Ermis Fatih, Akyuz Filiz, Arici Serpil, Uyanikoglu Ahmet, Yakar Fatih, Pinarbasi Binnur, Demir Kadir, Ozdil Sadakat, Besisik Fatih, Kaymakoglu Sabahattin, Boztas Gungor, Cuhadaroglu Caglar, Mungan Zeynel
Department of Gastroenterology, Istanbul University, Istanbul, Turkey.
Hepatogastroenterology. 2011 Sep-Oct;58(110-111):1566-73. doi: 10.5754/hge10465. Epub 2011 Jul 15.
BACKGROUND/AIMS: There is an increasing interest for a link between gastroesophageal reflux (GER) and obstructive sleep apnea syndrome (OSAS). There is no study in the literature which examines the relationship between OSAS and esophageal functions in adults with impedance. We first evaluated the role of reflux in OSAS with simultaneous polysomnography and impedance-pHmetry and then investigated whether the effect of proton pump inhibitor (PPI) treatment changes in these parameters.
Twenty two OSAS patients who had applied to sleep laboratory between September 2007 and May 2008 were consecutively enrolled to the study. Twenty four hours esophageal impedance study was performed during polysomnographic recording. At least 50% of all apneas in patients must proceed with a reflux event in 2 minute intervals in order to be considered reflux related apnea patient.
Pathologic reflux episodes were determined in 20 patients (8 were weakly acidic, 12 were acidic). Reflux dependent apnea was found in 6 patients. There was endoscopically esophagitis in all reflux related apnea patients. There was a negative correlation between initial mean SaO2 and gas reflux events at night (p=0.004, r =-0.588) and mixed reflux events at night (p=0.02, r=0.493). There was a statistically significant regression of AHI (apnea hypopnea index) after 3-months PPI treatment (p=0.012).
Reflux may trigger apnea in some of the OSAS patients. Therefore, each OSAS patient must be inquired about esophageal and extraesophageal symptoms of reflux.
背景/目的：胃食管反流（GER）与阻塞性睡眠呼吸暂停综合征（OSAS）之间的联系越来越受到关注。文献中尚无研究探讨成人阻抗情况下OSAS与食管功能之间的关系。我们首先通过同步多导睡眠图和阻抗pH监测评估反流在OSAS中的作用，然后研究质子泵抑制剂（PPI）治疗对这些参数的影响是否发生变化。
连续纳入2007年9月至2008年5月期间申请进入睡眠实验室的22例OSAS患者。在多导睡眠图记录期间进行24小时食管阻抗研究。患者所有呼吸暂停中至少50%必须在2分钟间隔内伴有反流事件，才能被视为反流相关性呼吸暂停患者。
20例患者（8例为弱酸反流，12例为酸反流）确定存在病理性反流发作。6例患者发现有反流相关性呼吸暂停。所有反流相关性呼吸暂停患者内镜检查均有食管炎。夜间初始平均血氧饱和度（SaO2）与气体反流事件（p = 0.004，r = -0.588）及夜间混合反流事件（p = 0.02，r = 0.493）之间呈负相关。PPI治疗3个月后呼吸暂停低通气指数（AHI）有统计学意义的下降（p = 0.012）。
反流可能在部分OSAS患者中引发呼吸暂停。因此，必须询问每例OSAS患者有无食管及食管外反流症状。
