Current guidelines suggest screening at-risk groups of patients for Barrett's esophagus (BE), a precursor to esophageal cancer. Although BE and obstructive sleep apnea (OSA) have common risk factors, including elevated body mass index (BMI) and gastroesophageal reflux disease (GERD), the relationship between these two conditions has not been well established.
Retrospectively, all patients who had undergone a polysomnography and esophagogastroduodenoscopy (EGD) at West Virginia University Hospital from 2013 to 2018 were identified and divided into groups based on the presence or absence of OSA. Clinical course and procedure reports were reviewed to identify relevant variables.
1091 patients met inclusion criteria. 60.9% were female, and mean age of participants was 53.5 years. Univariate analysis revealed that male gender, age, diagnosis of OSA, severity of OSA, and a clinical diagnosis of GERD were associated with Barrett's esophagus (P values < 0.05). Multiple logistic regression incorporating age, sex, clinical diagnosis of GERD, smoking history, BMI, Helicobacter pylori status, and presence of hiatal hernia was utilized. Patients with OSA had an increased risk of Barrett's esophagus when compared with those without OSA [P < 0.001, Odds Ratio 3.26 (1.72-6.85)]. The risk increased with increasing severity of OSA, categorized in apnea-hyponea index increments of 10. In a separate multivariable regression model where OSA was graded in AHI increments of 10, an increased risk for Barrett's esophagus with every 10 point increase in AHI was found (OR 1.10, 95% CI: 1.02 – 1.19). BMI, evaluated in increments of 5, was not associated with BE. The association of OSA with BE remained unchanged in a separate model incorporating a binary variable with BMI of greater than 30 used as a surrogate for central adiposity.
OSA is associated with Barrett's esophagus, a relationship that is independent of other known risk factors. Additionally, this risk increases with increasing severity of OSA. Future efforts should determine if patients with severe OSA need to be screened for Barrett's esophagus due to its potential for causing esophageal cancer.