title: Predictors of heartburn during sleep in a large prospective cohort study.
abstract: OBJECTIVE
  Nocturnal gastroesophageal reflux, which may result in nocturnal heartburn, has been demonstrated to be associated with a more severe form of gastroesophageal reflux disease (GERD). The aim of this study was to determine the clinical predictors of heartburn during sleep in a large prospective cohort study.
  
  
  METHODS
  Study subjects were members of the parent cohorts from which the Sleep Heart Health Study (SHHS) recruited participants. SHHS is a multicenter, longitudinal, cohort study of the cardiovascular consequences of sleep-disordered breathing. As part of the recruitment process, parent cohort members completed a questionnaire that permitted an assessment of the relationships between heartburn during sleep, and patient demographics, sleep abnormalities, medical history, and social habits in nine community-based parent cohorts across the United States. All variables, significant at the p < 0.05 level, were included as independent variables in multivariate logistic regression models with heartburn during sleep status included as the dependent variable
  
  
  RESULTS
  A total of 15,314 subjects completed the questions about heartburn during sleep, and of these, 3,806 subjects (24.9%) reported having this symptom. In four increasingly comprehensive multivariate models, increased body mass index (BMI), carbonated soft drink consumption, snoring and daytime sleepiness (Epworth sleepiness scale score), insomnia, hypertension, asthma, and usage of benzodiazepines were strong predictors of heartburn during sleep. In contrast, college education decreased the risk of reporting heartburn during sleep.
  
  
  CONCLUSIONS
  Heartburn during sleep is very common in the general population. Reports of this type of symptom of GERD are strongly associated with increased BMI, carbonated soft drink consumption, snoring and daytime sleepiness, insomnia, hypertension, asthma, and usage of benzodiazepines. Overall, heartburn during sleep may be associated with sleep complaints and excessive daytime sleepiness.
authors.affiliation: Section of Gastroenterology, Department of Medicine, Arizona Respiratory Center, University of Arizona College of Medicine, Tucson, AZ, USA. Ronnie.Fass@med.Va.gov <Ronnie.Fass@med.Va.gov>
authors.forename: Ronnie
authors.initials: R
authors.lastname: Fass
authors.forename: Stuart F
authors.initials: SF
authors.lastname: Quan
authors.forename: George T
authors.initials: GT
authors.lastname: O'Connor
authors.forename: Ann
authors.initials: A
authors.lastname: Ervin
authors.forename: Conrad
authors.initials: C
authors.lastname: Iber
mesh_terms: D000368:Aged; D015992:Body Mass Index; D002253:Carbonated Beverages; D015331:Cohort Studies; D004522:Educational Status; D005260:Female; D005764:Gastroesophageal Reflux / Q000453:epidemiology; D006356:Heartburn / Q000453:epidemiology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011446:Prospective Studies; D012890:Sleep; D011795:Surveys and Questionnaires