title: Symptoms of aerophagia are common in patients on continuous positive airway pressure therapy and are related to the presence of nighttime gastroesophageal reflux.
abstract: OBJECTIVE
  Continuous positive airway pressure (CPAP), the mainstay treatment for obstructive sleep apnea (OSA), involves administration of air under pressure to the upper airway. A well-known but poorly understood side effect of positive airway pressure therapies is aerophagia, air entering the esophagus and stomach rather than the lungs. Gastric distension, a consequence of aerophagia, can increase gastroesophageal reflux (GER) by increasing transient lower esophageal sphincter relaxations, the most common cause of reflux. This study aimed to determine: (i) the prevalence of aerophagia symptoms in a group of OSA patients on CPAP therapy, and (ii) whether aerophagia symptoms are related to an increase in prevalence of GER symptoms.
  
  
  METHODS
  Consecutive OSA patients undergoing polysomnography for the purpose of optimizing their CPAP therapy completed a validated questionnaire regarding GER symptoms and aerophagia symptoms. Complete datasets were collected for 259 individuals (203 males).
  
  
  RESULTS
  The group with aerophagia symptoms (n = 130) had a greater prevalence of frequent (≥ once a week) GER symptoms (29% vs. 10%, p < 0.05) and nighttime GER symptoms (9 vs. 2%, p < 0.05) than those without aerophagia (n = 129). The group with nighttime GER symptoms (n = 27) had a greater prevalence of aerophagia symptoms (63% vs. 23%, p < 0.05) than those without nighttime GER symptoms (n = 232).
  
  
  CONCLUSIONS
  In patients with OSA being treated with CPAP, the prevalence of GER and nighttime GER symptoms is greater in those with symptoms of aerophagia than those without. CPAP-induced aerophagia might precipitate GER, particularly nighttime GER, by exacerbating transient lower esophageal relaxations through gastric distension.
authors: West Australian Sleep Disorders Research Institute, Department of Pulmonary Physiology and Sleep Medicine, Sir Charles Gairdner Hospital, Nedlands, Australia.
authors: Kelly
authors: K
authors: Shepherd
authors: David
authors: D
authors: Hillman
authors: Peter
authors: P
authors: Eastwood
mesh_terms: D000334:Aerophagy / Q000453:epidemiology / Q000209:etiology*; D045422:Continuous Positive Airway Pressure / Q000009:adverse effects*; D005260:Female; D005764:Gastroesophageal Reflux / Q000453:epidemiology / Q000209:etiology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D017286:Polysomnography; D015995:Prevalence; D020181:Sleep Apnea, Obstructive / Q000150:complications / Q000628:therapy; D011795:Surveys and Questionnaires