Relevance of sleep disturbance to the integrity and characteristics of secondary peristalsis in patients with gastroesophageal reflux disease.
OBJECTIVE
Sleep disturbance is common in patients with gastroesophageal reflux disease (GERD). Secondary peristalsis is important for clearance of the refluxate from the esophagus. We aimed to test the hypothesis whether secondary peristalsis is impaired in GERD patients with sleep disturbance.


METHODS
Secondary peristalsis was stimulated with slow and rapid air injections into mid-esophagus in 8 age-matched health controls and 41 patients with GERD. Sleep disturbance was assessed by the Pittsburg Sleep Quality Index (PSQI). Objective sleep measures were assessed by ambulatory actigraphy.


RESULTS
The threshold volume for inducing secondary peristalsis during slow air injection was significantly higher in GERD patients with sleep disturbance than healthy controls (14.3 ± 1.2 vs. 8.9 ± 0.5 mL, p < .05). GERD patients with sleep disturbance had higher threshold volume of secondary peristalsis during rapid air injection than GERD patients without sleep disturbance (5.1 ± 0.4 vs. 3.9 ± 0.2 mL, p < .05) and healthy controls (5.1 ± 0.4 vs. 3.6 ± 0.2 mL, p < .05). There was a negative correlation between PSQI score and peristaltic frequency during rapid air injection (r = -.39, p = .01). Secondary peristaltic amplitude during rapid air injection was negatively correlated with wake after sleep onset (r = -.34, p = .04).


CONCLUSIONS
Sleep disturbance is associated with secondary peristaltic response to distension-induced esophageal stimulation in patients with GERD. Our study suggests that sleep disturbance per se may adversely influence the effectiveness of esophageal peristalsis and bolus clearance during sleep in patients with GERD.
a Department of Medicine , Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation and Tzu Chi University , Hualien , Taiwan.
Chih-Hsun
CH
Yi
a Department of Medicine , Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation and Tzu Chi University , Hualien , Taiwan.
Wei-Yi
WY
Lei
a Department of Medicine , Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation and Tzu Chi University , Hualien , Taiwan.
Jui-Sheng
JS
Hung
a Department of Medicine , Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation and Tzu Chi University , Hualien , Taiwan.
Tso-Tsai
TT
Liu
b Department of Physiology, Lynn Institute for Healthcare Research , University of Oklahoma Health Sciences Center , Oklahoma City , OK , USA.
William C
WC
Orr
a Department of Medicine , Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation and Tzu Chi University , Hualien , Taiwan.
Chien-Lin
CL
Chen
D000328:Adult; D016022:Case-Control Studies; D004947:Esophagus / Q000503:physiopathology*; D005260:Female; D005764:Gastroesophageal Reflux / Q000150:complications* / Q000503:physiopathology*; D006801:Humans; D008297:Male; D008365:Manometry; D008875:Middle Aged; D010528:Peristalsis; D011446:Prospective Studies; D012893:Sleep Wake Disorders / Q000150:complications*; D013624:Taiwan
Esophageal motility; GERD; esophagus; secondary peristalsis; sleep disturbance