title: Symptoms of Obstructive Sleep Apnea, Gastroesophageal Reflux and the Risk of Barrett's Esophagus in a Population-Based Case-Control Study.
abstract: BACKGROUND
  Gastroesophageal reflux is overrepresented in people with obstructive sleep apnea (OSA) and it has been suggested that OSA worsens gastroesophageal reflux symptoms. Aggravated reflux might lead to an increased risk of Barrett's esophagus.
  
  
  OBJECTIVE
  To assess the association between sleep apnea symptoms and Barrett's esophagus.
  
  
  METHODS
  Included in a case-control study in Brisbane, Australia were 237 patients with histologically confirmed Barrett's esophagus and 247 population controls. The controls were randomly selected from the electoral roll and frequency-matched to the cases by age and sex. Information on OSA symptoms (excessive daytime sleepiness and sleep related apnea symptoms), gastroesophageal reflux symptoms and anthropometric measures were collected through interviews and written questionnaires. Multivariable logistic regression provided odds ratios (OR) and 95% confidence intervals (CI), adjusted for potential confounding by BMI and gastroesophageal reflux.
  
  
  RESULTS
  The prevalence of Barrett's esophagus was higher among people with excessive daytime sleepiness than those without (24% vs. 18%; p-value 0.1142) and in participants with sleep-related apnea symptoms (20% vs. 13%; p-value 0.1730). However, there were non-significantly increased ORs of Barrett's esophagus among people with excessive daytime sleepiness (OR 1.42, 95% CI 0.90-2.34) and sleep related apnea symptoms (OR 1.32, 95% CI 0.74-2.36) when adjusting for age, sex and BMI. After further adjustment for gastroesophageal reflux symptoms, the point ORs were no longer increased (OR 1.02, 95% CI 0.61-1.70 for daytime sleepiness and OR 0.72, 95% CI 0.38-1.38 for sleep related apnea symptoms).
  
  
  CONCLUSIONS
  Symptoms of OSA are possibly associated with an increased risk of Barrett's esophagus, an association that appears to be mediated entirely by gastroesophageal reflux.
authors.affiliation: Upper GI Surgery, Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden; Cancer Control Laboratory, QIMR Berghofer Medical Research Institute, Brisbane, Queensland, Australia.
authors.forename: Anna
authors.initials: A
authors.lastname: Lindam
authors.affiliation: Cancer Control Laboratory, QIMR Berghofer Medical Research Institute, Brisbane, Queensland, Australia; Department of Medicine, School of Medicine, The University of Queensland, Brisbane, Queensland, Australia.
authors.forename: Bradley J
authors.initials: BJ
authors.lastname: Kendall
authors.affiliation: Cancer Control Laboratory, QIMR Berghofer Medical Research Institute, Brisbane, Queensland, Australia.
authors.forename: Aaron P
authors.initials: AP
authors.lastname: Thrift
authors.affiliation: Department of Medicine, School of Medicine, The University of Queensland, Brisbane, Queensland, Australia.
authors.forename: Graeme A
authors.initials: GA
authors.lastname: Macdonald
authors.affiliation: Cancer Control Laboratory, QIMR Berghofer Medical Research Institute, Brisbane, Queensland, Australia.
authors.forename: Suzanne
authors.initials: S
authors.lastname: O'Brien
authors.affiliation: Upper GI Surgery, Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden; Division of Cancer Studies, King's College London, London, United Kingdom.
authors.forename: Jesper
authors.initials: J
authors.lastname: Lagergren
authors.affiliation: Cancer Control Laboratory, QIMR Berghofer Medical Research Institute, Brisbane, Queensland, Australia.
authors.forename: David C
authors.initials: DC
authors.lastname: Whiteman
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001315:Australia; D001471:Barrett Esophagus / Q000453:epidemiology* / Q000209:etiology*; D016022:Case-Control Studies; D005260:Female; D005764:Gastroesophageal Reflux / Q000150:complications* / Q000175:diagnosis; D006801:Humans; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D011159:Population Surveillance; D012306:Risk; D020181:Sleep Apnea, Obstructive / Q000150:complications* / Q000175:diagnosis; D055815:Young Adult