title: Involvement of autonomic nervous activity changes in gastroesophageal reflux in neonates during sleep and wakefulness.
abstract: BACKGROUND
  It has been suggested that disturbed activity of the autonomic nervous system is one of the factors involved in gastroesophageal reflux (GER) in adults. We sought to establish whether transient ANS dysfunction (as assessed by heart rate variability) is associated with the occurrence of GER events in neonates during sleep and wakefulness.
  
  
  METHODS
  Nineteen neonates with suspected GER underwent simultaneous, synchronized 12-hour polysomnography and esophageal multichannel impedance-pH monitoring. We compared changes in HRV parameters during three types of periods (control and prior to and during reflux) with respect to the vigilance state.
  
  
  RESULTS
  The vigilance state influenced the distribution of GER events (P<0.001), with 53.4% observed during wakefulness, 37.6% observed during active sleep and only 9% observed during quiet sleep. A significant increase in the sympathovagal ratio (+32%, P=0.013) was observed in the period immediately prior to reflux (due to a 15% reduction in parasympathetic activity (P=0.017)), relative to the control period. This phenomenon was observed during both wakefulness and active sleep.
  
  
  CONCLUSIONS
  Our results showed that GER events were preceded by a vigilance-state-independent decrease in parasympathetic tone. This suggests that a pre-reflux change in ANS activity is one of the factors contributing to the mechanism of reflux in neonates.
authors.affiliation: PériTox Laboratory (EA4285-UMI 01 INERIS), Faculty of Medicine, Jules Verne University of Picardy, Amiens, France ; Pediatric Gastroenterology Unit, Amiens University Medical Center, Amiens, France.
authors.forename: Djamal-Dine
authors.initials: DD
authors.lastname: Djeddi
authors.affiliation: Neonatal and Pediatric Intensive Care Unit, Amiens University Medical Center, Amiens, France ; GRAMFC (INSERM U 1105), Faculty of Medicine, Jules Verne University of Picardy, Amiens, France.
authors.forename: Guy
authors.initials: G
authors.lastname: Kongolo
authors.affiliation: PériTox Laboratory (EA4285-UMI 01 INERIS), Faculty of Medicine, Jules Verne University of Picardy, Amiens, France.
authors.forename: Erwan
authors.initials: E
authors.lastname: Stéphan-Blanchard
authors.affiliation: PériTox Laboratory (EA4285-UMI 01 INERIS), Faculty of Medicine, Jules Verne University of Picardy, Amiens, France.
authors.forename: Mohamed
authors.initials: M
authors.lastname: Ammari
authors.affiliation: PériTox Laboratory (EA4285-UMI 01 INERIS), Faculty of Medicine, Jules Verne University of Picardy, Amiens, France ; Neonatal and Pediatric Intensive Care Unit, Amiens University Medical Center, Amiens, France.
authors.forename: André
authors.initials: A
authors.lastname: Léké
authors.affiliation: PériTox Laboratory (EA4285-UMI 01 INERIS), Faculty of Medicine, Jules Verne University of Picardy, Amiens, France.
authors.forename: Stéphane
authors.initials: S
authors.lastname: Delanaud
authors.affiliation: PériTox Laboratory (EA4285-UMI 01 INERIS), Faculty of Medicine, Jules Verne University of Picardy, Amiens, France.
authors.forename: Véronique
authors.initials: V
authors.lastname: Bach
authors.affiliation: PériTox Laboratory (EA4285-UMI 01 INERIS), Faculty of Medicine, Jules Verne University of Picardy, Amiens, France.
authors.forename: Frederic
authors.initials: F
authors.lastname: Telliez
mesh_terms: D000328:Adult; D005260:Female; D005764:Gastroesophageal Reflux / Q000503:physiopathology*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D010275:Parasympathetic Nervous System / Q000503:physiopathology*; D012890:Sleep; D014851:Wakefulness