Gislason Thorarinn, Janson Christer, Vermeire Paul, Plaschke Peter, Björnsson Eythor, Gislason David, Boman Gunnar
Department of Lung Medicine, Vifilsstadir Hospital, Gardabaer, Iceland.
Chest. 2002 Jan;121(1):158-63. doi: 10.1378/chest.121.1.158.
To estimate the possible association between reported symptoms of gastroesophageal reflux (GER) after bedtime, sleep-disordered breathing, respiratory symptoms, and asthma.
Cross-sectional international population survey.
Participants consisted of 2,661 subjects (age range, 20 to 48 years) from three countries (Iceland, Belgium, and Sweden), of whom 2,202 were randomly selected from the general population and 459 were added because of reported asthma.
The investigation included a structured interview, spirometry, methacholine challenge, peak flow diary, skin-prick tests, and a questionnaire on sleep disturbances.
In the random population sample, 101 subjects (4.6%) reported GER, which was defined as the occurrence of heartburn or belching after going to bed at least once per week. Subjects with nocturnal GER more often were overweight and had symptoms of sleep-disordered breathing than participants not reporting GER. Participants with GER were more likely to report wheezing (adjusted odds ratio [OR], 2.5), breathlessness at rest (adjusted OR, 2.8), and nocturnal breathlessness (adjusted OR, 2.9), and they had increased peak flow variability compared to the subjects without GER. Physician-diagnosed current asthma was reported by 9% of subjects with GER compared to 4% of those not reporting GER (p < 0.05). Subjects with the combination of asthma and GER had a higher prevalence of nocturnal cough, morning phlegm, sleep-related symptoms, and higher peak flow variability than subjects with asthma alone.
The occurrence of GER after bedtime is strongly associated with both asthma and respiratory symptoms, as well as symptoms of obstructive sleep apnea syndrome. The partial narrowing or occlusion of the upper airway during sleep, followed by an increase in intrathoracic pressure, might predispose the patient to nocturnal GER and, consequently, to respiratory symptoms.
评估就寝后报告的胃食管反流（GER）症状、睡眠呼吸紊乱、呼吸道症状和哮喘之间可能存在的关联。
横断面国际人群调查。
参与者包括来自三个国家（冰岛、比利时和瑞典）的2661名受试者（年龄范围为20至48岁），其中2202名是从普通人群中随机选取的，另外459名因报告患有哮喘而被纳入。
调查包括结构化访谈、肺活量测定、乙酰甲胆碱激发试验、呼气峰值流速日记、皮肤点刺试验以及一份关于睡眠障碍的问卷。
在随机抽取的人群样本中，101名受试者（4.6%）报告有GER，GER定义为每周至少一次上床睡觉后出现烧心或嗳气。夜间有GER的受试者比未报告GER的参与者更常超重且有睡眠呼吸紊乱症状。有GER的参与者更有可能报告喘息（调整后的优势比[OR]为2.5）、静息时呼吸急促（调整后的OR为2.8）和夜间呼吸急促（调整后的OR为2.9），并且与没有GER的受试者相比，他们的呼气峰值流速变异性增加。报告有医生诊断的当前哮喘的受试者中，有GER的占9%，而未报告GER的受试者中这一比例为4%（p<0.05）。与仅患有哮喘的受试者相比，同时患有哮喘和GER的受试者夜间咳嗽、晨起咳痰、睡眠相关症状的患病率更高，呼气峰值流速变异性也更高。
就寝后GER的发生与哮喘、呼吸道症状以及阻塞性睡眠呼吸暂停综合征的症状密切相关。睡眠期间上呼吸道的部分狭窄或阻塞，随后胸腔内压力增加，可能使患者易患夜间GER，进而导致呼吸道症状。
