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Effect of One Week of CPAP on Esophageal Reflux in Patients With Obstructive Sleep Apnea

OU Health Sciences Center and Lynn Health Sciences Institute, Oklahoma City, OK

PURPOSE: Patients with obstructive sleep apnea (OSA) syndrome have a very high incidence of gastro-esophageal reflux disease (GERD). Previous studies have shown that one night of CPAP is efficacious in reducing the frequency of reflux events. The aim of this study was to assess the effect of one week of CPAP treatment on gastro-esophageal reflux in patients with objectively documented OSA and GERD.

METHODS: Patients with suspected OSA and GERD based on clinical criteria were recruited. Polysomnography (PSG) and 24h continuous esophageal pH monitoring were performed. Patients with AHI > 20 events / hour and esophageal acid contact time of at least 6% were included. All patients had a CPAP titration to reduce the AHI < 10 events / hour. Patients were sent home on nasal CPAP for one week. Patients were re-evaluated after 7 nights of CPAP therapy. On the seventh night of CPAP treatment, repeat esophageal pH monitoring and PSG were performed.

RESULTS: Twelve patients age (53±11) years with a BMI (33.4±5.4) completed the protocol with useable data. The mean AHI prior to treatment was 56.3 ± 31.5 and during CPAP treatment it was 4.1 ± 2.9. The mean CPAP treatment level was 8.2 ± 2.4 cmH2O. Sleep related acid contact pct (ACP) fell from 11.1 ± 8.8 to 7.2 ± 9.7 after CPAP (p < .05). The number of reflux events during sleep declined from 34.5 to 13.0 (P < .05). Arousal responses were not significantly altered.

CONCLUSIONS: 1) Chronic CPAP use does significantly reduce episodes of reflux and ACP 2) Reduction in reflux events appears to be related to the decline in obstructive events, but acid contact time is reduced only by approximately 4%.

CLINICAL IMPLICATIONS: A reduction in only 4% ACP is of questionable clinical significance.

DISCLOSURE: M.M. Tawk, None.