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Sgaria VP, Cielo CA, Bortagarai FM, Fleig AHD, Callegaro CC. CPAP Treatment Improves Quality of Life and Self-perception of Voice Impairment in Patients with OSA. J Voice 2024:S0892-1997(24)00026-2. [PMID: 38519333 DOI: 10.1016/j.jvoice.2024.02.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2023] [Revised: 02/01/2024] [Accepted: 02/05/2024] [Indexed: 03/24/2024]
Abstract
OBJECTIVE The purpose of this study is to examine vocal fatigue and impairment, gastroesophageal symptoms, dysphagia risk, and sleep-related quality of life in individuals with obstructive sleep apnea (OSA) who have been treated with continuous positive airway pressure (CPAP) compared to those who have not received treatment. METHODS Fifty-four participants diagnosed with OSA completed an online research form. Of these, 29 were receiving CPAP treatment, while 25 were not undergoing treatment. The following instruments were used: Vocal Fatigue Index, Voice Handicap Index, Gastroesophageal symptoms, Eating Assessment Tool, and Quebec Sleep Questionnaire. RESULTS The group that received CPAP treatment had significantly lower scores in the functional domain and total Voice Handicap Index. They also experienced fewer symptoms of regurgitation, reduced daytime sleepiness, fewer nocturnal symptoms, and better emotional and social interactions in their quality of life compared to the untreated group. There were no significant differences in voice fatigue and dysphagia risk between the groups. CONCLUSION Individuals treated with CPAP experience reduced vocal impairment, fewer regurgitation symptoms, and improvement in the emotional and social interactions domains of their quality of life compared to individuals without treatment.
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Affiliation(s)
- Victória Possebon Sgaria
- UFSM Federal University of Santa Maria, Graduate Program in Human Communication Disorders, Santa Maria, Rio Grande do Sul, Brazil
| | - Carla Aparecida Cielo
- UFSM Federal University of Santa Maria, Graduate Program in Human Communication Disorders, Santa Maria, Rio Grande do Sul, Brazil; UFSM Federal University of Santa Maria, Department of Speech Therapy, Voice Laboratory, Santa Maria, Rio Grande do Sul, Brazil
| | - Francine Manara Bortagarai
- UFSM Federal University of Santa Maria, Laboratory of Physiology and Rehabilitation, Santa Maria, Rio Grande do Sul, Brazil
| | | | - Carine Cristina Callegaro
- UFSM Federal University of Santa Maria, Graduate Program in Human Communication Disorders, Santa Maria, Rio Grande do Sul, Brazil; UFSM Federal University of Santa Maria, Department of Physiotherapy, Laboratory of Physiology and Rehabilitation, Santa Maria, Rio Grande do Sul, Brazil.
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Emilsson ÖI, Aspelund T, Janson C, Benediktsdottir B, Juliusson S, Maislin G, Pack AI, Keenan BT, Gislason T. Positive airway pressure treatment affects respiratory symptoms and gastro-oesophageal reflux: the Icelandic Sleep Apnea Cohort Study. ERJ Open Res 2023; 9:00387-2023. [PMID: 37817868 PMCID: PMC10561083 DOI: 10.1183/23120541.00387-2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Accepted: 07/24/2023] [Indexed: 10/12/2023] Open
Abstract
Aim To study the effect of positive airway pressure (PAP) treatment on nocturnal gastro-oesophageal reflux (nGOR) and respiratory symptoms among clinical obstructive sleep apnoea (OSA) patients. Methods 822 patients newly diagnosed with OSA referred for PAP treatment were recruited. 732 patients had a 2-year follow-up visit with continuous PAP compliance data (366 full PAP users, 366 partial/non-PAP users). They answered questionnaires, including reporting of nGOR, sleep and respiratory symptoms and general health. Patients with nGOR symptoms once a week or more were defined as "with nGOR". Those without nGOR symptoms and nGOR medication were defined as "no nGOR". Others were defined as "possible nGOR". Results At 2-year follow-up, PAP treatment among full users resulted in decreased nGOR (adjusted OR 0.58, 95% CI 0.40-0.86) and wheezing (adjusted OR 0.56, 95% CI 0.35-0.88) compared with partial/non-PAP users. Decreased nGOR, among both full and partial/non-users of PAP treatment, was associated with a decrease in productive morning cough (adjusted OR 4.70, 95% CI 2.22-9.99) and a decrease in chronic bronchitis (adjusted OR 3.86, 95% CI 1.74-8.58), but not decreased wheezing (adjusted OR 0.90, 95% CI 0.39-2.08). A mediation analysis found that PAP treatment directly led to a decrease in wheezing, not mediated through nGOR. Conversely, PAP treatment decreased productive cough mediated through a decrease in nGOR. Conclusion In an unselected group of OSA patients, PAP treatment for 2 years was associated with a decrease in nGOR and respiratory symptoms. The PAP treatment itself was associated with less wheezing. A decrease in nGOR through PAP treatment was associated with a decrease in productive cough.
