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Patients With Sleep Disturbances May Have GERD Even Without Heartburn Symptoms: Presented at ACG

By Paula Moyer

HONOLULU, HI -- November 7, 2005 -- Gastroesophageal reflux disease (GERD) may cause nocturnal arousal and awakening even in patients who do not have heartburn symptoms, according to investigators who presented their findings here at the 70^th annual meeting of the American College of Gastroenterology (ACG).

"This study involved patients without significant heartburn symptoms, but who were experiencing acid reflux during sleep," said principal investigator William C. Orr, PhD, Professor of Physiology, University of Oklahoma Health Sciences Center, and Director, National Sleep Foundation, Oklahoma City, Oklahoma, United States.

Dr. Orr said physicians should suspect GERD when patients present with unexplained sleep interruptions, even if heartburn symptoms are absent. He presented study findings on November 1^st.

Prior research established that patients with GERD often report sleeping poorly and that sleep arousals had been associated with contact of refluxed gastric acid with esophageal mucosa, Dr. Orr explained. Other investigators had also found that GERD-related respiratory symptoms could occur without heartburn sensations, he said.

Therefore, Dr. Orr and colleagues undertook a study to determine whether people who have poor sleep but no significant heartburn are experiencing silent GERD.

The team recruited 104 subjects who complained of poor sleep or sleep interruptions at least 3 nights per week. After a 2-week run in period with recorded sleep diaries, the investigators identified 81 subjects who met the criteria for sleep complaints. These subjects completed two polysomnographic sleep evaluations that included distal esophageal pH assessment. The polysomnographic studies were separated by 10 to 21 days.

Among these patients, 26% had reflux on at least 1 night. The study defined reflux as an esophageal pH of less than 4 and persisting for more than 30 seconds on at least 1 night. Among those with reflux, 21% had an acid contact time (ACT) for more than 4% of the night, and 25% had at least one event that lasted more than 5 minutes.

The average ACT was 28% of the night, and each reflux episode lasted for an average of 34.4 minutes. Arousal or awakening occurred in virtually all of the recorded reflux events (94%).

Dr. Orr noted that when the investigators compared these results to a historical comparison group of symptomatic GERD patients with concomitant sleep complaints, the average ACT was significantly lower (12%; P < .05) in the historical controls.

The study was funded by AstraZeneca, which manufactures Nexium and Prilosec.


[Presentation title: "Silent" Esophageal Reflux in Patients with Unexplained Sleep Complaints. Abstract 308]

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