Gastroesophageal reflux associated with respiratory abnormalities during sleep.
To determine whether gastroesophageal reflux (GER) might be a factor in the pathogenesis of apnea in certain infants, we analyzed the frequency of prolonged central apnea (greater than 15 s) and of numerous irregularly repeated short apneas (5-15 s) ("respiratory dysfunction") in infants with an apparent life-threatening event (ALTE) (group 1, n = 62), in control infants (group 2, n = 387), and in infants with GER pathologic findings (group 3, n = 60). Finally, the incidence of GER was analyzed in 76 infants with a respiratory dysfunction during sleep (group 4). Gastroesophageal reflux was investigated using 24-h esophageal pH monitoring; respiration during sleep was investigated by polysomnography. The pH monitoring data and results of sleep investigation were analyzed in a double-blind study. A great number of infants who had an ALTE appeared to suffer from GER (42%, 26 of 62 infants), especially if the ALTE occurred while the infant was awake (52%, 14 of 27 infants). In the control infants, pH monitoring data were abnormal in 8.5%; respiratory dysfunction was observed in 5%. In those with a respiratory dysfunction, GER was detected in 75% (15 of 20 infants). In those with GER, respiratory dysfunction was observed in 45% (15 of 33 infants). In groups 3 and 4, respiratory dysfunction was associated with abnormal pH data in 40-43%. If, in the infants with a respiratory dysfunction, the GER pathologic symptoms were treated efficiently (normalization of pH data), respiratory dysfunction disappeared in 92%.(ABSTRACT TRUNCATED AT 250 WORDS)
Academisch Ziekenhuis Kinderen, Vrije Universiteit Brussel, Belgium.
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L
Sacré
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Y
Vandenplas
D004947:Esophagus; D005764:Gastroesophageal Reflux / Q000150:complications / Q000503:physiopathology*; D006801:Humans; D006863:Hydrogen-Ion Concentration; D007223:Infant; D007231:Infant, Newborn; D008991:Monitoring, Physiologic; D012120:Respiration Disorders / Q000209:etiology / Q000503:physiopathology*; D012891:Sleep Apnea Syndromes / Q000209:etiology / Q000503:physiopathology*