Freidin N, Fisher M J, Taylor W, Boyd D, Surratt P, McCallum R W, Mittal R K
Department of Internal Medicine, University of Virginia, Charlottesville.
Gut. 1991 Nov;32(11):1275-9. doi: 10.1136/gut.32.11.1275.
Nocturnal gastro-oesophageal reflux may be important in the pathogenesis of reflux oesophagitis. This study aimed to determine whether: (1) gastro-oesophageal reflux occurs during sleep in patients with reflux oesophagitis and, if so, to explore the mechanism, and (2) the sleep pattern of patients with oesophagitis is different from that of control subjects. After a standard evening meal, simultaneous manometric, oesophageal pH, and polysomnographic recordings were obtained in 11 patients with endoscopic oesophagitis and 11 control subjects. Patients with gastrooesophageal reflux disease had significantly more total reflux episodes throughout the nocturnal monitoring period than control subjects (105 v 6). Ninety two of 105 episodes of gastro-oesophageal reflux in patients occurred during the awake state and 10 during sleep stage II. A number of reflux episodes occurred during brief periods of arousal from the various sleep stages. Of the 105 reflux events recorded in patients, 42 were induced by transient lower oesophageal sphincter relaxation, 20 by stress reflux, 22 by free reflux mechanisms, and in 21 the mechanism was unclear. The sleep pattern and the time spent in each sleep stage was not different between the two groups. It is concluded that the awake state is crucial for the occurrence of nocturnal reflux episodes in normal subjects as well as in patients with reflux oesophagitis and that the difference between the frequency of gastro-oesophageal reflux between normal subjects and patients cannot be explained by different sleep patterns.
夜间胃食管反流可能在反流性食管炎的发病机制中起重要作用。本研究旨在确定：（1）反流性食管炎患者睡眠期间是否发生胃食管反流，若发生，探究其机制；（2）食管炎患者的睡眠模式是否与对照受试者不同。在标准晚餐后，对11例内镜诊断为食管炎的患者和11名对照受试者同时进行食管测压、食管pH值监测及多导睡眠图记录。在整个夜间监测期间，胃食管反流病患者的总反流发作次数显著多于对照受试者（105次对6次）。患者的105次胃食管反流发作中，92次发生在清醒状态，10次发生在睡眠二期。在从各个睡眠阶段短暂觉醒期间发生了多次反流发作。在患者记录的105次反流事件中，42次由一过性食管下括约肌松弛诱发，20次由应激性反流诱发，22次由自由反流机制诱发，21次机制不明。两组之间的睡眠模式及各睡眠阶段所花费的时间并无差异。结论是，清醒状态对于正常受试者以及反流性食管炎患者夜间反流发作的发生至关重要，正常受试者与患者之间胃食管反流频率的差异不能用不同的睡眠模式来解释。
