Interaction of sleep disturbances and gastroesophageal reflux in chronic laryngitis.
BACKGROUND
A considerable percentage of patients with reflux laryngitis do not respond to conventional treatment with proton pump inhibitors or prokinetics. At the present time, the reasons for this are not well known.


OBJECTIVE
To investigate whether nocturnal reflux associated with sleep-related respiratory disorders is the cause of refractory laryngitis.


METHODS
The data from 227 patients (133 women, ages 18 to 75 years, body mass index 17.4 to 38.3, mean 32.1 kg/m(2)) with LG were analyzed retrospectively. All received laryngoscopy and gastroscopy. All patients initially received 40- to 80 mg omeprazole and underwent a follow-up laryngoscopy after 6 weeks. Of the patients, 202 showed a clear improvement, whereas 25 (11.1%) did not. All underwent 24-hour pH monitoring and cardiorespiratory polysomnography.


RESULTS
All of the patients showed laryngoscopic signs of LG. Of the patients, 102 (45%) had a hiatal hernia and 53 (28%) suffered from reflux esophagitis. Forty-two patients (19%) were found to have Helicobacter pylori in the stomach. Among the 25 patients who failed to respond to omeprazole, pH monitoring showed nocturnal acid reflux in 15 (60%). Twenty-four patients (96%) showed a sleep-related respiratory disturbance manifesting as pathologic snoring (16 patients) or obstructive sleep apnea (8 patients, respiratory disturbance index [RDI] 11 to 33, mean 16.3/h). All received nasal continuous positive airway pressure (nCPAP) treatment, 16 with constant mask pressure (4 to 12, mean, 5.6 mbar) and 8 with autoadjusting pressure. One patient abandoned treatment; the other 23 showed clear subjective and objective improvement after 3 months of treatment.


CONCLUSIONS
Even without pH monitoring evidence of nocturnal reflux, refractory LG is very often associated with sleep-related respiratory disorders and responds well to nCPAP treatment. Prospective studies are needed to clarify the details of this association.
Konermann
Martin
M
Medical Department, Marienkrankenhaus, Marburger Strasse 85, 34127 Kassel, Germany.
Radü
Hans-Joachim
HJ
Teschler
Helmut
H
Rawert
Berthold
B
Heimbucher
Johannes
J
Sanner
Bernd Martin
BM
D000293:Adolescent; D000328:Adult; D000368:Aged; D000897:Anti-Ulcer Agents / Q000627:therapeutic use; D002908:Chronic Disease; D004942:Esophagitis, Peptic / Q000150:complications* / Q000188:drug therapy / Q000382:microbiology; D004945:Esophagoscopy; D005260:Female; D005500:Follow-Up Studies; D005773:Gastroscopy / Q000379:methods; D016481:Helicobacter Infections / Q000188:drug therapy / Q000382:microbiology; D016480:Helicobacter pylori / Q000302:isolation & purification; D006801:Humans; D007827:Laryngitis / Q000175:diagnosis / Q000209:etiology*; D007828:Laryngoscopy / Q000379:methods; D008297:Male; D008875:Middle Aged; D009853:Omeprazole / Q000627:therapeutic use; D017286:Polysomnography; D011175:Positive-Pressure Respiration / Q000379:methods; D020181:Sleep Apnea, Obstructive / Q000150:complications* / Q000175:diagnosis / Q000628:therapy; D012913:Snoring / Q000209:etiology
D000897:Anti-Ulcer Agents; D009853:Omeprazole