title: Gastroesophageal Reflux Affects Sleep Quality in Snoring Obese Children.
abstract: OBJECTIVE
  This study was performed to evaluate the quality of sleep in snoring obese children without obstructive sleep apnea (OSA); and to study the possible relationship between sleep interruption and gastroesophageal reflux (GER) in snoring obese children.
  
  
  METHODS
  Study subjects included 13 snoring obese children who were referred to our sleep lab for possible sleep-disordered breathing. Patients underwent multichannel intraluminal impedance and esophageal pH monitoring with simultaneous polysomnography. Exclusion criteria included history of fundoplication, cystic fibrosis, and infants under the age of 2 years. Significant association between arousals and awakenings with previous reflux were defined by symptom-association probability using 2-minute intervals.
  
  
  RESULTS
  Sleep efficiency ranged from 67-97% (median 81%). A total of 111 reflux episodes (90% acidic) were detected during sleep, but there were more episodes per hour during awake periods after sleep onset than during sleep (median 2.3 vs. 0.6, p=0.04). There were 279 total awakenings during the sleep study; 56 (20.1%) of them in 9 patients (69.2%) were preceded by reflux episodes (55 acid, 1 non-acid). In 5 patients (38.5%), awakenings were significantly associated with reflux.
  
  
  CONCLUSIONS
  The data suggest that acid GER causes sleep interruptions in obese children who have symptoms of snoring or restless sleep and without evidence of OSA.
authors.affiliation: Department of Pediatrics, Escola Paulista de Medicina, Universidade Federal de Sao Paulo, Sao Paulo, Brazil.
authors.forename: Rodrigo Strehl
authors.initials: RS
authors.lastname: Machado
authors.affiliation: Division of Pediatric Gastroenterology, Ohio State University, Columbus, OH, USA.
authors.forename: Frederick W
authors.initials: FW
authors.lastname: Woodley
authors.affiliation: Department of Pediatrics,Nationwide Children's Hospital, Columbus, OH, USA.
authors.forename: Beth
authors.initials: B
authors.lastname: Skaggs
authors.affiliation: Division of Pediatric Gastroenterology, Ohio State University, Columbus, OH, USA.
authors.forename: Carlo
authors.initials: C
authors.lastname: Di Lorenzo
authors.affiliation: Department of Pediatrics, Ohio State University, Columbus, OH, USA.
authors.forename: Ihuoma
authors.initials: I
authors.lastname: Eneli
authors.affiliation: Department of Pediatrics, Ohio State University, Columbus, OH, USA.
authors.forename: Mark
authors.initials: M
authors.lastname: Splaingard
authors.affiliation: Division of Pediatric Gastroenterology, Ohio State University, Columbus, OH, USA.
authors.forename: Hayat
authors.initials: H
authors.lastname: Mousa
keywords: Besity; Child; Electric impedance; Gastroesophageal reflux; Obstructive sleep apnea; Sleep wake disorders