Surgical trial investigating nocturnal gastroesophageal reflux and sleep (STINGERS).
BACKGROUND
Nocturnal reflux is important in the pathogenesis of esophagitis. The relationship between reflux and sleep is poorly understood, although data support both paradigms of nocturnal reflux causing arousal and nocturnal arousal allowing reflux. Furthermore, the effect of fundoplication on sleep is unknown.


METHODS
Seven volunteers and 11 patients with gastroesophageal reflux disease (GERD) and nocturnal symptoms were studied with esophageal pH and polysomnography at baseline and at 8 to 10 weeks follow-up evaluation, with patients undergoing interval fundoplication. Gastrointestinal and sleep questionnaires were completed before each study.


RESULTS
Questionnaire data between the groups showed differences at baseline, which were eliminated by surgery. No objective differences in sleep were observed between the groups at baseline or at follow-up evaluation. However, the patient group significantly increased the fraction of the night spent in deeper sleep (49.6% vs 58.3%; p = 0.022). Reflux events were associated with arousals in sleep.


CONCLUSIONS
Fundoplication improves both subjective and objective sleep quality in patients with nocturnal GERD symptoms.
Cohen
J A
JA
Section of Surgical Sciences, Division of General Surgery, Vanderbilt University, MCN D-5219, Nashville, TN 37232-2905, USA.
Arain
A
A
Harris
P A
PA
Byrne
D W
DW
Holzman
M D
MD
Sharp
K W
KW
Richards
W O
WO
D016022:Case-Control Studies; D004435:Eating; D004569:Electroencephalography; D004942:Esophagitis, Peptic / Q000150:complications* / Q000503:physiopathology / Q000601:surgery; D005260:Female; D018662:Fundoplication; D005764:Gastroesophageal Reflux / Q000150:complications* / Q000503:physiopathology / Q000601:surgery; D006801:Humans; D006863:Hydrogen-Ion Concentration; D008297:Male; D008875:Middle Aged; D012890:Sleep / Q000502:physiology*; D012893:Sleep Wake Disorders / Q000150:complications* / Q000503:physiopathology; D013997:Time Factors