Laryngopharyngeal Reflux in Sleep-Disordered Breathing Patients

Document Type : Original

Authors

1 Department of Otorhinolaryngology Head and Neck Surgery, Faculty of Medicine Universitas Indonesia – Cipto Mangunkusumo Hopsital, Jakarta, Indonesia.

2 Department Nutrition, Faculty of Medicine Universitas Indonesia – Cipto Mangunkusumo Hospital, Jakarta, Indonesia.

3 Department of Otorhinolaryngology Head and Neck Surgery, Faculty of Medicine Universitas Indonesia – Universitas Indonesia Hospital, Depok, Indonesia.

Abstract

Introduction:
Our study aims to evaluate the distribution of laryngopharyngeal reflux (LPR) in patients with sleep-disordered breathing (SDB) via the Reflux Symptom Index (RSI) and to describe the sleep architecture in SDB patients with and without LPR.
Materials and Methods:
A cross-sectional, descriptive study was conducted. Patients with SDB were identified via the Epworth Sleepiness Scale (ESS) and STOP-BANG questionnaire; they were then screened with the RSI and physical examination for LPR. PSG was performed to evaluate obstructive sleep apnea (OSA).
Results:
Of 45 patients, 15 were scored as having LPR via the RSI. Utilizing the Respiratory Disturbance Index (RDI), patients were further classified into four groups: 9 non-LPR with non-OSA SDB, 21 non-LPR with OSA, 4 LPR with non-OSA SDB, and 11 LPR with OSA. The prevalence of LPR was 30.8% in the non-OSA SDB group and 34.4% in the OSA group. All SDB parameters in both groups were similar. SDB patients with high body mass index tended to have LPR and/or OSA. Average ESS scores in the four groups suggested excessive daytime sleepiness, and patients with LPR had higher ESS scores. Regardless of LPR status, SDB patients had a lower percentage of REM sleep and a higher percentage of light sleep.
Conclusions:
The incidence of LPR in OSA patients was similar in non-OSA SDB patients. REM sleep percentage decreased in the four groups, with the non-OSA SDB group having the lowest percentage of REM sleep; light sleep percentage increased in the four groups, with the OSA group having the highest percentage of light sleep.