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Affiliation(s)
- Össur Ingi Emilsson
- Department of Sleep, Landspitali – The National University Hospital of Iceland, Reykjavik, Iceland
- Faculty of Medicine, University of Iceland, Reykjavik, Iceland
- Department of Medical Sciences: Respiratory Medicine and Allergology, Uppsala University, Uppsala, Sweden
| | - Thor Aspelund
- Centre for Public Health Sciences, University of Iceland, Reykjavik, Iceland
| | - Christer Janson
- Department of Medical Sciences: Respiratory Medicine and Allergology, Uppsala University, Uppsala, Sweden
| | - Bryndis Benediktsdottir
- Department of Sleep, Landspitali – The National University Hospital of Iceland, Reykjavik, Iceland
- Faculty of Medicine, University of Iceland, Reykjavik, Iceland
| | - Sigurdur Juliusson
- Department of Otolaryngology, Landspitali – The National University Hospital of Iceland, Reykjavik, Iceland
| | - Greg Maislin
- Division of Sleep Medicine/Department of Medicine, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania
| | - Allan I. Pack
- Division of Sleep Medicine/Department of Medicine, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania
| | - Brendan T. Keenan
- Division of Sleep Medicine/Department of Medicine, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania
| | - Thorarinn Gislason
- Department of Sleep, Landspitali – The National University Hospital of Iceland, Reykjavik, Iceland
- Faculty of Medicine, University of Iceland, Reykjavik, Iceland
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El Hage Chehade N, Fu Y, Ghoneim S, Shah S, Song G, Fass R. Association between obstructive sleep apnea and gastroesophageal reflux disease: A systematic review and meta-analysis. J Gastroenterol Hepatol 2023; 38:1244-1251. [PMID: 37300443 DOI: 10.1111/jgh.16245] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Accepted: 05/16/2023] [Indexed: 06/12/2023]
Abstract
BACKGROUND AND AIM We aim to conduct a systematic review and determine the association between obstructive sleep apnea (OSA) and gastroesophageal reflux disease (GERD). METHODS Literature search for eligible studies was performed across major databases. The main endpoint was to assess the association between GERD and OSA. Subgroup analyses were performed to determine this strength of the association stratified by the diagnostic tools used for OSA (nocturnal polysomnogram or Berlin questionnaire) and GERD (validated reflux questionnaire or esophagogastroduodenoscopy). We also compared sleep efficiency, apnea hypopnea index, oxygen desaturation index, and Epworth Sleepiness Scale in OSA patients with or without GERD. Results were pooled together using Reviewer Manager 5.4. RESULTS Six studies involving 2950 patients with either GERD or OSA were included in the pooled analysis. Our findings suggest that there was a statistically significant unidirectional association between GERD and OSA (odds ratio [OR] = 1.53, P = 0.0001). Subgroup analyses redemonstrated an OSA-GERD association irrespective of the tools used for diagnosing either GERD or OSA (P = 0.24 and P = 0.82, respectively). Sensitivity analyses demonstrated the same association after controlling for gender (OR = 1.63), BMI (OR = 1.81), smoking (OR = 1.45), and alcohol consumption (OR = 1.79). In patients with OSA, there were no statistically significant differences between patients with or without GERD in terms of apnea hypopnea index (P = 0.30), sleep efficiency (P = 0.67), oxygen desaturation index (P = 0.39), and Epworth Sleepiness Scale (P = 0.07). CONCLUSION There exists an association between OSA and GERD that is independent of the modalities used for screening or diagnosing both disorders. However, the presence of GERD did not affect the severity of OSA.
