Faculty Collaboration Database

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 Apr;137(4):769-76

Date

11/17/2009

Pubmed ID

19914981

DOI

10.1378/chest.09-0913

Scopus ID

2-s2.0-77950842823 (requires institutional sign-in at Scopus site)   53 Citations

Abstract

BACKGROUND: Gastroesophageal reflux (GER) is thought to be induced by decreasing intraesophageal pressure during obstructive sleep apnea (OSA). However, pressure changes in the upper esophageal sphincter (UES) and gastroesophageal junction (GEJ) pressure during OSA events have not been measured. The aim of this study was to determine UES and GEJ pressure change during OSA and characterize the GER and esophagopharyngeal reflux (EPR) events during sleep.

METHODS: We studied 15 controls, nine patients with GER disease (GERD) and without OSA, six patients with OSA and without GERD, and 11 patients with both OSA and GERD for 6 to 8 h postprandially during sleep. We concurrently recorded the following: (1) UES, GEJ, esophageal body (ESO), and gastric pressures by high-resolution manometry; (2) pharyngeal and esophageal reflux events by impedance and pH recordings; and (3) sleep stages and respiratory events using polysomnography. End-inspiration UES, GEJ, ESO, and gastric pressures over intervals of OSA were averaged in patients with OSA and compared with average values for randomly selected 10-s intervals during sleep in controls and patients with GERD.

RESULTS: ESO pressures decreased during OSA events. However, end-inspiratory UES and GEJ pressures progressively increased during OSA, and at the end of OSA events were significantly higher than at the beginning (P < .01). The prevalence of GER and EPR events during sleep in patients with OSA and GERD did not differ from those in controls, patients with GERD and without OSA, and patients with OSA and without GERD.

CONCLUSIONS: Despite a decrease in ESO pressure during OSA events, compensatory changes in UES and GEJ pressures prevent reflux.

Author List

Kuribayashi S, Massey BT, Hafeezullah M, Perera L, Hussaini SQ, Tatro L, Darling RJ, Franco R, Shaker R

Authors

Rose Franco MD Professor in the Medicine department at Medical College of Wisconsin
Benson T. Massey MD Professor in the Medicine department at Medical College of Wisconsin
Reza Shaker MD Assoc Provost, Sr Assoc Dean, Ctr Dir, Chief, Prof in the Medicine department at Medical College of Wisconsin

MESH terms used to index this publication - Major topics in bold

Adolescent
Adult
Aged
Case-Control Studies
Esophageal Sphincter, Upper
Esophageal pH Monitoring
Esophagogastric Junction
Exhalation
Female
Gastroesophageal Reflux
Humans
Inhalation
Laryngopharyngeal Reflux
Male
Manometry
Middle Aged
Polysomnography
Sleep Apnea, Obstructive
Young Adult