Zeng Xiangxia, Wang Shijia, Zhang Peiting
Department of Nutrition, School of Public Health, Guangzhou Medical University, Guangzhou, 511436, People's Republic of China.
The Key Laboratory of Advanced Interdisciplinary Studies, The First Affiliated Hospital, Guangzhou Medical University, Guangzhou, 511436, People's Republic of China.
Nat Sci Sleep. 2025 Sep 10;17:2165-2183. doi: 10.2147/NSS.S535962. eCollection 2025.
Obstructive sleep apnea (OSA) and gastroesophageal reflux disease (RD) are two common yet frequently co-occurring conditions that significantly impact sleep quality and overall health. While a growing body of evidence suggests a potential link between these disorders, the nature and strength of their relationship remain unclear. This systematic review and meta-analysis aims to comprehensively evaluate the association between OSA and RD, focusing on the incidence of RD in OSA patients and the potential impact of RD on sleep parameters, including sleep stages and apnea severity.
We systematically searched PubMed, Embase, the Cochrane Library, and Scopus databases to identify relevant studies for this review. Eligible studies had to investigate the association between obstructive sleep apnea (OSA) and gastroesophageal reflux disease (RD) in adult populations. The primary outcomes assessed were the incidence of RD in OSA patients, as well as the impact of RD on sleep parameters, including sleep stages, apnea severity, and the Epworth Sleepiness Scale (ESS).
Totally 49 studies were included in this analysis. A modest association between obstructive sleep apnea (OSA) and the increased incidence of gastroesophageal reflux disease (RD), with a pooled relative risk of 1.23 (95% CI: 1.00, 1.52), although this did not reach statistical significance (p = 0.056). A trend towards increased reflux symptoms in severe OSA patients compared to mild OSA was noted (p=0.036). Patients with RD exhibited significantly lower sleep efficiency (p=0.003) and reduced oxygen saturation (p<0.001). Heterogeneity analysis indicated moderate variability across studies, primarily due to differences in patient characteristics and OSA severity.
A certain association between obstructive sleep apnea (OSA) and gastroesophageal reflux disease (RD) was observed, but this association did not reach statistical significance. RD was significantly associated with reduced sleep efficiency, but no significant relationship was found between RD and OSA severity levels. While RD may influence early sleep stages (eg, N1), this effect remains inconclusive due to limited and variable supporting data. These findings highlight the need for further research to clarify the nature and direction of the OSA-RD relationship.
阻塞性睡眠呼吸暂停（OSA）和胃食管反流病（RD）是两种常见且经常同时出现的病症，它们会显著影响睡眠质量和整体健康。虽然越来越多的证据表明这些疾病之间存在潜在联系，但其关系的性质和强度仍不明确。本系统评价和荟萃分析旨在全面评估OSA与RD之间的关联，重点关注OSA患者中RD的发生率以及RD对睡眠参数（包括睡眠阶段和呼吸暂停严重程度）的潜在影响。
我们系统检索了PubMed、Embase、Cochrane图书馆和Scopus数据库，以确定本评价的相关研究。符合条件的研究必须调查成年人群中阻塞性睡眠呼吸暂停（OSA）与胃食管反流病（RD）之间的关联。评估的主要结局是OSA患者中RD的发生率，以及RD对睡眠参数的影响，包括睡眠阶段、呼吸暂停严重程度和爱泼华嗜睡量表（ESS）。
本分析共纳入49项研究。阻塞性睡眠呼吸暂停（OSA）与胃食管反流病（RD）发生率增加之间存在适度关联，合并相对风险为1.23（95%CI：1.00，1.52），尽管这未达到统计学显著性（p = 0.056）。与轻度OSA患者相比，重度OSA患者的反流症状有增加趋势（p = 0.036）。患有RD的患者睡眠效率显著降低（p = 0.003），血氧饱和度降低（p < 0.001）。异质性分析表明，各研究之间存在中度变异性，主要是由于患者特征和OSA严重程度的差异。
观察到阻塞性睡眠呼吸暂停（OSA）与胃食管反流病（RD）之间存在一定关联，但这种关联未达到统计学显著性。RD与睡眠效率降低显著相关，但未发现RD与OSA严重程度水平之间存在显著关系。虽然RD可能影响早期睡眠阶段（如N1），但由于支持数据有限且多变，这种影响仍不确定。这些发现凸显了进一步研究以阐明OSA - RD关系的性质和方向的必要性。