Keywords

References

  1. Foldvary-Schaefer NR, Waters TE. Sleep-Disordered Breathing: Contin Lifelong Learn Neurol. 2017;23(4):1093–116.
  2. Tsara V, Amfilochiou A, Papagrigorakis MJ, Georgopoulos D, Liolios E. Guidelines for diagnosis and treatment of sleep-related breathing disorders in adults and children. Definition and classification of sleep related breathing disorders in adults: different types and indications for sleep studies (Part 1). Hippokratia. 2009;13(3):187–91.
  3. Xavier SD, Eckley CA, Duprat AC, de Souza Fontes LH, Navarro-Rodriguez T, Patrocínio J, et al. Temporal Association Between Respiratory Events and Reflux in Patients With Obstructive Sleep Apnea and Laryngopharyngeal Reflux. J Clin Sleep Med. 2019; 15(10):1397–402.
  4. Karimi M, Hedner J, Häbel H, Nerman O, Grote L. Sleep Apnea Related Risk of Motor Vehicle Accidents is Reduced by Continuous Positive Airway Pressure: Swedish Traffic Accident Registry Data. Sleep. 2015;38(3):341–9.
  5. Teklu M, Gouveia CJ, Yalamanchili A, Ghadersohi S, Price CPE, Bove M, et al. Predicting Obstructive Sleep Apnea Status With the Reflux Symptom Index in a Sleep Study Population. The Laryngoscope [Internet]. 2020 [cited 2021 Mar 24]; 130 (12). Available from: https://onlinelibrary. wiley.com/doi/10.1002/lary.28592
  6. Magliulo G, Iannella G, Polimeni A, De Vincentiis M, Meccariello G, Gulotta G, et al. Laryngopharyngeal reflux in obstructive sleep apnoea patients: Literature review and meta-analysis. Am J Otolaryngol. 2018;39(6):776–80.
  7. Zhao C, Viana A, Ma Y, Capasso R. High Tongue Position is a Risk Factor for Upper Airway Concentric Collapse in Obstructive Sleep Apnea: Observation Through Sleep Endoscopy. Nat Sci Sleep. 2020;Volume 12:767–74.
  8. De Benedetto M, Garbarino S, Sanna A. Obstructive sleep apnea (OSA): healthcare and social costs. Med Lav [Internet]. 2017 [cited 2021 Apr 1];108(4). Available from: https://doi.org/10. 23749/ mdl. v108i4.6411
  9. Caparroz FA, Campanholo M de AT, Regina CG, Park SW, Haddad L, Gregório LC, et al. Clinical and polysomnographic predictors of laryngopharyngeal reflux in obstructive sleep apnea syndrome. Braz J Otorhinolaryngol. 2019;85(4): 408–15.
  10. Xavier SD, Moraes JP, Eckley CA. Prevalence of signs and symptoms of laryngopharyngeal reflux in snorers with suspected obstructive sleep apnea. Braz J Otorhinolaryngol. 2013; 79(5):589–93.
  11. Kuribayashi S, Massey BT, Hafeezullah M, Perera L, Hussaini SQ, Tatro L, et al. Upper Esophageal Sphincter and Gastroesophageal Junction Pressure Changes Act to Prevent Gastroesophageal and Esophagopharyngeal Reflux During Apneic Episodes in Patients With Obstructive Sleep Apnea. Chest. 2010;137(4):769–76.
  12. Eskiizmir G, Kezirian E. Is there a vicious cycle between obstructive sleep apnea and laryngo pharyngeal reflux disease? Med Hypotheses. 2009; 73(5):706–8.
  13. Erdem D, Yılmaz YF, Özcan M, Titiz A, Özlügedik S, Ünal A. Correlation of sleep-disordered breathing and laryngopharyngeal reflux: a two-channel triple-sensor pHmetry catheter study. Eur Arch Otorhinolaryngol. 2018;275(10):2585–92.
  14. Iannella G, Vicini C, Polimeni A, Greco A, Gobbi R, Montevecchi F, et al. Laryngopharyngeal Reflux Diagnosis in Obstructive Sleep Apnea Patients Using the Pepsin Salivary Test. Int J Environ Res Public Health. 2019;16(11):2056.
  15. Bassett J. The asia-pacific perspective: Redefining obesity and its treatment. Australia: International Diabetes Institute World Health Organization International Association for the Study of Obesity International Obesity TaskForce.; 2002.
  16. Kim SJ, Kim HY, Jeong JI, Hong SD, Chung S-K, Dhong H-J. Changes in the Reflux Symptom Index After Multilevel Surgery for Obstructive Sleep Apnea. Clin Exp Otorhinolaryngol. 2017; 10(3): 259–64.
