Southern Arizona VA Health Care System, University of Arizona Health Sciences Center, Tucson, Arizona.
MetroHealth Medical Center, Case Western Reserve University, Cleveland, Ohio.
Clin Gastroenterol Hepatol. 2015 Jan;13(1):94-9. doi: 10.1016/j.cgh.2014.05.017. Epub 2014 Jun 4.
BACKGROUND & AIMS: Acid reflux during nighttime sleep has been associated with more severe gastroesophageal reflux disease (GERD). Napping is common, especially after lunch time, in many cultures. We aimed to compare reflux characteristics between nighttime sleep and naps in patients with GERD.
We performed a study of 15 patients (mean age, 58.5 ± 18.4 y; 10 men) with heartburn and/or regurgitation at least 3 times/week for the past 3 months, who experienced a nap in addition to regular nighttime sleep. All were evaluated using the demographics and GERD Symptoms Checklist questionnaires. Patients underwent pH testing concomitantly with actigraphy when they were not receiving antireflux treatment; only patients with abnormal results from pH tests were included in the study. Raw data from actigraphy analyses were superimposed over those collected from pH monitoring, matched by time. Integrative software was used to determine recumbent-awake, recumbent-asleep, and naps alongside pH monitoring data.
The mean duration of nocturnal sleep time and nap time were 446.0 ± 100.7 minutes and 61.9 ± 51.8 minutes, respectively. The mean number of reflux events per hour was significantly greater during nap than nocturnal sleep time (40.1 ± 69.9/h vs 3.5 ± 4.2/h; P < .05). The mean duration of reflux events was longer during nap than nocturnal sleep time (1.9 ± 2.8 min vs 1.5 ± 2.7 min). The percentage of time spent at a pH less than 4 was significantly greater during naptime than nocturnal sleep time (36.2% ± 38.8% vs 8.9% ± 11.6%; P < .05). Arousals from naps were rare, compared with nocturnal sleep (mean, 0.7 ± 1.1 vs 4.2 ± 2.9; P < .05). Patients also experienced more acid reflux associated with symptoms during nap than nocturnal sleep (mean, 8.08% vs 0.45%; P < .05).
We associated naps with significantly greater numbers of, and duration of, esophageal acid exposure and symptoms, compared with nocturnal sleep. Naps therefore might have important effects on disease severity.
夜间睡眠时的胃酸反流与更严重的胃食管反流病（GERD）有关。在许多文化中，午睡是很常见的，尤其是在午饭后。我们旨在比较 GERD 患者夜间睡眠和午睡时的反流特征。
我们对 15 名（平均年龄 58.5 ± 18.4 岁；男性 10 名）至少每周有 3 次烧心和/或反流症状的患者进行了一项研究，这些患者除了常规夜间睡眠外，还会午睡。所有患者均接受了人口统计学和 GERD 症状清单问卷评估。在未接受抗反流治疗时，患者同时接受 pH 测试和动作描记法检查；只有 pH 测试结果异常的患者才被纳入研究。动作描记法分析的原始数据与 pH 监测数据叠加，通过时间匹配。综合软件用于确定 pH 监测数据的卧位清醒、卧位睡眠和午睡时间。
夜间睡眠时间和午睡时间的平均时长分别为 446.0 ± 100.7 分钟和 61.9 ± 51.8 分钟。每小时反流事件数在午睡时明显高于夜间睡眠时间（40.1 ± 69.9/h 比 3.5 ± 4.2/h；P <.05）。午睡时反流事件的平均持续时间长于夜间睡眠时间（1.9 ± 2.8 分钟比 1.5 ± 2.7 分钟）。午睡时 pH 值小于 4 的时间百分比明显高于夜间睡眠时间（36.2% ± 38.8% 比 8.9% ± 11.6%；P <.05）。与夜间睡眠相比，午睡时的觉醒次数较少（平均 0.7 ± 1.1 比 4.2 ± 2.9；P <.05）。与夜间睡眠相比，患者在午睡时也经历了更多与症状相关的胃酸反流（平均 8.08% 比 0.45%；P <.05）。
与夜间睡眠相比，我们发现午睡时的食管酸暴露和症状的次数和持续时间明显增加。因此，午睡可能对疾病严重程度有重要影响。
