title: Associations among gastroesophageal reflux disease, psychological stress, and sleep disturbances in Japanese adults.
abstract: OBJECTIVE
  Gastroesophageal reflux disease (GERD) and psychological stress are associated with sleep disturbances. The aim of the present study was to examine the prevalence of sleep disturbances, anxiety, and depression by GERD subtypes and to identify factors associated with sleep disturbances in general population.
  
  
  METHODS
  A total of 2002 Japanese subjects, who underwent annual health checkups, were enrolled and asked to fill out a questionnaire, including the frequency scale for the symptoms of GERD (FSSG), Athens Insomnia Scale (AIS), Rome III questionnaire, and Hospital Anxiety and Depression Scale (HADS). GERD was divided into asymptomatic erosive reflux disease (a-ERD), symptomatic ERD (s-ERD), and non-erosive reflux disease (NERD), according to the presence or absence of esophageal mucosal injury on endoscopy, and the FSSG scores. Sleep disturbances were diagnosed in subjects with AIS score ≥6.
  
  
  RESULTS
  Prevalence of sleep disturbances was significantly higher in GERD subjects than in controls (35.9 and 14.7%, respectively), especially, in the NERD group (45.1%). Sleep duration was significantly shorter in the s-ERD group compared with other groups. Subjects in the NERD and s-ERD groups showed higher HADS scores, resulting in higher incidences of anxiety and depression than those in the control and a-ERD groups. Reflux symptoms, anxiety, depression, and coexisting functional dyspepsia, but not the presence of esophageal mucosal injury, were associated with an increased odds ratio for sleep disturbances.
  
  
  CONCLUSIONS
  There were significant positive associations among reflux symptoms, psychological stress, and sleep disturbance in Japanese adults. Further studies investigating the efficacy of therapy are needed.
authors: a Department of Gastroenterology , Kashiwara Municipal Hospital , Kashiwara , Japan.
authors: Masatsugu
authors: M
authors: Okuyama
authors: b Department of Gastroenterology , Naniwa Ikuno Hospital , Osaka , Japan.
authors: Osamu
authors: O
authors: Takaishi
authors: a Department of Gastroenterology , Kashiwara Municipal Hospital , Kashiwara , Japan.
authors: Kenichi
authors: K
authors: Nakahara
authors: a Department of Gastroenterology , Kashiwara Municipal Hospital , Kashiwara , Japan.
authors: Narika
authors: N
authors: Iwakura
authors: a Department of Gastroenterology , Kashiwara Municipal Hospital , Kashiwara , Japan.
authors: Tomoki
authors: T
authors: Hasegawa
authors: a Department of Gastroenterology , Kashiwara Municipal Hospital , Kashiwara , Japan.
authors: Maizumi
authors: M
authors: Oyama
authors: a Department of Gastroenterology , Kashiwara Municipal Hospital , Kashiwara , Japan.
authors: Ayumi
authors: A
authors: Inoue
authors: a Department of Gastroenterology , Kashiwara Municipal Hospital , Kashiwara , Japan.
authors: Hirotaka
authors: H
authors: Ishizu
authors: a Department of Gastroenterology , Kashiwara Municipal Hospital , Kashiwara , Japan.
authors: Hiroshi
authors: H
authors: Satoh
authors: c Department of Gastroenterology , Osaka City University Graduate School of Medicine , Osaka , Japan.
authors: Yasuhiro
authors: Y
authors: Fujiwara
mesh_terms: D000328:Adult; D000368:Aged; D001007:Anxiety / Q000523:psychology; D003863:Depression / Q000523:psychology; D004415:Dyspepsia / Q000523:psychology*; D005260:Female; D005764:Gastroesophageal Reflux / Q000150:complications*; D006801:Humans; D015994:Incidence; D007564:Japan; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D011569:Psychiatric Status Rating Scales; D012720:Severity of Illness Index; D012893:Sleep Wake Disorders / Q000453:epidemiology*; D013315:Stress, Psychological / Q000175:diagnosis* / Q000453:epidemiology*; D011795:Surveys and Questionnaires
keywords: Gastroesophageal reflux disease; psychological stress; reflux symptoms; sleep disturbances