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Affiliation(s)
- Nabil El Hage Chehade
- Department of Internal Medicine, MetroHealth Medical Center, Case Western Reserve University, Cleveland, Ohio, USA
| | - Yuhan Fu
- Department of Internal Medicine, MetroHealth Medical Center, Case Western Reserve University, Cleveland, Ohio, USA
| | - Sara Ghoneim
- Division of Gastroenterology and Hepatology, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Sagar Shah
- Department of Internal Medicine, Ronald Reagan Medical Center, University of California Los Angeles, Los Angeles, California, USA
| | - Gengqing Song
- Division of Gastroenterology and Hepatology, Esophageal and Swallowing Center, MetroHealth Medical Center, Case Western Reserve University, Cleveland, Ohio, USA
| | - Ronnie Fass
- Division of Gastroenterology and Hepatology, Esophageal and Swallowing Center, MetroHealth Medical Center, Case Western Reserve University, Cleveland, Ohio, USA
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Chen G, Gong X, Liu S, Xie J, Wang Y, Guo W, Liao W, Song L, Zhang X. Causal analysis between gastro-oesophageal reflux disease and obstructive sleep apnoea. ERJ Open Res 2023; 9:00127-2023. [PMID: 37650083 PMCID: PMC10463038 DOI: 10.1183/23120541.00127-2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2023] [Accepted: 05/28/2023] [Indexed: 09/01/2023] Open
Abstract
Background Based on evidence from existing observational research, clarifying the causal relationship between gastro-oesophageal reflux disease (GORD) and obstructive sleep apnoea (OSA) is challenging. Here, Mendelian randomisation, a method based on genetics, was used to provide new evidence for causality. Methods Summary statistics from two publicly available genome-wide association studies were used to evaluate the causal relationship between GORD and OSA (the GORD database was used as an exposure variable and the OSA database as an outcome). Inverse variance weighting was used as the main analytical tool in Mendelian randomisation to estimate causal effects. The robustness of the results was evaluated by sensitivity analysis. Possible mediators were evaluated using multivariate Mendelian randomisation. Results A statistically significant causal relationship was observed between GORD and OSA (OR 1.597, 95% CI 1.401-1.821, p<0.001), and similar results were observed in weighted median and Mendelian randomisation-Egger regression analyses. No bias was found in the sensitivity analysis of Mendelian randomisation estimation. Multivariate Mendelian randomisation showed that GORD significantly increased the risk of developing OSA, even when the possible mediator was excluded (OR 1.107, 95% CI 1.101-1.212, p<0.001). Conclusion Our study confirmed a causal relationship between GORD and OSA and suggests that intervention measures should be taken for patients with GORD to prevent the occurrence of OSA.
