title: Proton-pump inhibitors in sleep-related breathing disorders: clinical response and predictive factors.
abstract: OBJECTIVE
  Gastroesophageal reflux is frequently associated with sleep-related breathing disorders. We aimed to evaluate the prevalence of acid reflux in patients with sleep-related breathing disorders, their clinical response to proton-pump inhibitor (PPI) treatment, and to identify predictive response factors to this treatment.
  
  
  METHODS
  Prospective study among patients attending a sleep clinic. Evaluation of typical and atypical gastroesophageal reflux symptoms, simultaneous 24 h dual-channel pH monitoring and polysomnography were performed in all patients. Patients were treated with pantoprazole. After 3-6 months clinical response was evaluated, and pHmetry and polysomnography repeated. Clinical response was defined in terms of snore, apnea and somnolence grading. Improvement in polysomnography was defined by the Stanford criteria.
  
  
  RESULTS
  One hundred and ninety-nine patients were included. Abnormal reflux levels were detected in the distal esophagus in 72% of patients, and in the proximal esophagus in 46%. Clinical or polysomnographic response to PPI treatment was found in 78% of patients. Pretreatment pHmetry was a significant predictor of success: 67% of responders had pathological proximal pHmetry (vs. 33% of nonresponders; P<0.001), and 55% also had pathological distal pHmetry (P<0.05). Age, sex, BMI, alcohol or tobacco abuse, typical or atypical gastroesophageal reflux symptoms, severity of sleeping disorder, and polysomnography were not predictive of outcome.
  
  
  CONCLUSIONS
  Patients with sleep-related breathing disorders have an increased prevalence of gastroesophageal reflux disease. They may be successfully treated with PPIs, particularly in patients with an abnormal proximal esophageal pHmetry.
authors.affiliation: Gastroenterology Unit, Consorci Sanitari de Terrassa, Spain. ines.modolell@gmail.com
authors.forename: Inés
authors.initials: I
authors.lastname: Modolell
authors.forename: Eduard
authors.initials: E
authors.lastname: Esteller
authors.forename: Francesc
authors.initials: F
authors.lastname: Segarra
authors.forename: Fermín
authors.initials: F
authors.lastname: Mearin
mesh_terms: D053799:2-Pyridinylmethylsulfinylbenzimidazoles / Q000627:therapeutic use; D000328:Adult; D000368:Aged; D050782:Esophageal pH Monitoring; D005260:Female; D005764:Gastroesophageal Reflux / Q000150:complications / Q000188:drug therapy*; D006801:Humans; D008297:Male; D008365:Manometry / Q000379:methods; D008875:Middle Aged; D000077402:Pantoprazole; D017286:Polysomnography / Q000379:methods; D011379:Prognosis; D054328:Proton Pump Inhibitors / Q000627:therapeutic use*; D012720:Severity of Illness Index; D012891:Sleep Apnea Syndromes / Q000209:etiology*; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D053799:2-Pyridinylmethylsulfinylbenzimidazoles; D054328:Proton Pump Inhibitors; D000077402:Pantoprazole