Poor sleep quality and obstructive sleep apnea in patients with GERD and Barrett's esophagus.
BACKGROUND
Gastroesophageal reflux disease (GERD) reduces sleep quality. Whether Barrett's esophagus (BE) affects sleep differently is unknown. Obstructive sleep apnea (OSA) often coexists with GERD and may disrupt sleep; whether GERD reduces sleep quality independently of OSA is unknown. Our aims were to compare the effect of GERD and BE on sleep quality, and assess the impact of OSA on this association.


METHODS
Validated questionnaires for GERD symptoms, sleep quality, and OSA risk were prospectively administered to subjects undergoing upper endoscopy. GERD was defined by erosive esophagitis and/or reflux symptoms >1/week. BE was defined histologically. Controls had normal endoscopy and were asymptomatic. Poor sleep quality was defined by a Pittsburgh Sleep Quality Index score >5. Risk of OSA was defined by a positive Berlin Questionnaire. The risk poor sleep quality in GERD, BE, and controls was evaluated in multivariate models.


RESULTS
83 GERD, 63 BE, and 75 controls were included. OSA and poor sleep quality were significantly more frequent in GERD (65% and 60%) but not BE (52% and 46%) compared with controls (48% and 39%). Controlling for age, race, gender, smoking, body mass index, and hypertension, the risk of poor sleep quality was significantly increased in GERD compared with controls (odds ratio [OR] = 2.79, 95% confidence interval [CI]: 1.08-6.80), significance was lost after adding OSA to the model (OR = 2.27, 95% CI: 0.87-5.85).


CONCLUSIONS
GERD but not BE increases the risk of poor sleep quality. This association is not independent of OSA.
Section of Gastroenterology and Hepatology, Michael E. DeBakey Veterans Affairs Medical Center and Baylor College of Medicine, Houston, TX, USA.
M F
MF
Vela
J R
JR
Kramer
P A
PA
Richardson
R
R
Dodge
H B
HB
El-Serag
D001471:Barrett Esophagus / Q000150:complications*; D005260:Female; D005764:Gastroesophageal Reflux / Q000150:complications*; D006801:Humans; D008297:Male; D008875:Middle Aged; D012890:Sleep; D020181:Sleep Apnea, Obstructive / Q000150:complications*
Barrett's Esophagus; gastroesophageal reflux disease; obstructive sleep apnea; sleep disturbance