Pantoprazole for sleepiness associated with acid reflux and obstructive sleep disordered breathing.
OBJECTIVE
To determine the effectiveness of Pantoprazole (Wyeth Pharmaceuticals Inc., Philadelphia, PA) therapy for daytime sleepiness in patients with symptoms of acid reflux and obstructive sleep-disordered breathing (OSDB).


METHODS
Prospective interventional cohort study.


METHODS
Twenty-seven adult subjects (67% men) with symptoms of acid reflux disease and mild to moderate OSDB were included in a 3-month study of proton pump inhibitor therapy (Pantoprazole 40 mg once daily). Primary outcomes included changes in daytime sleepiness, reflux symptoms, and bed partner assessment of snoring. Secondary outcomes included changes in snoring quantification, apnea, and apnea-hypopnea indices (AHI) with SNAP Laboratories (Glenview, IL) home sleep study and self-reported global symptom improvement.


RESULTS
At baseline, patients were typically middle-aged, obese men with mild to moderate sleep apnea (mean AHI = 15) with excessive daytime somnolence (mean Epworth Sleepiness Score = 13). After 3-month treatment with Pantoprazole, a statistically significant improvement was noted for daytime sleepiness (P = .002) and total reflux symptoms (P = .0006). Subjects also reported a significant reduction in reflux awakening them from sleep (P < .0001). Bed-partner assessment of snoring significantly improved (P = .03); however, no significant improvements were noted in snoring quantification, apnea, or AHI. When compared with a disease-severity matched historic placebo-control group, this cohort demonstrated a significantly greater reduction in daytime sleepiness (P = .04).


CONCLUSIONS
This cohort of subjects had significant improvements in daytime sleepiness and reflux symptoms, including reflux awakening from sleep, with Pantoprazole therapy. Further controlled studies are indicated to confirm these results. Improvement in daytime somnolence likely resulted from a reduction in reflux-related arousals because no improvements occurred in OSDB.
Department of Otolaryngology-Head and Neck Surgery and The Neuroscience Institute at the University of Cincinnati College of Medicine, Cincinnati, OH, USA. David.Steward@uc.edu
David L
DL
Steward
D053799:2-Pyridinylmethylsulfinylbenzimidazoles; D000328:Adult; D000897:Anti-Ulcer Agents / Q000009:adverse effects / Q000627:therapeutic use*; D001143:Arousal / Q000187:drug effects; D001562:Benzimidazoles / Q000009:adverse effects / Q000627:therapeutic use*; D002940:Circadian Rhythm / Q000187:drug effects; D015331:Cohort Studies; D006970:Disorders of Excessive Somnolence / Q000188:drug therapy*; D005260:Female; D005764:Gastroesophageal Reflux / Q000188:drug therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009853:Omeprazole / Q000031:analogs & derivatives; D000077402:Pantoprazole; D011446:Prospective Studies; D054328:Proton Pump Inhibitors; D020181:Sleep Apnea, Obstructive / Q000188:drug therapy*; D013454:Sulfoxides / Q000009:adverse effects / Q000627:therapeutic use*; D016896:Treatment Outcome; D014851:Wakefulness / Q000187:drug effects
D053799:2-Pyridinylmethylsulfinylbenzimidazoles; D000897:Anti-Ulcer Agents; D001562:Benzimidazoles; D054328:Proton Pump Inhibitors; D013454:Sulfoxides; D000077402:Pantoprazole; D009853:Omeprazole