SLEEP MICROSTRUCTURE IN PATIENTS WITH GASTROESOPHAGEAL REFLUX AND OSAS

Introduction: Recent observations underline the importance of nocturnal gastroesofageal reflux (GER) and its possible correlations with obstructive sleep apnea sindrome (OSAS). However, polysomnographic (PSG) data on the interactions between the two diseases and their effects on sleep structure are scarce. Aim of this work is to evaluate cyclic alternating pattern (CAP) and the characteristics of GER episodes in patients with and without OSAS and correlations between different kinds of events. Methods: Seventeen consecutive patients with a clinical history suitable for OSAS and GER syndrome were enrolled in the study. All patients underwent nocturnal PSG recording and a simultaneous esophageal pH monitoring. After PSG evaluation, patients were divided in OSAS (6 male subjects, mean age: 53,3 ± 11,7 yrs.) and 11 non-OSAS (6 males and 5 female, mean age: 52,6 ± 9,3 yrs.). Beside conventional PSG and pHmetric variables and their correlations, CAP parameters were measured and temporal correlations between apneas, refluxes and microstructural modifications were examined. Results: Non-OSAS patients presented reflux episodes during wakefulness, while OSAS patients mostly during sleep with a significant association with CAP. Recorded refluxes were longer if associated to non CAP sleep as compared to CAP and in OSAS patients as compared to non OSAS patients. Reflux events provoked an increase of CAP rate during episodes. Ninety-three percent of the reflux episodes were temporally related to respiratory events in OSAS patients Conclusion: Our data suggest that CAP could play a major role in sleep modifications due to gastroesophageal reflux, but also in the modulation of GER itself. The utility of different approaches to evaluate sleep in this kind of pathology is underlined.