Sleep disorders and the prevalence of asymptomatic nocturnal acid and non-acid reflux.
BACKGROUND
Nocturnal acid reflux is associated with symptomatic and asymptomatic sleep arousals, leading to fragmented sleep. The frequency and influence of acid reflux in patients with various forms of insomnia has not been reported. The aim of this study was to quantify nocturnal acid and nonacid reflux in patients with primary sleep disorders as previously diagnosed by polysomnography.


METHODS
THIRTY ONE SUBJECTS WERE STUDIED: (A) 9 subjects with a polysomnographically diagnosed sleep disorder (1 with restless legs syndrome, 4 with narcolepsy, 4 with periodic limb movement disorder); (B) 12 subjects with primary insomnia (PI) and unrevealing polysomnography; and (C) 10 controls without disturbed sleep. All subjects underwent a physical examination and 24 h transnasal pH and impedance monitoring to detect acid and non-acid reflux.


RESULTS
The 21 subjects with fragmented sleep due to a primary sleep disorder had significantly more recumbent acid exposure (>1.2% of time) as compared with control subjects (33% versus 0%). When fragmented sleep subjects were divided into two groups, 17% of PI subjects and 55% of subjects with a diagnosed sleep disorder had significant recumbent acid exposure (P=0.009). Likewise, the median recumbent nonacid events were increased in the sleep disordered group (P=0.011).


CONCLUSIONS
This study indicates that patients with primary sleep disorders have prominent nocturnal acid reflux without symptoms of daytime acid reflux. Acid reflux is most prominent in patients with polysomnographic findings of disturbed sleep as compared to patients with PI; while non acid reflux is increased minimally in these patients.
Division Gastroenterology and Hepatology (Christine Herdman, Dina Halegoua-De Marzio, Susie Denuna-Rivera, Sidney Cohen, Anthony J. DiMarino), Thomas Jefferson University, Philadelphia, PA, USA.
Christine
C
Herdman
Division Gastroenterology and Hepatology (Christine Herdman, Dina Halegoua-De Marzio, Susie Denuna-Rivera, Sidney Cohen, Anthony J. DiMarino), Thomas Jefferson University, Philadelphia, PA, USA.
Dina Halegoua-De
DH
Marzio
Department of Internal Medicine (Paurush Shah), Thomas Jefferson University, Philadelphia, PA, USA.
Paurush
P
Shah
Division Gastroenterology and Hepatology (Christine Herdman, Dina Halegoua-De Marzio, Susie Denuna-Rivera, Sidney Cohen, Anthony J. DiMarino), Thomas Jefferson University, Philadelphia, PA, USA.
Susie
S
Denuna-Rivera
Sleep Disorders Center, Department of Psychiatry and Human Behaviors (Karl Doghramji), Thomas Jefferson University, Philadelphia, PA, USA.
Karl
K
Doghramji
Division Gastroenterology and Hepatology (Christine Herdman, Dina Halegoua-De Marzio, Susie Denuna-Rivera, Sidney Cohen, Anthony J. DiMarino), Thomas Jefferson University, Philadelphia, PA, USA.
Sidney
S
Cohen
Division Gastroenterology and Hepatology (Christine Herdman, Dina Halegoua-De Marzio, Susie Denuna-Rivera, Sidney Cohen, Anthony J. DiMarino), Thomas Jefferson University, Philadelphia, PA, USA.
Anthony J
AJ
Dimarino
Gastro-esophageal reflux; insomnia; nocturnal acid reflux; non-acid reflux; sleep disorders