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Extra-esophageal reflux, NOSE score, and sleep quality in an adult clinic population. Laryngoscope 2013 Dec;123(12):3233-8



Pubmed ID




Scopus ID

2-s2.0-84888428865   7 Citations


OBJECTIVES/HYPOTHESIS: Gastroesophageal reflux disease and heartburn negatively impact sleep; the impact of extraesophageal reflux (EER) symptoms on sleep is unknown. This study's goal was to evaluate the association of EER and measures of nasal obstruction, mood, insomnia, hypersomnia, and obstructive sleep apnea (OSA) risk.

STUDY DESIGN: Cross-sectional study.

SETTING: Tertiary care hospital.

SUBJECTS AND METHODS: A prospective cohort of adult patients was evaluated using validated questionnaires for insomnia (PSQI), hypersomnia (ESS), OSA risk (STOP-Bang), sleep quality of life (FOSQ-10), EER reflux symptoms (RSI), nasal symptoms (NOSE), and measures of mood (HADA). Pharyngeal saliva samples underwent Western blot immunoassay for pepsin.

RESULTS: Ninety-three adults (mean age 50.2 ± 15.2 years, 43% female) were evaluated. Reflux Symptom Index (RSI) was elevated in 32% of patients and significant heartburn symptoms were reported in only 12% of patients. Prevalence of pepsin (+) was 27%. Both RSI and NOSE were significantly associated with sleep measures related to insomnia (r = 0.48 and r = 0.50; P < 0.001, respectively), Quality of Life (QOL) (r = 0.30 and r = 0.34; P < 0.001, respectively), and hypersomnolance (r = 0.18 and P < 0.04; r = 0.29 and P < 0.01, respectively), but not apnea risk (all P < 0.05). Nasal symptoms and mood were associated with all non-OSA sleep metrics (r = 0.24). In multivariate analysis, both NOSE and RSI remained significantly associated with sleep measures.

CONCLUSIONS: Insomnia, hypersomnia, and sleep QOL are associated with measures of EER, nasal symptoms, and mood but not OSA risk, supporting that disrupted sleep may be associated with EER and nasal symptoms independent of sleep apnea.

Author List

Laohasiriwong S, Johnston N, Woodson BT


Nikki Johnston PhD Associate Professor in the Otolaryngology department at Medical College of Wisconsin
B Tucker Woodson MD Chief, Professor in the Otolaryngology department at Medical College of Wisconsin

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

Cross-Sectional Studies
Follow-Up Studies
Laryngopharyngeal Reflux
Middle Aged
Prospective Studies
Sleep Wake Disorders
Surveys and Questionnaires
Tertiary Care Centers
United States
jenkins-FCD Prod-480 9a4deaf152b0b06dd18151814fff2e18f6c05280