Department of Pediatrics, Federal University of São Paulo (UNIFESP), São Paulo, Brazil.
J Pediatr Gastroenterol Nutr. 2013 Apr;56(4):431-5. doi: 10.1097/MPG.0b013e31827f02f2.
Little is known about the relation between gastroesophageal reflux (GER) episodes and sleep interruptions in infants. The aim of the study was to evaluate the relationship between GER and the incidence of sleep interruptions in infants.
Study patients included 24 infants (younger than 1 year) referred for multichannel intraluminal impedance and esophageal pH monitoring with simultaneous polysomnography. Exclusion criteria were a previous fundoplication and studies lasting <20 hours. Tests were clinically indicated to investigate suspicion of GER-related apnea (17, 70.8%), stridor (6, 25%), noisy breathing (2, 8.3%), and cyanotic spells (1, 4.2%). Most patients presented with significant comorbidities (19, 79.2%).
The number of nonacid GER (NAGER) per hour was greater during sleep time than during daytime and awakening following sleep onset (median 0.27 vs 1.85 and 1.45, P<0.01). A total of 1204 (range 7-86 per infant) arousals in 24 infants was detected, 165 (13.7%) that followed GER episodes, and 43 (3.6%) that preceded GER episodes. Seven patients presented with a positive symptom association probability for arousals; 5 were exclusively because of NAGER. A positive symptom association probability for awakenings was detected in 9 patients; 4 were because of NAGER, 4 were because of AGER, and 1 was because of both NAGER and GER. Patients with awakenings related to GER presented longer mean clearance time of AGER during sleep (165.5 vs 92.8 seconds, P=0.03).
GER was a frequent cause of interrupting sleep among our infant patients, and NAGER proved to be equally important as AGER for causing arousals and awakenings in infants.
对于胃食管反流（GER）发作与婴儿睡眠中断之间的关系知之甚少。本研究旨在评估 GER 与婴儿睡眠中断发生率之间的关系。
研究对象包括 24 名（年龄小于 1 岁）接受多通道腔内阻抗和食管 pH 监测并同时进行多导睡眠图检查的婴儿。排除标准为先前进行过胃底折叠术和持续时间<20 小时的研究。进行这些检查是为了临床评估 GER 相关呼吸暂停（17 例，70.8%）、喘鸣（6 例，25%）、呼吸声响亮（2 例，8.3%）和发绀发作（1 例，4.2%）的可能性。大多数患者伴有显著的合并症（19 例，79.2%）。
与清醒后刚入睡时（中位数分别为 0.27 比 1.85 和 1.45，P<0.01）相比，睡眠时和觉醒时的非酸性胃食管反流（NAGER）每小时次数更多。在 24 名婴儿中总共检测到 1204 次（每个婴儿 7-86 次）觉醒，其中 165 次（13.7%）紧随 GER 发作后，43 次（3.6%）在 GER 发作前。7 名患者的觉醒与 GER 存在阳性症状关联概率；其中 5 例仅因 NAGER 而存在阳性症状关联概率。9 名患者的觉醒存在阳性症状关联概率；其中 4 例因 NAGER，4 例因 AGER，1 例因 NAGER 和 GER。与 GER 相关的觉醒患者在睡眠时的 AGER 清除时间较长（165.5 比 92.8 秒，P=0.03）。
GER 是导致我们的婴儿患者睡眠中断的常见原因，NAGER 与 AGER 一样，是导致婴儿觉醒和觉醒的重要原因。