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Affiliation(s)
- Gui Chen
- State Key Laboratory of Respiratory Disease, Department of Otolaryngology – Head and Neck Surgery, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
- These authors contributed equally
| | - Xin Gong
- Department of Otolaryngology – Head and Neck Surgery, Wushan County People's Hospital of Chongqing, Wushan, China
- These authors contributed equally
| | - Shenrong Liu
- Department of Cardiology, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Junyang Xie
- State Key Laboratory of Respiratory Disease, Department of Otolaryngology – Head and Neck Surgery, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Yingqi Wang
- State Key Laboratory of Respiratory Disease, Department of Otolaryngology – Head and Neck Surgery, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Wucheng Guo
- Department of Stomatology, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Wenjing Liao
- State Key Laboratory of Respiratory Disease, Department of Otolaryngology – Head and Neck Surgery, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Lijuan Song
- State Key Laboratory of Respiratory Disease, Department of Otolaryngology – Head and Neck Surgery, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Xiaowen Zhang
- State Key Laboratory of Respiratory Disease, Department of Otolaryngology – Head and Neck Surgery, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
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Genzor S, Prasko J, Mizera J, Kufa J, Zurkova M, Jakubec P, Vykopal M, Vanek J. Sex transition from female to male as a risk factor for sleep-disordered breathing. Sleep Med 2023; 102:180-185. [PMID: 36701832 DOI: 10.1016/j.sleep.2023.01.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Revised: 01/02/2023] [Accepted: 01/10/2023] [Indexed: 01/16/2023]
Abstract
AIM The female-to-male (FtM) sex transition requires lifelong supplementation with male sex hormones, resulting in high prevalence of weight gain, fat redistribution and other metabolic changes. Although sleep-disordered breathing (SDB) data for this group of patients are very limited, increased prevalence is expected. We report a mini-series of six case reports of FtM transsexuals treated in our centre. PATIENTS AND METHODS All reported cases are consecutive patients referred to a department of respiratory diseases and tuberculosis of a university hospital from 2017 to 2022. The standard pulmonary examination was performed, followed by limited polysomnography. RESULTS In all FtM subjects, SDB was present and continuous positive airway pressure (CPAP) therapy was indicated. The sex transition process was completed in three individuals while the other three only took testosterone supplementation at the assessment time. The subjects' age ranged from 21 to 38 years, the apnoea-hypopnea index ranged from 17.3 to 104.1, and the BMI was 33.48-43.41. The CPAP therapy was effective in five patients, with one requiring bi-level positive airway pressure therapy. One subject committed suicide before the first check-up, four patients had a good level of compliance at one-year follow-up, and one had insufficient CPAP adherence. CONCLUSION SDB decreases the quality of life and life expectancy of FtM individuals. Their prognosis is undoubtedly better with effective treatment. Hence, obese FtM subjects should be considered at risk and screened for SDB.
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Affiliation(s)
- Samuel Genzor
- Department of Respiratory Diseases and Tuberculosis, Faculty of Medicine and Dentistry, Palacky University Olomouc and University Hospital Olomouc, Czech Republic; Center for Digital Health, Faculty of Medicine and Dentistry, Palacky University Olomouc and University Hospital Olomouc, Czech republic
| | - Jan Prasko
- Department of Psychiatry, University Hospital Olomouc and Faculty of Medicine and Dentistry, Palacky University Olomouc, Czech Republic; Institute for Postgraduate Education in Health Care, Prague, Czech Republic; Department of Psychology Sciences, Faculty of Social Science and Health Care, Constantine the Philosopher University in Nitra, Slovak Republic.
| | - Jan Mizera
- Department of Respiratory Diseases and Tuberculosis, Faculty of Medicine and Dentistry, Palacky University Olomouc and University Hospital Olomouc, Czech Republic
| | - Jiri Kufa
- Department of Respiratory Diseases and Tuberculosis, Faculty of Medicine and Dentistry, Palacky University Olomouc and University Hospital Olomouc, Czech Republic
| | - Monika Zurkova
- Department of Respiratory Diseases and Tuberculosis, Faculty of Medicine and Dentistry, Palacky University Olomouc and University Hospital Olomouc, Czech Republic
| | - Petr Jakubec
- Department of Respiratory Diseases and Tuberculosis, Faculty of Medicine and Dentistry, Palacky University Olomouc and University Hospital Olomouc, Czech Republic
| | - Martin Vykopal
- Department of Respiratory Diseases and Tuberculosis, Faculty of Medicine and Dentistry, Palacky University Olomouc and University Hospital Olomouc, Czech Republic
| | - Jakub Vanek
- Department of Psychiatry, University Hospital Olomouc and Faculty of Medicine and Dentistry, Palacky University Olomouc, Czech Republic
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Choi BY, Kim JK, Cho JH. A Review of a Recent Meta-Analysis Study on Obstructive Sleep Apnea. JOURNAL OF RHINOLOGY 2022. [DOI: 10.18787/jr.2022.00422] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
This paper summarizes a recent meta-analysis of various topics in obstructive sleep apnea (OSA). In addition to cardiovascular disease and neurocognitive dysfunction, a wide variety of diseases have been associated with OSA, and associations with cancer have also been reported. Although continuous positive airway pressure is a very effective treatment, the results have shown that it does not reduce the incidence of various complications. It has been reported that uvulopalatopharyngoplasty was effective, and robotic surgery for the tongue root and hypoglossal nerve stimulation were also effective. The effectiveness of various medications to reduce daytime sleepiness has also been demonstrated. Although exercise lowered the apnea-hypopnea index, it was not related to changes in body composition, and it was also reported that exercise combined with weight control were effective. Additionally, interesting and clinically meaningful meta-analysis results were summarized and presented.
