title: Conscious awakenings are commonly associated with Acid reflux events in patients with gastroesophageal reflux disease.
abstract: OBJECTIVE
  More than half of patients with gastroesophageal reflux disease (GERD) report heartburn that awakens them from sleep. We aimed to determine the frequency of conscious awakenings associated with acid reflux events during sleep and their relationship with symptoms in patients with GERD compared with normal subjects.
  
  
  METHODS
  The study included 39 patients with heartburn and/or regurgitation at least 3 times each week and 9 healthy individuals as controls. Subjects underwent pH testing concomitantly with actigraphy. Novel software simultaneously integrated raw actigraphy and pH data matched by time to determine patients' conscious awakenings during sleep and their temporal relationship with acid reflux events and GERD-related symptoms.
  
  
  RESULTS
  A total of 104 and 11 conscious awakenings were recorded in 89.7% of patients and 77.8% of normal controls, respectively. The mean number of conscious awakenings was significantly higher in the group with GERD compared with controls (3.0 ± 0.3 vs 1.8 ± 0.4, P < .05). Of the conscious awakenings, 51.9% (51/104) were associated with an acid reflux event in GERD patients and 0 in controls (P < .01). Only 16.3% of total conscious awakenings were symptomatic. In most of the conscious awakenings that were associated with an acid reflux event (85.6%), the awakening preceded the reflux event.
  
  
  CONCLUSIONS
  Acid reflux events occur primarily after an awakening episode. Conscious awakenings from sleep are common among patients with GERD and are frequently associated with acid reflux events. However, conscious awakenings associated with reflux events are seldom symptomatic.
authors.affiliation: Department of Medicine, Section of Gastroenterology, Neuroenteric Clinical Research Group, Southern Arizona VA Health Care System, Tucson, Arizona, USA.
authors.forename: Choo Hean
authors.initials: CH
authors.lastname: Poh
authors.forename: Larissa
authors.initials: L
authors.lastname: Allen
authors.forename: Anita
authors.initials: A
authors.lastname: Gasiorowska
authors.forename: Tomás
authors.initials: T
authors.lastname: Navarro-Rodriguez
authors.forename: Stuart F
authors.initials: SF
authors.lastname: Quan
authors.forename: Isaac
authors.initials: I
authors.lastname: Malagon
authors.forename: Jeannette
authors.initials: J
authors.lastname: Powers
authors.forename: Marcia R
authors.initials: MR
authors.lastname: Willis
authors.forename: Nicole
authors.initials: N
authors.lastname: Ashpole
authors.forename: Ronnie
authors.initials: R
authors.lastname: Fass
mesh_terms: D056044:Actigraphy; D000328:Adult; D050782:Esophageal pH Monitoring; D005260:Female; D005764:Gastroesophageal Reflux / Q000150:complications* / Q000473:pathology*; D006356:Heartburn / Q000150:complications* / Q000453:epidemiology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D007319:Sleep Initiation and Maintenance Disorders / Q000150:complications* / Q000453:epidemiology*