Nasal continuous positive airway pressure. A new treatment for nocturnal gastroesophageal reflux?
Nasal continuous positive airway pressure (CPAP) reduces nocturnal gastroesophageal reflux (GER) in obstructive sleep apnea syndrome (OSAS) patients. The primary objectives of our investigation were to determine if CPAP could reduce reflux in non-OSAS patients and, if so, by what mechanism. Esophageal pH was monitored for 48 h in six nocturnal reflux patients. During the first 24 h, basal reflux data were collected; the second night, nasal CPAP was administered (pressure = 8 cm H2O). Esophageal manometry was obtained in six healthy adult volunteers both on and off nasal CPAP (pressure = 8 cm H2O) to ascertain CPAP's effects on esophageal pressure and peristalsis. The six reflux patients experienced less nocturnal GER while on CPAP. The mean percent time esophageal pH < 4 was reduced from 27.7 +/- 10.0 to 5.8 +/- 2.6 (p < 0.004); the mean reflux duration dropped from 2.1 +/- 0.6 to 0.9 +/- 0.5 min (p < 0.03); and the mean duration of longest reflux improved from 84.3 +/- 32.6 to 13.8 +/- 6.9 min (p < 0.01). The CPAP raised the mean resting midesophageal pressure by 4.4 cm H2O (p < 0.01) and the mean resting lower esophageal pressure (LES) by 13.2 cm H2O (p < 0.02) in the healthy volunteers. Nasal CPAP effectively reduced nocturnal GER in six patients with nocturnal reflux. The antireflux activity of CPAP is likely due to passive elevation of intraesophageal pressure and possibly to reflex LES constriction.
Kerr
P
P
Sleep and GI Laboratories, St. Boniface General Hospital, Winnipeg, Manitoba, Canada.
Shoenut
J P
JP
Steens
R D
RD
Millar
T
T
Micflikier
A B
AB
Kryger
M H
MH
D000281:Administration, Intranasal; D000293:Adolescent; D000328:Adult; D004947:Esophagus / Q000503:physiopathology; D005260:Female; D005764:Gastroesophageal Reflux / Q000503:physiopathology / Q000628:therapy*; D006801:Humans; D006863:Hydrogen-Ion Concentration; D008297:Male; D008365:Manometry; D008875:Middle Aged; D010528:Peristalsis; D017286:Polysomnography; D011175:Positive-Pressure Respiration / Q000379:methods*; D011312:Pressure; D011446:Prospective Studies; D012893:Sleep Wake Disorders / Q000503:physiopathology / Q000628:therapy*