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The Impact of Transoral Robotic Surgery on Erectile Dysfunction and Lower Urinary Tract Symptoms in Male Patients with Moderate-to-Severe Obstructive Sleep Apnea. Healthcare (Basel) 2022; 10:healthcare10091633. [PMID: 36141245 PMCID: PMC9498748 DOI: 10.3390/healthcare10091633] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Revised: 08/18/2022] [Accepted: 08/24/2022] [Indexed: 11/17/2022] Open
Abstract
Obstructive sleep apnea (OSA), lower urinary tract symptoms (LUTS), and erectile dysfunction (ED) are chronic conditions that seriously affect middle-aged men. This study aimed to evaluate the changes in the presence of these conditions after transoral robotic surgery (TORS) for OSA. This prospective observational study recruited 48 men with moderate-to-severe OSA (mean age 40.6 ± 8.1 years) who underwent TORS from October 2019 to November 2021 at a tertiary center. Baseline polysomnographic parameters, Epworth Sleepiness Scale (ESS), and demographic characteristics were measured. The evaluations of LUTS and ED were based on self-administered International Prostate Symptom Score (IPSS) and International Index of Erectile Function (IIEF-5) questionnaires, respectively, before TORS. The treatment outcomes were assessed three months postoperatively in the patients undergoing TORS due to moderate-to-severe OSA. There was significant Apnea-Hypopnea Index (AHI) reduction from 53.10 ± 25.77 to 31.66 ± 20.34 three months after undergoing TORS (p < 0.001). There was also a significant decrease in the total IPSS score (5.06 ± 5.42 at baseline to 2.98 ± 2.71 at three months postoperatively, p = 0.001), the storage domain, and the voiding domain (p < 0.05). The ED also improved significantly, as seen in the IIEF score (20.98 ± 3.32 to 22.17± 3.60, p = 0.007). The reduction of AHI was associated with changes in body weight and the lowest oxygen saturation (SpO2) levels during sleep (rho = 0.395, p = 0.005; rho = 0.526, p < 0.001, respectively). However, the reduction in AHI was not significantly associated with improvement in IPSS or IIEF scores (p > 0.05). For men with moderate-to-severe OSA, TORS can significantly improve the polysomnography parameters, sleep-related questionnaire scores, and quality of life, and alleviate ED and LUTS. AHI reduction is not a crucial factor for ED and LUTS improvement after TORS for OSA, especially in ED.
