title: Naps are associated more commonly with gastroesophageal reflux, compared with nocturnal sleep.
abstract: OBJECTIVE
  Acid reflux during nighttime sleep has been associated with more severe gastroesophageal reflux disease (GERD). Napping is common, especially after lunch time, in many cultures. We aimed to compare reflux characteristics between nighttime sleep and naps in patients with GERD.
  
  
  METHODS
  We performed a study of 15 patients (mean age, 58.5 ± 18.4 y; 10 men) with heartburn and/or regurgitation at least 3 times/week for the past 3 months, who experienced a nap in addition to regular nighttime sleep. All were evaluated using the demographics and GERD Symptoms Checklist questionnaires. Patients underwent pH testing concomitantly with actigraphy when they were not receiving antireflux treatment; only patients with abnormal results from pH tests were included in the study. Raw data from actigraphy analyses were superimposed over those collected from pH monitoring, matched by time. Integrative software was used to determine recumbent-awake, recumbent-asleep, and naps alongside pH monitoring data.
  
  
  RESULTS
  The mean duration of nocturnal sleep time and nap time were 446.0 ± 100.7 minutes and 61.9 ± 51.8 minutes, respectively. The mean number of reflux events per hour was significantly greater during nap than nocturnal sleep time (40.1 ± 69.9/h vs 3.5 ± 4.2/h; P < .05). The mean duration of reflux events was longer during nap than nocturnal sleep time (1.9 ± 2.8 min vs 1.5 ± 2.7 min). The percentage of time spent at a pH less than 4 was significantly greater during naptime than nocturnal sleep time (36.2% ± 38.8% vs 8.9% ± 11.6%; P < .05). Arousals from naps were rare, compared with nocturnal sleep (mean, 0.7 ± 1.1 vs 4.2 ± 2.9; P < .05). Patients also experienced more acid reflux associated with symptoms during nap than nocturnal sleep (mean, 8.08% vs 0.45%; P < .05).
  
  
  CONCLUSIONS
  We associated naps with significantly greater numbers of, and duration of, esophageal acid exposure and symptoms, compared with nocturnal sleep. Naps therefore might have important effects on disease severity.
authors.affiliation: Southern Arizona VA Health Care System, University of Arizona Health Sciences Center, Tucson, Arizona.
authors.forename: Laya
authors.initials: L
authors.lastname: Nasrollah
authors.affiliation: MetroHealth Medical Center, Case Western Reserve University, Cleveland, Ohio.
authors.forename: Carla
authors.initials: C
authors.lastname: Maradey-Romero
authors.affiliation: Southern Arizona VA Health Care System, University of Arizona Health Sciences Center, Tucson, Arizona.
authors.forename: Lokesh K
authors.initials: LK
authors.lastname: Jha
authors.affiliation: Southern Arizona VA Health Care System, University of Arizona Health Sciences Center, Tucson, Arizona.
authors.forename: Rakshith
authors.initials: R
authors.lastname: Gadam
authors.affiliation: Division of Sleep Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts.
authors.forename: Stuart F
authors.initials: SF
authors.lastname: Quan
authors.affiliation: MetroHealth Medical Center, Case Western Reserve University, Cleveland, Ohio. Electronic address: ronnie.fass@gmail.com.
authors.forename: Ronnie
authors.initials: R
authors.lastname: Fass
mesh_terms: D056044:Actigraphy; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D005750:Gastric Juice / Q000737:chemistry; D005764:Gastroesophageal Reflux / Q000453:epidemiology* / Q000473:pathology*; D006801:Humans; D006863:Hydrogen-Ion Concentration; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D012890:Sleep; D055815:Young Adult
keywords: Awakening; GERD; Heartburn; Recumbency