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Symptomatic Patients with Erosive Esophagitis Demonstrate Reduced Delta Electroencephalographic Activity during Sleep Compared to Those without Erosive Esophagitis or Abnormal Esophageal Acid Exposure

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Budhiraja, Rohit MD; Dickman, Ram MD; Quan, Stuart F. MD; Punjabi, Naresh MD; Fass, Shira PhD; Fass, Ronnie MD

American Journal of Gastroenterology: September 2006 - Volume 101 - Issue - p S65
Abstracts: ESOPHAGUS
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Medicine, Southern Arizona Veterans Affairs Health Care Syst, Tucson, AZ; Medicine, University of Arizona College of Medicine, Tucson, AZ and Asthma and Allergy Center, Johns Hopkins University School of Medicine, Baltimore, MD.

Purpose: To compare the polysomnographic and spectral sleep in patients with erosive esophagitis and a control population with symptoms of GERD but no erosive esophagitis on endoscopy or abnormal esophageal acid exposure on 24-hour esophageal pH monitoring.

Methods: A prospective cohort study was conducted involving 11 subjects with erosive esophagitis confirmed by endoscopy, and 6 controls with GERD-related symptoms but no esophagitis or abnormal esophageal acid exposure. All subjects underwent upper endoscopy and 24-hour pH monitoring. Sleep was polysomnographically recorded in the sleep laboratory. A spectral analysis of the sleep electroencephalogram (EEG) was performed.

Results: The erosive esophagitis and the control groups were similar in age (mean ± S.D), (40 ± 20 years vs. 42 ± 17 years, p= 0.80). The esophagitis group had 36.4% women (N = 4) and the control group had 66.7% women (N = 4) (p= 0.33). The two groups were similar in regard to diverse polysomnographic variables on visual scoring. There were no differences in sleep efficiency, arousals or the absolute or percentage of delta sleep. However, on spectral analysis of EEG, subjects with erosive esophagitis had a significantly lower delta power of 44.9% (95% CI 40.7–49.0%) compared to the control group, who had a delta power of 47.9% (95% CI 43.6–52.1%) (p= 0.02).

Conclusions: The macro architecture of sleep in symptomatic patients with endoscopically-confirmed erosive esophagitis was not different in comparison to those without erosive esophagitis. However, a more quantitative and in-depth analysis of sleep EEG demonstrated a significantly reduced delta power, an efficient indicator of sleep homeostasis, in patients with erosive esophagitis. Future studies assessing the effect of treatment of GERD on sleep disturbances should include not only polysomnographic, but also EEG spectral analysis of sleep.

© The American College of Gastroenterology 2006. All Rights Reserved.