Kerr P, Shoenut J P, Steens R D, Millar T, Micflikier A B, Kryger M H
Sleep and GI Laboratories, St. Boniface General Hospital, Winnipeg, Manitoba, Canada.
J Clin Gastroenterol. 1993 Dec;17(4):276-80. doi: 10.1097/00004836-199312000-00002.
Nasal continuous positive airway pressure (CPAP) reduces nocturnal gastroesophageal reflux (GER) in obstructive sleep apnea syndrome (OSAS) patients. The primary objectives of our investigation were to determine if CPAP could reduce reflux in non-OSAS patients and, if so, by what mechanism. Esophageal pH was monitored for 48 h in six nocturnal reflux patients. During the first 24 h, basal reflux data were collected; the second night, nasal CPAP was administered (pressure = 8 cm H2O). Esophageal manometry was obtained in six healthy adult volunteers both on and off nasal CPAP (pressure = 8 cm H2O) to ascertain CPAP's effects on esophageal pressure and peristalsis. The six reflux patients experienced less nocturnal GER while on CPAP. The mean percent time esophageal pH < 4 was reduced from 27.7 +/- 10.0 to 5.8 +/- 2.6 (p < 0.004); the mean reflux duration dropped from 2.1 +/- 0.6 to 0.9 +/- 0.5 min (p < 0.03); and the mean duration of longest reflux improved from 84.3 +/- 32.6 to 13.8 +/- 6.9 min (p < 0.01). The CPAP raised the mean resting midesophageal pressure by 4.4 cm H2O (p < 0.01) and the mean resting lower esophageal pressure (LES) by 13.2 cm H2O (p < 0.02) in the healthy volunteers. Nasal CPAP effectively reduced nocturnal GER in six patients with nocturnal reflux. The antireflux activity of CPAP is likely due to passive elevation of intraesophageal pressure and possibly to reflex LES constriction.
鼻持续气道正压通气（CPAP）可减少阻塞性睡眠呼吸暂停综合征（OSAS）患者的夜间胃食管反流（GER）。我们研究的主要目的是确定CPAP是否能减少非OSAS患者的反流，如果可以，其机制是什么。对6名夜间反流患者的食管pH值进行了48小时监测。在最初的24小时内，收集基础反流数据；第二个晚上，给予鼻CPAP（压力=8 cm H₂O）。在6名健康成年志愿者使用和不使用鼻CPAP（压力=8 cm H₂O）时进行食管测压，以确定CPAP对食管压力和蠕动的影响。6名反流患者在使用CPAP时夜间GER减少。食管pH值<4的平均时间百分比从27.7±10.0降至5.8±2.6（p<0.004）；平均反流持续时间从2.1±0.6降至0.9±0.5分钟（p<0.03）；最长反流的平均持续时间从84.3±32.6改善至13.8±6.9分钟（p<0.01）。在健康志愿者中，CPAP使食管中段平均静息压力升高4.4 cm H₂O（p<0.01），食管下括约肌（LES）平均静息压力升高13.2 cm H₂O（p<0.02）。鼻CPAP有效减少了6名夜间反流患者的夜间GER。CPAP的抗反流作用可能是由于食管内压力的被动升高以及可能的LES反射性收缩。
