Systematic review: Relationships between sleep and gastro-oesophageal reflux

Background Gastro-oesophageal reflux disease (GERD) adversely impacts on sleep, but the mechanism remains unclear. Aim To review the literature concerning gastro-oesophageal reflux during the sleep period, with particular reference to the sleep/awake state at reflux onset. Methods Studies identified...

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Main Authors: Dent, J., Holloway, R., Eastwood, Peter
Format: Journal Article
Published: 2013
Online Access:http://hdl.handle.net/20.500.11937/20696
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author Dent, J.
Holloway, R.
Eastwood, Peter
author_facet Dent, J.
Holloway, R.
Eastwood, Peter
author_sort Dent, J.
building Curtin Institutional Repository
collection Online Access
description Background Gastro-oesophageal reflux disease (GERD) adversely impacts on sleep, but the mechanism remains unclear. Aim To review the literature concerning gastro-oesophageal reflux during the sleep period, with particular reference to the sleep/awake state at reflux onset. Methods Studies identified by systematic literature searches were assessed. Results Overall patterns of reflux during the sleep period show consistently that oesophageal acid clearance is slower, and reflux frequency and oesophageal acid exposure are higher in patients with GERD than in healthy individuals. Of the 17 mechanistic studies identified by the searches, 15 reported that a minority of reflux episodes occurred during stable sleep, but the prevailing sleep state at the onset of reflux in these studies remains unclear owing to insufficient temporal resolution of recording or analysis methods. Two studies, in healthy individuals and patients with GERD, analysed sleep and pH with adequate resolution for temporal alignment of sleep state and the onset of reflux: all 232 sleep period reflux episodes evaluated occurred during arousals from sleep lasting less than 15 s or during longer duration awakenings. Six mechanistic studies found that transient lower oesophageal sphincter relaxations were the most common mechanism of sleep period reflux. Conclusions Contrary to the prevailing view, subjective impairment of sleep in GERD is unlikely to be due to the occurrence of reflux during stable sleep, but could result from slow clearance of acid reflux that occurs during arousals or awakenings from sleep. Definitive studies are needed on the sleep/awake state at reflux onset across the full GERD spectrum. © 2013 John Wiley & Sons Ltd.
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spelling curtin-20.500.11937-206962017-09-13T13:48:14Z Systematic review: Relationships between sleep and gastro-oesophageal reflux Dent, J. Holloway, R. Eastwood, Peter Background Gastro-oesophageal reflux disease (GERD) adversely impacts on sleep, but the mechanism remains unclear. Aim To review the literature concerning gastro-oesophageal reflux during the sleep period, with particular reference to the sleep/awake state at reflux onset. Methods Studies identified by systematic literature searches were assessed. Results Overall patterns of reflux during the sleep period show consistently that oesophageal acid clearance is slower, and reflux frequency and oesophageal acid exposure are higher in patients with GERD than in healthy individuals. Of the 17 mechanistic studies identified by the searches, 15 reported that a minority of reflux episodes occurred during stable sleep, but the prevailing sleep state at the onset of reflux in these studies remains unclear owing to insufficient temporal resolution of recording or analysis methods. Two studies, in healthy individuals and patients with GERD, analysed sleep and pH with adequate resolution for temporal alignment of sleep state and the onset of reflux: all 232 sleep period reflux episodes evaluated occurred during arousals from sleep lasting less than 15 s or during longer duration awakenings. Six mechanistic studies found that transient lower oesophageal sphincter relaxations were the most common mechanism of sleep period reflux. Conclusions Contrary to the prevailing view, subjective impairment of sleep in GERD is unlikely to be due to the occurrence of reflux during stable sleep, but could result from slow clearance of acid reflux that occurs during arousals or awakenings from sleep. Definitive studies are needed on the sleep/awake state at reflux onset across the full GERD spectrum. © 2013 John Wiley & Sons Ltd. 2013 Journal Article http://hdl.handle.net/20.500.11937/20696 10.1111/apt.12445 unknown
spellingShingle Dent, J.
Holloway, R.
Eastwood, Peter
Systematic review: Relationships between sleep and gastro-oesophageal reflux
title Systematic review: Relationships between sleep and gastro-oesophageal reflux
title_full Systematic review: Relationships between sleep and gastro-oesophageal reflux
title_fullStr Systematic review: Relationships between sleep and gastro-oesophageal reflux
title_full_unstemmed Systematic review: Relationships between sleep and gastro-oesophageal reflux
title_short Systematic review: Relationships between sleep and gastro-oesophageal reflux
title_sort systematic review: relationships between sleep and gastro-oesophageal reflux
url http://hdl.handle.net/20.500.11937/20696