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Huang Z, Aarab G, Chattrattrai T, Su N, Volgenant CMC, Hilgevoord AAJ, de Vries N, Lobbezoo F. Associated factors of primary snoring and obstructive sleep apnea in patients with sleep bruxism: a questionnaire study. J Oral Rehabil 2022; 49:970-979. [PMID: 35789500 PMCID: PMC9543241 DOI: 10.1111/joor.13354] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Revised: 06/16/2022] [Accepted: 06/20/2022] [Indexed: 11/28/2022]
Abstract
Background By being aware of the associated factors of primary snoring (PS) and obstructive sleep apnoea (OSA) in sleep bruxism (SB) patients, dentists may contribute to the screening and early recognition of SB patients with PS or OSA. Objective To identify the associated factors of PS and OSA from questionnaire‐based data in SB patients. Methods A total of 968 self‐reported SB patients (31.6% men; median age 44.5 years) were retrospectively enrolled. Self‐reported sleep‐related breathing status (viz., no sleep‐related breathing condition, PS and OSA) was the dependent variable. Independent variables were questionnaire‐based data on demographics, lifestyle, psychological status, pain and sleep. Results For PS, no statistically significant associated factor was identified in analyses. For OSA, increased age (OR = 1.04 [1.03–1.06]), male gender (OR = 3.33 [2.17–5.00]), daily alcohol consumption (OR = 1.96 [1.18–3.33]), depression (OR = 1.10 [1.06–1.14]), daytime sleepiness (OR = 2.94 [1.85–4.76]) and high risk of gastroesophageal reflux disease (GERD; OR = 2.63 [1.52–4.76]) were found to be significant risk factors, while high risk of temporomandibular disorder (TMD) pain (OR = 0.51 [0.30–0.86]) and chronic pain (OR = 0.73 [0.59–0.90]) were significant protective factors. These results were confirmed in the subsequent network analysis. Conclusion Within the limitations of this study, no associated factor is identified for PS. For OSA, dentists should keep in mind that increased age, male gender, daily alcohol consumption, depression, daytime sleepiness and high GERD risk are associated with increased OSA risk in SB patients, while high TMD‐pain risk and chronic pain are associated with decreased OSA risk in this population.
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Affiliation(s)
- Zhengfei Huang
- Department of Orofacial Pain and Dysfunction Academic Center for Dentistry Amsterdam (ACTA), University of Amsterdam and Vrije Universiteit Amsterdam Amsterdam the Netherlands
- Department of Clinical Neurophysiology OLVG Amsterdam the Netherlands
| | - Ghizlane Aarab
- Department of Orofacial Pain and Dysfunction Academic Center for Dentistry Amsterdam (ACTA), University of Amsterdam and Vrije Universiteit Amsterdam Amsterdam the Netherlands
| | - Thiprawee Chattrattrai
- Department of Orofacial Pain and Dysfunction Academic Center for Dentistry Amsterdam (ACTA), University of Amsterdam and Vrije Universiteit Amsterdam Amsterdam the Netherlands
| | - Naichuan Su
- Department of Oral Public Health Academic Center for Dentistry Amsterdam (ACTA), University of Amsterdam and Vrije Universiteit Amsterdam Amsterdam the Netherlands
| | - Catherine M. C. Volgenant
- Department of Preventive Dentistry Academic Center for Dentistry Amsterdam (ACTA), University of Amsterdam and Vrije Universiteit Amsterdam Amsterdam the Netherlands
| | | | - Nico de Vries
- Department of Orofacial Pain and Dysfunction Academic Center for Dentistry Amsterdam (ACTA), University of Amsterdam and Vrije Universiteit Amsterdam Amsterdam the Netherlands
- Department of Otorhinolaryngology ‐ Head and Neck Surgery OLVG Amsterdam the Netherlands
- Department of Otorhinolaryngology ‐ Head and Neck Surgery Antwerp University Hospital (UZA) Antwerp Belgium
| | - Frank Lobbezoo
- Department of Orofacial Pain and Dysfunction Academic Center for Dentistry Amsterdam (ACTA), University of Amsterdam and Vrije Universiteit Amsterdam Amsterdam the Netherlands
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Reduced gastroesophageal reflux disease symptom severity following upper airway surgery for comorbid obstructive sleep apnea. Am J Otolaryngol 2022; 43:103340. [PMID: 34923278 DOI: 10.1016/j.amjoto.2021.103340] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2021] [Accepted: 12/11/2021] [Indexed: 11/21/2022]
Abstract
PURPOSE To evaluate patient-reported quality of life pertaining to gastroesophageal reflux disease symptoms in patients undergoing upper airway surgery for comorbid obstructive sleep apnea. MATERIALS AND METHODS A prospective survey-based study was conducted on patients with gastroesophageal reflux disease and comorbid obstructive sleep apnea receiving surgery from July 2020-December 2020. Patients completed the Gastroesophageal Reflux Disease-Health Related Quality of Life Questionnaire at two time-points: one week before surgery and at 6 months following surgery. Disease-related symptoms were rated from 0 (no symptoms) to 5 (incapacitating symptoms). Patient survey scores, demographics, medications, and sleep study parameters were collected for analysis. A p-value <0.05 indicated statistical significance. RESULTS Twenty-two patients completed the baseline preoperative and 6-month postoperative questionnaires. Median baseline vs. 6-month survey scores significantly decreased for symptoms including heartburn in general (3.0 vs. 2.0, p = 0.006), when lying down (2.5 vs. 1.5, p = 0.046), when standing (2.0 vs 1.0, p = 0.003), following meals (2.0 vs. 2.0, p = 0.042), and cumulative survey score (15.5 vs. 11.0, p = 0.029). Heartburn altering diet or sleep, odynophagia, dysphagia, and medication burden did not change following surgery (p > 0.05). More patients were satisfied with their postoperative condition compared to baseline, however this did not reach statistical significance (40.9% vs. 18.2%, p = 0.18). CONCLUSIONS Our results suggest that upper airway surgery to treat obstructive sleep apnea may have a positive impact on patient-reported symptoms of gastroesophageal reflux disease, and further investigation into the role of surgery in this setting for improvement of both quality of life and true clinical disease severity is merited.
