title: Extra-esophageal reflux, NOSE score, and sleep quality in an adult clinic population.
abstract: OBJECTIVE
  Gastroesophageal reflux disease and heartburn negatively impact sleep; the impact of extraesophageal reflux (EER) symptoms on sleep is unknown. This study's goal was to evaluate the association of EER and measures of nasal obstruction, mood, insomnia, hypersomnia, and obstructive sleep apnea (OSA) risk.
  
  
  METHODS
  Cross-sectional study.
  
  
  METHODS
  Tertiary care hospital.
  
  
  METHODS
  A prospective cohort of adult patients was evaluated using validated questionnaires for insomnia (PSQI), hypersomnia (ESS), OSA risk (STOP-Bang), sleep quality of life (FOSQ-10), EER reflux symptoms (RSI), nasal symptoms (NOSE), and measures of mood (HADA). Pharyngeal saliva samples underwent Western blot immunoassay for pepsin.
  
  
  RESULTS
  Ninety-three adults (mean age 50.2 ± 15.2 years, 43% female) were evaluated. Reflux Symptom Index (RSI) was elevated in 32% of patients and significant heartburn symptoms were reported in only 12% of patients. Prevalence of pepsin (+) was 27%. Both RSI and NOSE were significantly associated with sleep measures related to insomnia (r = 0.48 and r = 0.50; P < 0.001, respectively), Quality of Life (QOL) (r = 0.30 and r = 0.34; P < 0.001, respectively), and hypersomnolance (r = 0.18 and P < 0.04; r = 0.29 and P < 0.01, respectively), but not apnea risk (all P < 0.05). Nasal symptoms and mood were associated with all non-OSA sleep metrics (r = 0.24). In multivariate analysis, both NOSE and RSI remained significantly associated with sleep measures.
  
  
  CONCLUSIONS
  Insomnia, hypersomnia, and sleep QOL are associated with measures of EER, nasal symptoms, and mood but not OSA risk, supporting that disrupted sleep may be associated with EER and nasal symptoms independent of sleep apnea.
authors.affiliation: Division of Sleep Medicine, Department of Otolaryngology & Communication Sciences, Medical College of Wisconsin, Milwaukee, Wisconsin, U.S.A; Department of Otorhinolaryngology, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand.
authors.forename: Supawan
authors.initials: S
authors.lastname: Laohasiriwong
authors.forename: Nikki
authors.initials: N
authors.lastname: Johnston
authors.forename: B Tucker
authors.initials: BT
authors.lastname: Woodson
mesh_terms: D000328:Adult; D003430:Cross-Sectional Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D057045:Laryngopharyngeal Reflux / Q000150:complications / Q000175:diagnosis* / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D011446:Prospective Studies; D012890:Sleep / Q000502:physiology*; D012893:Sleep Wake Disorders / Q000453:epidemiology / Q000209:etiology* / Q000503:physiopathology; D011795:Surveys and Questionnaires; D062606:Tertiary Care Centers; D014481:United States / Q000453:epidemiology
keywords: GERD; OSA; Sleep; Western blot immunoassay; anxiety; apnea; depression; extraesophageal reflux; gastroesophageal reflux; heartburn; hypersomnia; insomnia; laryngopharyngeal reflux; mood; nasal obstruction; nose; pepsin; quality of life; reflux; sleep disorders; sleep medicine