  17. Rizki NA, Tamin S, Faradizza F, Wardani RS, Marsaban A, Bardosono S, et al. The comparison of configuration, degree and sites of obstruction in patients with sleep disordered breathing: examination using drug-induced sleep endoscopy, mueller maneuver and polysomnography. Int J Appl Pharm. 2020; 12(3):1–4.
  18. Cumpston EC, Blumin JH, Bock JM. Dual pH with multichannel intraluminal impedance testing in the evaluation of subjective laryngopharyngeal reflux symptoms. Otolaryngol Neck Surg. 2016;155(6): 1014–20.
  19. Payne RJ, Kost KM, Frenkiel S, Zeitouni AG, Sejean G, Sweet RC, et al. Laryngeal inflammation assessed using the reflux finding score in obstructive sleep apnea. Otolaryngol Neck Surg. 2006; 134(5): 836–42.
  20. Horner RL, Innes JA, Murphy K, Guz A. Evidence for reflex upper airway dilator muscle activation by sudden negative airway pressure in man. J Physiol. 1991;436(1):15–29.
  21. Qu Y, Ye J-Y, Han D-M, Zheng L, Cao X, Zhang Y-H, et al. Esophageal functional changes in obstructive sleep apnea/hypopnea syndrome and their impact on laryngopharyngeal reflux disease. Chin Med J (Engl). 128(16):2162–7.
  22. Appleton S, Gill T, Taylor A, McEvoy D, Shi Z, Hill C, et al. Influence of Gender on Associations of Obstructive Sleep Apnea Symptoms with Chronic Conditions and Quality of Life. Int J Environ Res Public Health. 2018;15(5):930.
  23. Bonsignore MR, Saaresranta T, Riha RL. Sex differences in obstructive sleep apnoea. Eur Respir Rev.2019;28:190030.
  24. Xiao Y-L, Liu F-Q, Li J, Lv J-T, Lin J-K, Wen W-P, et al. Gastroesophageal and laryngopharyngeal reflux profiles in patients with obstructive sleep apnea/hypopnea syndrome as determined by combined multichannel intraluminal impedance-pH monitoring: GER and LPR profile in OSAHS patients. Neurogastroenterol Motil. 2012; 24(6): e258–65.
  25. Rodrigues MM, Dibbern RS, Santos VJ, Passeri LA. Influence of obesity on the correlation between laryngopharyngeal reflux and obstructive sleep apnea. Braz J Otorhinolaryngol. 2014;80:5-10.
  26. Bixler EO, Vgontzas AN, Ten Have T, Tyson K, Kales A. Effects of Age on Sleep Apnea in Men: I. Prevalence and Severity. Am J Respir Crit Care Med. 1998;157(1):144–8.
  27. Yilmazel G, Nacar M, Baykan Z, Cetinkaya F. Excessive Daytime Sleepiness and Related Factors in Adults. J Behav Health. 2017;6(1):26.
  28. Steward DL. Pantoprazole for Sleepiness Associated with Acid Reflux and Obstructive Sleep Disordered Breathing: The Laryngoscope. 2004; 114(9): 1525–8.
  29. Laohasiriwong S, Johnston N, Woodson BT. Extra-esophageal Reflux, NOSE score, and sleep quality in an adult clinic population: EER, NOSE Score, and Sleep QoL in an Adult Clinic Population. The Laryngoscope. 2013;123(12):3233–8.
  30. Zhang Y, Jiang X, Chen H, Li H, Wang Z, Chen Y, et al. Chronic REM-sleep deprivation induced laryngopharyngeal reflux in rats: A preliminary study. Auris Nasus Larynx. 2020; S0385814620302935.
  31. Fagioli I, Bes F, Franc B, Putet G, Ricour C, Salzarulo P. Oxygen consumption during sleep in children under continuous and cyclic nutrition. Physiol Behav. 1991;49(6):1159–62.
  32. Varga AW, Kishi A, Mantua J, Lim J, Koushyk V, Leibert DP, et al. Apnea-Induced Rapid Eye Movement Sleep Disruption Impairs Human Spatial Navigational Memory. J Neurosci. 2014; 34(44): 14571–7.
  33. Shahveisi K, Jalali A, Moloudi MR. Sleep architecture in patients with primary snoring and obstructive sleep apnea. Basic Clin Neurosci J. 2018; 9(2):147–56.
  34. Lang IM, Medda BK, Shaker R. Mechanisms of reflexes induced by esophageal distension. Am J Physiol-Gastrointest Liver Physiol. 2001; 281(5): G1246–63.
  35. Gottesmann C. GABA mechanisms and sleep. Neuroscience. 2002;111(2):231–9.
  36. Wu ZH, Yang XP, Niu X, Xiao XY, Chen X. The relationship between obstructive sleep apnea hypopnea syndrome and gastroesophageal reflux disease: a meta-analysis. Sleep Breath. 2019; 23(2): 389–97.

 

 

 

 

 

 

 

 

 

 

Iranian Journal of Otorhinolaryngology
Volume 34, Issue 6
November and December 2022
Pages 303-310

Files

Share

How to cite

Statistics