The Effect of Acid Suppression on Upper Airway Anatomy and Obstruction in Patients with Sleep Apnea and Gastroesophageal Reflux Disease

摘要: Gastroesophageal reflux disease (GERD) and obstructive sleep apnea syndrome (OSAS) are often comorbid disorders.1–3 OSAS is a condition marked by pharyngeal narrowing, resulting in upper airway obstruction during sleep, which, turn, produces repeated episodes of decreased oxygen saturation brief arousals from sleep. It well recognized clinically that patients with complain heartburn, they clearly share major overlapping risk factor, which obesity. In one investigation, the referred for overnight studies, 74% reported GERD-related symptoms, including acid regurgitation, or both.2 Other studies have also shown significant increase symptoms demonstrated OSAS.1,4 The incidence these ranges 62% to 74%. another study, whose was successfully treated continuous positive pressure (CPAP) had improvement nighttime reflux, compared those who were noncompliant did not use CPAP.1 In study utilized polysomnography concurrent distal esophageal pH monitoring, Ing colleagues5 found exhibited more frequent nocturnal than similar very mild OSAS. this same study,5 clearance prolonged significantly greater proportion time at an < 4.0. Similar results Berg et al.,6 concluded events causally linked but may be consequence coexisting pathology. interest CPAP treatment itself will lower percentage contact.7 Another has powerful inhibition proton pump inhibitor (pantoprazole) markedly improve sleepiness documented OSAS.8 Senior al.3 GERD via 24- hour monitoring reduce apnea-hypopnea index (AHI). However, it should noted consisted only 10 patients, 3 actually responded treatment. authors conclude further investigation necessary establish whether reducing gastroesophageal (GER) alter airway, reduction obstruction. Thus, appears common substantially improved treating events. remains determined definitely suppressing GER improves anatomy, physiology, both anatomy physiology way could result events. In present we undertaken evaluation selected 24-hour recording GERD. We hypothesized objective evidence would number accompanied improvements quality. Patients subjected suppression (ie, rabeprazole 20 mg, twice day) 2 months. assessed laryngoscopy, as full before after suppression.