Nap studies underestimate the incidence of gastroesophageal reflux.
Shorter nap (1 and 4 hr) pH studies inaccurately diagnosed gastroesophageal reflux (GER) in a group of infants evaluated for apparent life threatening events (ALTE) and recurrent apnea. Twenty-five infants with a postconceptional age of 42 +/- 8 SD weeks, were evaluated by 12-hr polysomnography (PSG). Prior to the start of the 12-hr study, a 1-hr Tuttle Test was performed. By means of the 12-hr study 11 infants were diagnosed as having GER while the Tuttle Test incorrectly diagnosed 6 infants, 5 as having no GER and 1 as having GER when no GER was present (P < 0.05). No differences in the amount of periodic breathing (PB) or apnea density (AD) were found between the two studies. In addition, the first 4 hr of the 12-hr PSG segment following the first feeding was evaluated separately. In the 4-hr segment, two of the infants were incorrectly diagnosed as not having GER. In this study, nap studies failed to diagnose all of the infants with GER. Therefore, we conclude that an infant cannot be accurately diagnosed as not having GER without prolonged pH recording.
Department of Pediatrics, Jersey Shore Medical Center, Neptune, NJ 07754.
M A
MA
Graff
F
F
Kashlan
M
M
Carter
K
K
Rovell
D G
DG
Ramos
D005260:Female; D005764:Gastroesophageal Reflux / Q000150:complications / Q000175:diagnosis* / Q000453:epidemiology; D006801:Humans; D015994:Incidence; D007223:Infant; D007231:Infant, Newborn; D007235:Infant, Premature, Diseases / Q000175:diagnosis* / Q000503:physiopathology; D008297:Male; D017286:Polysomnography; D012307:Risk Factors; D012680:Sensitivity and Specificity; D012891:Sleep Apnea Syndromes / Q000150:complications / Q000175:diagnosis* / Q000503:physiopathology; D013997:Time Factors