title: Obstructive Sleep Apnea and Gastroesophageal Reflux: A Multivariate Population-Level Analysis.
abstract: OBJECTIVE
  Previous studies investigating the relationship between gastroesophageal reflux (GER) and obstructive sleep apnea (OSA) demonstrate mixed results and have had limited capacity to control for concurrent confounders. Our objectives were to (1) determine if GER is significantly associated with OSA when simultaneously adjusting for the presence of other potentially confounding conditions and (2) quantify the magnitude of any such association that exists.
  
  
  METHODS
  Cross-sectional analysis of the National Ambulatory Medical Care Survey and National Hospital Ambulatory Medical Care Survey, 2005-2010.
  
  
  METHODS
  Ambulatory visits in the United States.
  
  
  METHODS
  Adults with a diagnosis of OSA or GER and potentially confounding conditions were identified. Univariate and multivariate logistic regression analyses were performed, as well as sensitivity analyses based on increasingly narrow diagnostic definitions.
  
  
  RESULTS
  A significant positive association between GER and OSA was observed, which persisted after adjustment for age, sex, race/ethnicity, sinonasal obstructive and inflammatory disorders, laryngopharyngeal obstructive and inflammatory disorders, obesity, asthma, and lung disorders. This positive association remained significant regardless of diagnostic criteria, whether broad (odds ratio: 1.94, 95% confidence interval: 1.07-3.54, P = .030) or narrow (odds ratio: 2.13, 95% confidence interval: 1.17-3.88, P = .014).
  
  
  CONCLUSIONS
  In this analysis of a national database defining the 3 most prioritized diagnoses, GER is independently associated with OSA, with double the odds of concurrent occurrence, even while controlling for potentially related conditions.
authors.affiliation: Department of Otolaryngology, Harvard Medical School, Boston, Massachusetts, USA.
authors.forename: Sapideh
authors.initials: S
authors.lastname: Gilani
authors.affiliation: Division of Sleep Medicine, Harvard Medical School, Boston, Massachusetts, USA.
authors.forename: Stuart F
authors.initials: SF
authors.lastname: Quan
authors.affiliation: Department of Otolaryngology, University of Michigan Medical School, Ann Arbor, Michigan, USA.
authors.forename: Melissa A
authors.initials: MA
authors.lastname: Pynnonen
authors.affiliation: Department of Otolaryngology, Harvard Medical School, Boston, Massachusetts, USA jennifer_shin@meei.harvard.edu.
authors.forename: Jennifer J
authors.initials: JJ
authors.lastname: Shin
mesh_terms: D000328:Adult; D016001:Confidence Intervals; D003430:Cross-Sectional Studies; D005260:Female; D005764:Gastroesophageal Reflux / Q000453:epidemiology / Q000209:etiology*; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D009819:Office Visits / Q000706:statistics & numerical data; D017286:Polysomnography; D011159:Population Surveillance / Q000379:methods*; D015995:Prevalence; D012189:Retrospective Studies; D012307:Risk Factors; D020181:Sleep Apnea, Obstructive / Q000150:complications* / Q000175:diagnosis / Q000453:epidemiology; D014481:United States / Q000453:epidemiology
keywords: United States; adult; asthma; comorbidity; esophagitis; gastroesophageal reflux; laryngopharyngeal reflux; lung disease; obesity; obstructive sleep apnea; sleep disorders