Airway pH monitoring in patients with suspected obstructive sleep apnoea using the Dx-pH oropharyngeal probe: preliminary report of a prospective cohort study

Correlation Between Rapid Eye Movement Sleep Duration and Laryngopharyngeal Reflux in Patients with Obstructive Sleep Apnea

Objectives: The aim of this study was to investigate the correlation between rapid eye movement (REM) sleep duration and laryngopharyngeal reflux (LPR) in patients with obstructive sleep apnea (OSA). Methods: In all, 99 patients with OSA were enrolled in this study, and the correlation between REM sleep duration and the severity of LPR was analyzed after the polysomnography (PSG) and reflux symptom index (RSI) scores were completed. Subsequently, a multiple linear regression analysis was performed to further clarify the factors affecting LPR. Results: Partial correlation analysis showed that the REM sleep duration was positively correlated with the RSI scores (r = 0.236, P = .022) after controlling for apnea-hypopnea index (AHI), body mass index (BMI), lowest oxygen saturation (LSO2), age, and sex. The multiple linear regression analysis indicated that only REM sleep duration was a factor influencing LPR (t = 2.330, P = .022). Conclusions: Our study found a correlation between REM sleep duration and LPR in OSA patients. The shorter the REM sleep duration, the less severe the LPR symptoms.

Relationship Between Laryngopharyngeal Reflux and Obstructive Sleep Apnea in Adult Males

OBJECTIVE

To investigate the relationship between laryngopharyngeal reflux (LPR) and obstructive sleep apnea (OSA).

METHODS

Patients diagnosed with OSA who were hospitalized in the Department of Otolaryngology-Head and Neck Surgery from November 2021 to April 2022 were selected, and male patients with non-OSA during the same period were selected as the control group. Patients who participated in the study completed the Reflux Symptom Index (RSI), the Reflux Finding Sign (RFS), and 24-hour multichannel intraluminal impedance-pH (MII-pH) monitoring. RSI, RFS, and outcomes of 24 hour-MII-pH monitoring were compared between the OSA group and the control group.

RESULTS

A total of 86 patients were enrolled, of whom 49 were OSA patients and 37 were non-OSA patients. The positive rate of LPR (97.96% vs 75.68%) and the median number of LPR episodes (9 vs 5) were significantly higher in OSA patients than in non-OSA patients (P < 0.01, P < 0.05, respectively). A logistic regression model including body mass index, alcohol consumption, and the presence of OSA showed that having OSA was a risk factor for the occurrence of LPR (P < 0.05, OR [odds ratio] = 9.995, 95% CI [confidence interval] 1.084-92.181). There were correlations between Apnea-Hypopnea Index and the number of non-acid LPR episodes and the number of alkaline LPR episodes (r = 0.243, P < 0.05, r = 0.274, P < 0.05, respectively).

CONCLUSIONS

Having OSA is a risk factor for LPR, and LPR episodes occur more frequently in patients with OSA compared to those without OSA. When OSA is comorbid with LPR, the occurrence of alkaline LPR, such as bile reflux, should be a concurrent concern.

A Comparison Between W Score and RYAN Score in Diagnosing Laryngopharyngeal Reflux Disease

OBJECTIVE

To assess the diagnostic value of the W score in differentiating laryngopharyngeal reflux disease (LPRD) patients from the normal population by pharyngeal pH (Dx-pH) monitoring, compared with the RYAN score.

METHODS

One hundred and eight patients with suspected LPRD and complete follow-up results after more than 8 weeks of anti-reflux therapy were enrolled from the Department of Otolaryngology-Head and Neck Surgery, Gastroenterology and Respiratory Medicine of seven hospitals. Their Dx-pH monitoring data before treatment were reanalyzed to obtain the W score in addition to the RYAN score and then the diagnostic sensitivity and specificity were compared and evaluated with reference to the result of anti-reflux therapy.

RESULTS

In eighty-seven (80.6%) cases, anti-reflux therapy was effective, and in 21 patients (19.4%), therapy was ineffective. Twenty-seven patients (25.0%) had a positive RYAN score. The W score was positive in 79 (73.1%) patients. There were 52 patients who had a negative RYAN score, but a positive W score. The diagnostic sensitivity, specificity, positive predictive value, and negative predictive value of the RYAN score were 28.7%, 90.5%, 92.6%, and 23.5%, respectively (kappa = 0.092, P = 0.068), whereas those of the W score for LPRD was 83.9%, 71.4%, 92.4%, and 51.7%, respectively (kappa = 0.484, P < 0.001).

CONCLUSIONS

W score is much more sensitive for the diagnosis of LPRD. Prospective studies with larger patient populations are necessary to validate and improve diagnostic efficacy.

TRIAL REGISTRATION

Chinese Clinical Trial Registry: ChiCTR1800014931.

Temporal Association Between Respiratory Events and Reflux in Patients With Obstructive Sleep Apnea and Laryngopharyngeal Reflux

STUDY OBJECTIVES

The aim of the current study was to test the hypothesis that there is a temporal correlation between reflux episodes and respiratory events in patients with laryngopharyngeal reflux and obstructive sleep apnea.

METHODS

Adults with clinically diagnosed laryngopharyngeal reflux confirmed by two validated instruments (reflux symptom index ≥ 13 and reflux finding score ≥ 7) and obstructive sleep apnea (OSA) underwent full polysomnography with concomitant and synchronized multichannel intraluminal impedance-pH esophageal monitoring. The apnea-hypopnea and arousal indexes that occurred 15, 30, and 45 minutes before and after each reflux episode were recorded and compared to full-night apnea and hypopnea and arousal index.

RESULTS

We studied 27 patients (14 males, age 51.7 ± 9.1 years, body mass index 32.4 ± 4.2 kg/m²) with laryngopharyngeal reflux (reflux symptom index 16 ± 2 and reflux finding score 12 ± 3) and OSA (apnea-hypopnea index = 32.3 ± 28.4 events/h). We evaluated 102 reflux episodes. Almost half of the reflux episodes occurred while awake (43.1%) and only five reflux episodes (4.9%) occurred during an obstructive respiratory event. The apnea and hypopnea and arousal indexes 15, 30, and 45 minutes before and after reflux episodes were lower than full-night apnea and hypopnea and arousal indexes, respectively.

CONCLUSIONS

Among patients with well-established laryngopharyngeal reflux and OSA, there is no temporal association between reflux and obstructive respiratory events. Even though the data comprised a small sample size, it seems that a more complex mechanism is involved with these two highly prevalent diseases.