West Australian Sleep Disorders Research Institute, Department of Pulmonary Physiology, Sir Charles Gairdner Hospital, Nedlands, Australia.
Sleep Breath. 2011 Sep;15(3):561-70. doi: 10.1007/s11325-010-0404-x. Epub 2010 Aug 14.
Obstructive sleep apnea (OSA) is associated with increased nocturnal gastroesophageal reflux (nocturnal GER) events and symptoms. Treatment of OSA with continuous positive airway pressure (CPAP) reduces nocturnal GER in patients with OSA. This study sought to determine the: (1) relationship of nocturnal GER events with apnea/hypopnea and arousal, (2) effect of upper airway obstruction on the barrier function of the lower esophageal sphincter (LES), (3) mechanism of LES failure for each nocturnal GER event and (4) effect of CPAP on LES function during sleep.
Eight patients with OSA and nocturnal GER underwent polysomnography with esophageal manometry and pH monitoring. The first half of the night was spent without CPAP and the second half with 10 cmH(2)O CPAP.
Baseline LES barrier pressure (P (b)) was low in these patients. When patients were off CPAP, there were 2.7 ± 1.8 nocturnal GER events per hour and 70 ± 39 obstructive respiratory events per hour. There was no direct relationship between the occurrence of GER and obstructive events. While upper airway obstruction did not alter P (b), CPAP tended to increase the nadir P (b) during LES relaxation (LESR) and decreased the duration of LESR.
Upper airway obstructive and nocturnal GER events are not directly related. The relatively low P (b) in these OSA patients raises the possibility of weakening of the gastroesophageal junction from repetitive strain associated with obstructed breathing events. The favourable effect of CPAP on nocturnal GER is possibly due to an increase in nadir P (b) and decrease in the duration for which the LES relaxes during swallow-induced and transient LESR.
阻塞性睡眠呼吸暂停（OSA）与夜间胃食管反流（夜间 GER）事件和症状增加有关。持续气道正压通气（CPAP）治疗 OSA 可减少 OSA 患者的夜间 GER。本研究旨在确定：（1）夜间 GER 事件与呼吸暂停/低通气和觉醒的关系，（2）上气道阻塞对下食管括约肌（LES）屏障功能的影响，（3）每个夜间 GER 事件的 LES 失败机制，以及（4）CPAP 对睡眠期间 LES 功能的影响。
8 例 OSA 合并夜间 GER 的患者接受多导睡眠图检查，同时进行食管测压和 pH 监测。前半夜间不使用 CPAP，后半夜间使用 10cmH(2)O CPAP。
这些患者的基础 LES 屏障压力（P（b））较低。当患者不使用 CPAP 时，每小时有 2.7±1.8 次夜间 GER 事件和 70±39 次阻塞性呼吸事件。GER 的发生与阻塞性事件之间没有直接关系。虽然上气道阻塞不会改变 P（b），但 CPAP 倾向于增加 LES 松弛（LESR）期间的 P（b）最低点，并缩短 LESR 的持续时间。
上气道阻塞和夜间 GER 事件之间没有直接关系。这些 OSA 患者的 P（b）相对较低，提示与阻塞性呼吸事件相关的重复性张力可能导致胃食管交界处减弱。CPAP 对夜间 GER 的有利影响可能是由于吞咽引起的 LESR 和短暂 LESR 期间 P（b）最低点增加和 LESR 持续时间缩短。
