Department of Pulmonary Physiology and Sleep Medicine, West Australian Sleep Disorders Research Institute, Sir Charles Gairdner Hospital, Nedlands, Australia.
Centre for Sleep Science, School of Human Sciences, University of Western Australia, Crawley, Australia.
Am J Gastroenterol. 2020 May;115(5):697-705. doi: 10.14309/ajg.0000000000000627.
Night-time gastroesophageal reflux (nGER) symptoms are commonly associated with interrupted sleep. Most studies attempting to understand the relationship between sleep, arousal, and nGER events have been performed so using accelerometry; however, this technology is limited in its ability to precisely determine the temporal association between sleep and reflux events. We aimed to examine the temporal relationships between nGER events and arousal/awakening from sleep using high resolution, in-laboratory polysomnography (PSG).
Individuals between 18 and 70 years who had undergone a gastroscopy within 12 months underwent simultaneous 24-hour pH/impedance monitoring and in-laboratory PSG. The temporal relationship between each nGER event and sleep/arousals/awakenings was determined for each participant. Analyses were limited to the sleep period (between "lights out" and time of final waking).
Analyses were conducted on the data from 25 individuals, 64% of whom had nGER episodes (5 ± 5 events per person, range 1-18) and 64% of whom had obstructive sleep apnea (OSA, mean apnea-hypopnea index 20 ± 11 events/hr, range 6-44). There were no differences in PSG-determined sleep duration, sleep efficiency, sleep architecture, arousals/awakenings, or sleep apnea severity between those with nGER and those without. Most nGER events (82%) occurred during a PSG epoch that had been classified as wake. Arousals/awakenings preceded almost all events (73/76), whereas fewer had an arousal/awakening after the event (15/76).
As opposed to what is typically assumed, nGER does not seem to cause arousal from sleep, but rather arousal from sleep predisposes to nGER.
夜间胃食管反流（nGER）症状通常与睡眠中断有关。大多数试图了解睡眠、觉醒与 nGER 事件之间关系的研究都是使用加速计进行的；然而，这种技术在精确确定睡眠与反流事件之间的时间关联方面存在局限性。我们旨在使用高分辨率、实验室多导睡眠图（PSG）检查 nGER 事件与睡眠觉醒之间的时间关系。
在 12 个月内接受过胃镜检查的 18 至 70 岁个体接受了 24 小时 pH/阻抗监测和实验室 PSG。为每位参与者确定了每个 nGER 事件与睡眠/觉醒/唤醒之间的时间关系。分析仅限于睡眠期（“熄灯”与最后一次清醒时间之间）。
对 25 名个体的数据进行了分析，其中 64%的个体有 nGER 发作（每人 5 ± 5 次，范围 1-18），64%的个体有阻塞性睡眠呼吸暂停（OSA，平均呼吸暂停-低通气指数为 20 ± 11 次/小时，范围 6-44）。有 nGER 和无 nGER 的个体之间在 PSG 确定的睡眠持续时间、睡眠效率、睡眠结构、觉醒/唤醒或睡眠呼吸暂停严重程度方面没有差异。大多数 nGER 事件（82%）发生在被归类为清醒的 PSG 时相期间。觉醒/唤醒几乎都先于所有事件（76 次中的 73 次），而事件后发生觉醒/唤醒的次数较少（76 次中的 15 次）。
与通常假设的相反，nGER 似乎不会引起睡眠觉醒，而是睡眠觉醒会导致 nGER。
