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Nighttime GERD Has Daytime Consequences

Nighttime GERD, even without reported symptoms of heartburn and regurgitation, can significantly impair sleep.

Gastroesophageal reflux disease is a well-recognized cause of impaired sleep in patients with frequent nocturnal GERD symptoms. However, the role of GERD in sleep disturbance of minimally symptomatic or asymptomatic patients who have poor sleep quality is less clear. Because GERD might occur at night without resulting in arousal or memory of arousal (sleep has an amnesic effect), it could be the primary underlying cause of their sleep disturbances.

This prospective, multicenter study compared 81 patients having disturbed or unrefreshing sleep to 39 controls having normal sleep. Both groups received simultaneous polysomnography and pH monitoring to detect the presence of nighttime gastroesophageal reflux and to determine sleep outcomes.

In the disturbed-sleep group, 27% of participants had at least one reflux event, compared with 33% in the normal-sleep group. Of those who experienced reflux, the disturbed-sleep group had a longer acid exposure time (expressed as a percentage of total sleep time) than the normal-sleep group (9.5% vs. 1.6%; P<0.05). Participants in the disturbed-sleep group also had longer sleep-onset latency (P<0.05) and less total sleep time (P<0.05) than the normal-sleep group.

Comment: Despite a lack of GERD symptoms, people who had disturbed sleep had a longer acid exposure time than those who had normal sleep. Although treatment intervention wasn’t part of this study, preliminary data suggest that aggressive treatment of GERD in such patients might result in improved sleep efficiency. A proton-pump inhibitor empirical trial should be considered in patients with sleep dysfunction. That 33% of people with normal sleep had reflux events highlights our need to understand the true prevalence and potential consequences of asymptomatic, sleep-related GERD.

— David A. Johnson, MD

Published in Journal Watch Gastroenterology March 20, 2009

Citation(s):

Orr WC et al. Occurrence of nighttime gastroesophageal reflux in disturbed and normal sleepers. Clin Gastroenterol Hepatol 2008 Oct; 6:1099.

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• gerd long term treatment
  greg mcgarry, 4 Jan 2010 4:05 PM EST
  potential consequences for long term PPI use? reducing dose causes severe night time reflux & pain. how to manage dose... [more]

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