title: Sleep disturbance and enhanced esophageal capsaicin sensitivity in patients with gastroesophageal reflux disease.
abstract: OBJECTIVE
  Esophageal infusion of capsaicin-containing red pepper sauce induced heartburn symptoms in patients with gastroesophageal reflux disease (GERD). We aimed to test the hypothesis whether sleep disturbance modulates esophageal sensitivity to capsaicin infusion in patients with GERD.
  
  
  METHODS
  We enrolled 40 patients with their sleep quality measured by the Pittsburg Sleep Quality Index with > 5 indicating sleep disturbance. Esophageal sensation to capsaicin infusion was documented via measures of lag time to initial heartburn perception, heartburn intensity rating, and sensitivity score by esophageal infusion of capsaicin-containing red pepper sauce. Objective sleep measures were assessed by ambulatory actigraphy.
  
  
  RESULTS
  We found 22 patients with sleep disturbance. The patients with sleep disturbance had shorter lag time to initial heartburn perception (P = 0.03) and greater sensory intensity rating (P = 0.02). The sensitivity score for capsaicin infusion was greater in patients with sleep disturbance when compared with those without sleep disturbance (P = 0.04). Actigraphy measures revealed that patients with sleep disturbance also had poor sleep efficiency (P = 0.04), longer average awakening time (P = 0.03), and greater total activity account (P = 0.04). The lag time for perceiving capsaicin infusion was positively correlated with total sleep time (r = 0.43, P = 0.03).
  
  
  CONCLUSIONS
  We have shown that GERD patients with sleep disturbance have significantly enhanced heartburn perception to capsaicin infusion as compared with those with normal sleep. Our findings suggest that sleep disturbance is associated with esophageal hypersensitivity to capsaicin infusion in patients with GERD.
authors.affiliation: Department of Medicine, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation and Tzu Chi University, Hualien, Taiwan.
authors.forename: Chih-Hsun
authors.initials: CH
authors.lastname: Yi
authors.affiliation: Department of Medicine, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation and Tzu Chi University, Hualien, Taiwan.
authors.forename: Wei-Yi
authors.initials: WY
authors.lastname: Lei
authors.affiliation: Department of Medicine, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation and Tzu Chi University, Hualien, Taiwan.
authors.forename: Jui-Sheng
authors.initials: JS
authors.lastname: Hung
authors.affiliation: Department of Medicine, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation and Tzu Chi University, Hualien, Taiwan.
authors.forename: Tso-Tsai
authors.initials: TT
authors.lastname: Liu
authors.affiliation: Lynn Institute for Healthcare Research, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA.
authors.forename: William C
authors.initials: WC
authors.lastname: Orr
authors.affiliation: Department of Medicine, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation and Tzu Chi University, Hualien, Taiwan.
authors.forename: Chien-Lin
authors.initials: CL
authors.lastname: Chen
mesh_terms: D056044:Actigraphy; D000328:Adult; D002211:Capsaicin / Q000008:administration & dosage*; D004947:Esophagus / Q000294:innervation*; D005260:Female; D005764:Gastroesophageal Reflux / Q000150:complications* / Q000175:diagnosis / Q000503:physiopathology / Q000523:psychology; D006356:Heartburn / Q000139:chemically induced / Q000503:physiopathology; D006801:Humans; D008297:Male; D008365:Manometry; D008875:Middle Aged; D010147:Pain Measurement; D058748:Pain Perception; D017288:Pain Threshold; D011237:Predictive Value of Tests; D018689:Sensory System Agents / Q000008:administration & dosage*; D012890:Sleep; D012893:Sleep Wake Disorders / Q000175:diagnosis / Q000209:etiology* / Q000503:physiopathology; D011795:Surveys and Questionnaires; D013997:Time Factors
chemical_list: D018689:Sensory System Agents; D002211:Capsaicin
keywords: GERD; capsaicin; esophageal sensitivity; motility; sleep disturbance