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“Silent” Gastroesophageal Reflux in Patients with Unexplained Sleep Complaints


Orr, William C., Ph.D.; Goodrich, Suanne, Ph.D.; Sturgeon, Robert, B.S.; Rosenburg, Russell, Ph.D.; Fernstrom, Paula, M.S.

American Journal of Gastroenterology: September 2005 - Volume 100 - Issue - p S50–S51
Supplement Abstracts Submitted for the 70th Annual Scientific Meeting of the American College of Gastroenterology: ESOPHAGUS

Sleep Laboratory, Lynn Health Science Institute, Oklahoma City, OK; Lynn Institute of the Rockies, Colorado Springs, CO; Atlanta Sleep Medicine Institute, Atlanta, GA and AstraZeneca, Molndal, Sweden.

Purpose: Patients with gastroesophageal reflux (GER) commonly report poor sleep, and it has been established that the arousals from sleep are frequently associated with acid mucosal contact via GER. It has also been shown that individuals with significant GER exacerbating respiratory symptoms may frequently be without complaints of heartburn. We posed the question of whether a substantial portion of individuals with sleep complaints, without significant heartburn, experience “silent” reflux during sleep.

Methods: 104 individuals with documented sleep complaints at least three nights per week were randomized after a two-week run in period with recorded sleep diaries. 81 subjects completed two polysomnographic sleep evaluations including distal esophageal pH separated by 10–21 days.

Results: Of the 81 subjects studied, 26% had reflux (pH < 4 for more than 30 sec) on at least one night. Of the participants with reflux, 21% had more than 4% acid contact time (ACT), 25% had at least one event that lasted more than five minutes and the average ACT was 28%. The average duration of each reflux episode was 34.4 minutes. Almost all (94%) of the recorded reflux events were associated with an arousal or awakening. An historical comparison group of symptomatic GERD patients with concomitant sleep complaints had an average ACT of only 12% (p < .05).

Conclusions: 1. A substantial portion of individuals with sleep complaints, and without significant heartburn symptoms, revealed “silent reflux” during sleep. 2. “Silent reflux” may be the cause of sleep disturbances in individuals with unexplained sleep disorders.

© The American College of Gastroenterology 2005. All Rights Reserved.