Advances in Technology Allow for Better Understanding of GERD-Sleep Connection

Advances in diagnostic technology are providing new insights into the link between gastroesophageal reflux disease (GERD) and obstructive sleep apnea (OSA), according to the authors of a new research review.

GERD is more common among patients with OSA than among the general US population (75% vs 14% report nocturnal reflux symptoms). This correlation has become easier to study with advances in diagnostic technology.

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For example, the sampling rate of esophageal probes is now quicker. While the rate used to be every 5 seconds, it is now understood that a second-by-second analysis is needed to get a better grasp for the connection between reflux and sleep events.

Further, researchers are getting away from using patient-reported data, which will strengthen accuracy, heighten the predictive value for clinical research purposes, and lower the underreporting of time documentation.

Now that technological advances in diagnostics are more clearly showing a correlation, the authors include several hypotheses for the proposed casual links between sleep and GERD.

For example, the authors of the review suggest that changes in intrathoracic and abdominal pressures secondary to OSA cause GERD. This hypothesis is supported by the fact that GERD is improved with continuous positive airway pressure therapy.

In determining a way to reduce nocturnal GERD symptoms and improve subjective sleep quality, the authors said that proton-pump inhibitor (PPI) therapy can help. However, the therapy does not improve objective sleep parameters in OSA.

“Recognition is important regarding the limitations of PPI therapy in controlling all nocturnal reflux,” the authors wrote. “The importance of weakly acidic reflux and nocturnal acid breakthrough of patients with persistent symptoms warrants investigation with objective testing using pH impedance probes.”

“Lack of gold standard data that define and establish cause-and-effect in patients with OSA and [GERD] should give pause to the use of more aggressive GERD therapy, such as fundoplication, for these patients.”

—Colleen Murphy

Reference:

Lim KG, Morgenthaler TI, Katzka DA. Sleep and nocturnal gastroesophageal reflux: an update. CHEST. 2018;154(4):963-971. https://doi.org/10.1016/j.chest.2018.05.030.