Clinical ReviewThe relationship between extraesophageal reflux (EER) and obstructive sleep apnea (OSA)
Section snippets
Purpose
The purpose of this review is to understand the association between obstructive sleep apnea (OSA) and extraesophageal reflux disease (EER) in the adult population. We will attempt to answer three main questions:
- 1.
What is the association between OSA and EER, and is there any evidence for a cause and effect relationship?
- 2.
Does the treatment of OSA by positive airway pressure improve EER symptoms?
- 3.
Does the treatment of EER by acid inhibition improve OSA symptoms?
What is the association between OSA and EER?
In a large national survey evaluating the presence of nocturnal GERD (nGER) and its effect on quality of life, 10% of respondents reported symptoms of nGER.7 This is in sharp contrast to the prevalence of nGER in OSA patients. The frequency of nGER in OSA patients ranges from 54 to 76% (reviewed in16). In a recent prospective study of 331 OSA patients, nGER was present in 62% before the start of continuous positive airway pressure (CPAP) treatment.16 Also, a small study of OSA and control
Does the treatment of OSA by positive airway pressure improve EER symptoms?
While it is not obvious why the treatment of OSA by positive pressure would improve EER, there is one prevailing hypothesis of why this may be true. As negative intrathoracic pressure is generated through inspiration, these negative pressures are transmitted to the intrathoracic esophagus. In OSA, the obstruction events cause higher negative pressure gradients to develop than normal physiology. This may allow for lower esophageal resistance to EER and it may allow for increased lower esophageal
Does treatment of EER improve OSA severity?
Given the high prevalence of GERD in OSA patients, it is hypothesized that acid exposure has a significant impact on the mucosa of the upper airway. Lower pH exposure in the upper airway may cause significant edema and tissue inflammation; this may in turn worsen the obstructive physiology of the upper airway. It makes biologic sense that treatment of EER could reduce OSA severity. A few small trials have attempted to evaluate this (Table 2); however, all of these should be considered
Acknowledgements
Special thanks to Farhad Ardeshirpour, UNC medical student, for help in preparation of this manuscript.
References* (24)
- et al.
Prevalence and clinical spectrum of gastroesophageal reflux: a population based study in Olmsted County, Minnesota
Gastroenterology
(1997) - et al.
Nasal CPAP reduces gastroesophageal reflux in obstructive sleep apnea syndrome
Chest
(1992) - et al.
Aspiration of solid food particles into lungs of patients with gastroesophageal reflux and chronic bronchial disease
Chest
(1988) - et al.
Symptomatic gastroesophageal reflux in subjects with a breathing sleep disorder
Chest
(2002) - et al.
Obstructive sleep apnea and gastroesophageal reflux
Am J Med
(2000) - et al.
Prospective study of the association between sleep-disordered breathing and hypertension
N Engl J Med
(2000) - et al.
Longer term survival of patients with obstructive sleep apnea treated with uvulopalatopharyngoplasty or nasal CPAP
Chest
(1994) - et al.
The occurrence of sleep-disordered breathing among middle-aged adults
N Engl J Med
(1993) - et al.
Sleep apnea and hypertension, a population based study
Ann Intern Med
(1994) - et al.
Association of sleep-disordered breathing, sleep apnea, and hypertension in a large community-based study. Sleep Heart Health Study
JAMA
(2000)
The impact of nocturnal symptoms associated with gastroesophageal reflux disease on health related quality of life
Arch Intern Med
Awake apnea associated with gastroesophageal reflux: a specific clinical syndrome
J Pediatr
Cited by (66)
Effects of Obstructive Sleep Apnea on Airway Immunity and Susceptibility to Respiratory Infections
2024, Sleep Medicine ClinicsRelationship between reflux diseases and obstructive sleep apnea together with continuous positive airway pressure treatment efficiency analysis
2020, Sleep MedicineCitation Excerpt :Since both OSA and GERD show similar risk factors such as obesity, male predominance, alcohol usage, and age [3,4]. Another reason is that one may aggravate the other and both of them may benefit from the same therapy [5–10]. Laryngopharyngeal reflux disease (LPRD) is an inflammatory reaction of the mucous membrane of pharynx or larynx that results from the contents of stomach reflux [11], which affects approximately 10–15% of outpatients in the otorhinolaryngology department [12].
Is Maxillomandibular Advancement Associated With Comorbidity Reduction in Patients With Obstructive Sleep Apnea?
2019, Journal of Oral and Maxillofacial SurgerySigns and symptoms of obstructive sleep apnea and upper airway resistance syndrome
2019, Sleep Apnea and Snoring: Surgical and Non-Surgical TherapyThe clinical value of the RGB value of an image of the interarytenoid area for diagnosis of laryngopharyngeal reflux
2018, American Journal of Otolaryngology - Head and Neck Medicine and Surgery
- *
The most important references are denoted by an asterisk.