sleep efficiency."

Dig Dis Sci 2008: 53(6): 1493-9
12 May 2008

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