Does CPAP treatment lead to gastroesophageal reflux in patients with moderate and severe OSA?

Causal association between obstructive sleep apnea and gastroesophageal reflux disease: A bidirectional two-sample Mendelian randomization study

Objectives: Correlations between obstructive sleep apnea (OSA) and gastroesophageal reflux disease (GERD) have been detected in previous observational studies. However, this association remains uncertain due to the potential presence of selection and confounding biases. Therefore, this bidirectional two-sample Mendelian randomization (MR) study was conducted to evaluate the causal relationship between OSA and GERD.

Methods: In this study, instrumental variables (IVs) for OSA were selected from publicly available genetic summary data (27,207 cases and 280,720 controls). Summary statistics for GERD were obtained from a genome-wide association study of 602,604 individuals. The inverse variance weighted (IVW) method was used as the main MR method. The MR-Egger intercept test, MR pleiotropy residual sum and outlier, and leave-one-out analysis were used to detect pleiotropy. Heterogeneity was detected by Cochran’s Q test.

Results: The IVW results revealed that OSA [odds ratio (OR): 1.19, 95% confidence interval (CI): 1.11–1.28, p = 8.88E-07] was causally associated with the incidence of GERD. Moreover, there was evidence of GERD leading to OSA in the IVW analysis (OR: 1.44, 95%CI: 1.33–1.57, p = 7.74E-19). No directional pleiotropy was detected by the MR-Egger intercept test (all p > 0.05).

Conclusion: This study found that OSA is linked to a higher incidence of GERD, and vice versa. This finding might be helpful for the screening and prevention of these two diseases.

Effect of continuous positive airway pressure on gastroesophageal reflux in patients with obstructive sleep apnea: a meta-analysis

PURPOSE

Gastroesophageal reflux disease (GERD) often occurs in patients with obstructive sleep apnea (OSA). Although continuous positive airway pressure (CPAP) is considered to be the preferred treatment for OSA, the effect of CPAP therapy on reflux events remains controversial. In this study, we utilized meta-analysis to investigate whether or not CPAP treatment reduces the incidence of reflux.

METHODS

Two independent reviewers obtained the data sources from the database of PubMed, Elsevier, Cochrane library, and CNKI using search terms, and then filtered the target articles based on the inclusion and exclusion criteria. RevMan (version 5.3) and STATA (version 12.0) were used for data synthesis. The effect of CPAP treatment on GERD was studied by calculating the weighted mean difference (WMD) and standard deviation (SD) before and after CPAP treatment.

RESULTS

Ten studies involving a total of 272 participants were included in this study. The results showed that the total of WMD before and after CPAP was - 17.68 (95% CI - 30.67 to - 4.69) for percentage time pH < 4, - 24.66 (95% CI - 36.15 to - 13.18) for the longest reflux duration, - 27.53 (95% CI - 49.53 to - 5.52) for number of reflux events, - 49.76 (95% CI - 60.18 to - 39.35) for DeMeester score, - 1.85 (95% CI - 3.00 to - 0.71) for reflux diseases questionnaire (RDQ) score, and - 8.95 (95% CI - 16.00 to - 1.89) for reflux symptom index (RSI). The subgroup analysis demonstrated that the improvement of reflux symptoms was more obvious with the extension of treatment time.

CONCLUSIONS

This meta-analysis showed that CPAP treatment significantly reduces the incidence of reflux events in patients with OSA.

Relationship between night reflux and sleep disturbance in elderly patients with gastroesophageal reflux disease in a tertiary hospital

BACKGROUND

The reflux symptoms of gastroesophageal reflux disease (GERD) seriously affect the quality of life of patients. Daytime reflux is obvious, but the duration of reflux is short, which has little impact on the quality of life. Although the frequency of nocturnal regurgitation is low, its duration is long, which seriously affects the sleep quality of patients. Therefore, GERD nocturnal regurgitation has become one of clinical research hotspots and an important problem to be solved.

AIM

To observe the relationship between night reflux and sleep disturbance in elderly patients with GERD in a tertiary hospital.

METHODS

Two hundred and forty elderly patients with gastroesophageal reflux admitted to the Second Jinhua Hospital of Zhejiang Province from February 2017 to August 2019 were selected as subjects for investigation of the incidence of nocturnal reflux symptoms, manifestations of sleep disorders, and the relationship between nocturnal reflux and sleep disorders.

RESULTS

Of 240 cases of GERD included, 36 (15.0%) had no nocturnal reflux and 204 (85.0%) had. In the past 1 mo, nocturnal reflux developed on average once a week or less in 34 (16.67%) of 204 patients with nocturnal reflux, twice a week in 78 (38.24%), and > 2 times in 52 (25.49%). Of 36 cases without nocturnal reflux symptoms, 9 (25.0%) had a sleep disorder, while all 204 (100.0%) cases with nocturnal reflux suffered from a sleep disorder. The incidence of sleep disorder was significantly higher in patients with nocturnal reflux than in those without (P < 0.05). Approximately 77.94% of the patients had decreased sleep quality. Daytime residual effect was found in 70.10% of patients. Sleep latency was prolonged in 55.88% of patients. When the latency was prolonged, the time to sleep was mainly 30-40 min. The total sleep time was shortened in 53.92% of patients, most of whom had a sleep time of 4-5 h. Among the 204 GERD patients, 106 (51.96%) needed drug therapy for nocturnal reflux, including 36 (33.96%) patients taking rabeprazole orally, 20 (18.87%) taking omeprazole orally, 30 (28.30%) taking cimetidine orally, and 20 (18.87%) taking sleeping pills orally, with an effective rate of 96.23% (102/106).

CONCLUSION

Nocturnal reflux may be one of the reasons affecting sleep disorders in elderly GERD patients. Proton pump inhibitor therapy can be administered in clinical practice.

Protocol: randomised trial to compare nasoduodenal tube and nasogastric tube feeding in infants with bronchiolitis on high-flow nasal cannula; Bronchiolitis and High-flow nasal cannula with Enteral Tube feeding Randomised (BHETR) trial

INTRODUCTION

High-flow nasal cannula (HFNC) is a non-invasive form of respiratory support used increasingly in bronchiolitis. HFNC provides a variable amount of positive pressure similar to continuous positive airway pressure (CPAP). The positive pressure in CPAP can distend and loosen oesophageal sphincter pressure leading to increased reflux. It is unclear if HFNC causes a similar action. Feeding tubes are used to provide nutrition and hydration to patients that are unable to safely take oral feedings. If there is increased reflux from HFNC, this would increase the risk of aspiration. Our institution places nasoduodenal tubes (NDT) to eliminate this risk. The purpose of the study is to infer if there is a difference between NDT and nasogastric tube (NGT) feeding with regard to length of respiratory support, number of emesis, number of chest X-rays and readmission/emergency room revisit rates.

METHODS AND ANALYSIS

Patients with bronchiolitis, on high-flow nasal cannula, and whose primary physicians have decided on feeding tube for nutrition/hydration will be approached for consent and enrolment. Patients will be randomised to NGT or NDT in variable block sizes and stratified into low- and high-risk groups. Outcomes will be analysed by both a frequentist and Bayesian statistical approach.

ETHICS AND DISSEMINATION

The trial was approved by local institutional review board. Every attempt will be made to reduce to an absolute minimum the interval between completion of data collection and release of study results through appropriate dissemination mediums including abstracts, poster presentations and journal publications.

TRIAL REGISTRATION NUMBER

NCT03346850; Pre-results.