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Kurin M, Shibli F, Kitayama Y, Kim Y, Fass R. Sorting out the Relationship between Gastroesophageal Reflux Disease and Sleep. Curr Gastroenterol Rep 2021; 23:15. [PMID: 34338891 DOI: 10.1007/s11894-021-00815-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/25/2021] [Indexed: 12/14/2022]
Abstract
PURPOSE OF REVIEW Gastroesophageal reflux disease is one of the most common conditions encountered by primary care physicians, gastroenterologists, foregut surgeons and otolaryngologists. While approximately 50% of patients experience nocturnal reflux symptoms, the relationship between gastroesophageal reflux disease and sleep is often overlooked. The aim of this review is to provide an update on the current understanding of this relationship and its clinical implications. Recent studies pertaining to the association between GERD and sleep with focus on sleep disturbances, obstructive sleep apnea, extraesophageal manifestations of GERD and treatment are discussed. RECENT FINDINGS There is a close relationship between GERD and sleep disturbances, but the nature of this relationship remains to be elucidated. Similarly, new data supports the association between GERD and obstructive sleep apnea, but whether this association is independent of confounding risk factors remains unresolved. Extraesophageal manifestations due to nocturnal GERD are primarily respiratory and can be explained by microaspiration and vagally-induced bronchospasm. Treatment of nocturnal GERD, both pharmacologically and surgically, improves sleep quality. Conversely, pharmacologic treatment of sleep disorders can improve nocturnal GERD symptoms. There is a bi-directional relationship between GERD and sleep. GERD is associated with various sleep disturbances. Sleep deficiency can exacerbate GERD. There is an association between extraesophageal manifestations and nocturnal GERD. Treatment directed towards GERD can improve sleep experience, and treatment directed to improve sleep can improve GERD symptoms.
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Affiliation(s)
- Michael Kurin
- Digestive Health Institute, Division of Gastroenterology and Hepatology, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - Fahmi Shibli
- The Esophageal and Swallowing Center, Division of Gastroenterology and Hepatology, MetroHealth Medical Center, Case Western Reserve University, 2500 MetroHealth Drive, Cleveland, OH, 44109, USA
| | - Yoshitaka Kitayama
- The Esophageal and Swallowing Center, Division of Gastroenterology and Hepatology, MetroHealth Medical Center, Case Western Reserve University, 2500 MetroHealth Drive, Cleveland, OH, 44109, USA
| | - Yeseong Kim
- The Esophageal and Swallowing Center, Division of Gastroenterology and Hepatology, MetroHealth Medical Center, Case Western Reserve University, 2500 MetroHealth Drive, Cleveland, OH, 44109, USA
| | - Ronnie Fass
- The Esophageal and Swallowing Center, Division of Gastroenterology and Hepatology, MetroHealth Medical Center, Case Western Reserve University, 2500 MetroHealth Drive, Cleveland, OH, 44109, USA.
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