Relationships between sleep quality and pH monitoring findings in persons with gastroesophageal reflux disease

Ram Dickman, Colleen Green, Shira S. Fass, Stuart F Quan, Roy Dekel, Sara Risner-Adler, Ronnie Fass

Research output: Contribution to journalArticle

69 Citations (Scopus)

Abstract

Background: Nighttime reflux has been shown to be associated with esophageal mucosal injury, complications, and extra-esophageal manifestations. However, few studies have assessed the impact of gastroesophageal reflux on reported quality of sleep and quality of sleep on gastroesophageal reflux. Aims: The aims of this study were (1) to determine the correlation between the severity of gastroesophageal reflux disease (GERD) symptoms and esophageal acid contact time and subjects' perceived quality of sleep; (2) to investigate the correlation between reported quality of sleep of the night prior and severity of GERD symptoms and esophageal acid contact time the following day; and (3) to define in a sleep laboratory the correlation between acid reflux events and sleep architecture. Methods: Subjects with typical GERD symptoms ≥3 times a week underwent upper endoscopy and pH monitoring. These subjects subsequently completed the GERD Symptom Assessment Score (GSAS), and the Sleep Heart Health Study Sleep Habits (SHHS) Questionnaire to assess baseline sleep symptoms and GERD symptoms, including an index of GERD symptom severity (GERD symptom index). Before and after the pH test, the patients completed a different instrument, the Sleep Quality Questionnaire, utilized specifically to assess the quality of each subject's sleep before and after pH testing. Fifteen randomly selected subjects also underwent a polysomnographic study during the pH test. Results: Forty-eight (33 males/15 females, mean age 48.8 ± 17.1 y) subjects were prospectively recruited. Using data from the GSAS and SHHS questionnaires, disorders of initiating and maintaining sleep were found to be positively associated with greater severity of the GERD symptom index (r = 0.33, p <0.05). More frequent awakenings also correlated with a higher GERD symptom index (r = 0.4, p <0.01). Correlations between the Sleep Quality Questionnaire on the night before sleep testing and pH monitoring data showed that subjects with poorer sleep quality had longer acid reflux events (r=-0.34, p<0.05). More perceived awakenings also were correlated with the number of supine acid reflux events > 5 min (r=0.31, p<0.05) and the duration of the longest supine acid reflux event (r = 0.28, p = 0.05). Inverse correlations were observed between overall sleep quality on the pH testing night and a higher percentage of time spent with pH<4 supine (r=-0.432, p <0.002), and the duration of the longest acid reflux event during the entire night (r = -0.38, p <0.01) and supine (r=-0.37, p<0.02). Conclusions: Persons with worse GERD symptoms report poorer subject sleep quality. Poor sleep quality on the night prior to pH testing was associated with more acid exposure the following day. Greater acid exposure at night was related to a worse perception of sleep quality the next day. These findings suggest important interactions between GERD and sleep quality.

Original languageEnglish (US)
Pages (from-to)505-513
Number of pages9
JournalJournal of Clinical Sleep Medicine
Volume3
Issue number5
StatePublished - Aug 15 2007

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Gastroesophageal Reflux
Sleep
Acids
Symptom Assessment
Habits
Health
Sleep Initiation and Maintenance Disorders

Keywords

  • GERD
  • Heartburn
  • pH test
  • Sleep

ASJC Scopus subject areas

  • Clinical Neurology
  • Pulmonary and Respiratory Medicine
  • Neurology

Cite this

Relationships between sleep quality and pH monitoring findings in persons with gastroesophageal reflux disease. / Dickman, Ram; Green, Colleen; Fass, Shira S.; Quan, Stuart F; Dekel, Roy; Risner-Adler, Sara; Fass, Ronnie.

In: Journal of Clinical Sleep Medicine, Vol. 3, No. 5, 15.08.2007, p. 505-513.

Research output: Contribution to journalArticle

Dickman, R, Green, C, Fass, SS, Quan, SF, Dekel, R, Risner-Adler, S & Fass, R 2007, 'Relationships between sleep quality and pH monitoring findings in persons with gastroesophageal reflux disease', Journal of Clinical Sleep Medicine, vol. 3, no. 5, pp. 505-513.
Dickman, Ram ; Green, Colleen ; Fass, Shira S. ; Quan, Stuart F ; Dekel, Roy ; Risner-Adler, Sara ; Fass, Ronnie. / Relationships between sleep quality and pH monitoring findings in persons with gastroesophageal reflux disease. In: Journal of Clinical Sleep Medicine. 2007 ; Vol. 3, No. 5. pp. 505-513.
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abstract = "Background: Nighttime reflux has been shown to be associated with esophageal mucosal injury, complications, and extra-esophageal manifestations. However, few studies have assessed the impact of gastroesophageal reflux on reported quality of sleep and quality of sleep on gastroesophageal reflux. Aims: The aims of this study were (1) to determine the correlation between the severity of gastroesophageal reflux disease (GERD) symptoms and esophageal acid contact time and subjects' perceived quality of sleep; (2) to investigate the correlation between reported quality of sleep of the night prior and severity of GERD symptoms and esophageal acid contact time the following day; and (3) to define in a sleep laboratory the correlation between acid reflux events and sleep architecture. Methods: Subjects with typical GERD symptoms ≥3 times a week underwent upper endoscopy and pH monitoring. These subjects subsequently completed the GERD Symptom Assessment Score (GSAS), and the Sleep Heart Health Study Sleep Habits (SHHS) Questionnaire to assess baseline sleep symptoms and GERD symptoms, including an index of GERD symptom severity (GERD symptom index). Before and after the pH test, the patients completed a different instrument, the Sleep Quality Questionnaire, utilized specifically to assess the quality of each subject's sleep before and after pH testing. Fifteen randomly selected subjects also underwent a polysomnographic study during the pH test. Results: Forty-eight (33 males/15 females, mean age 48.8 ± 17.1 y) subjects were prospectively recruited. Using data from the GSAS and SHHS questionnaires, disorders of initiating and maintaining sleep were found to be positively associated with greater severity of the GERD symptom index (r = 0.33, p <0.05). More frequent awakenings also correlated with a higher GERD symptom index (r = 0.4, p <0.01). Correlations between the Sleep Quality Questionnaire on the night before sleep testing and pH monitoring data showed that subjects with poorer sleep quality had longer acid reflux events (r=-0.34, p<0.05). More perceived awakenings also were correlated with the number of supine acid reflux events > 5 min (r=0.31, p<0.05) and the duration of the longest supine acid reflux event (r = 0.28, p = 0.05). Inverse correlations were observed between overall sleep quality on the pH testing night and a higher percentage of time spent with pH<4 supine (r=-0.432, p <0.002), and the duration of the longest acid reflux event during the entire night (r = -0.38, p <0.01) and supine (r=-0.37, p<0.02). Conclusions: Persons with worse GERD symptoms report poorer subject sleep quality. Poor sleep quality on the night prior to pH testing was associated with more acid exposure the following day. Greater acid exposure at night was related to a worse perception of sleep quality the next day. These findings suggest important interactions between GERD and sleep quality.",
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AU - Dickman, Ram

AU - Green, Colleen

AU - Fass, Shira S.

AU - Quan, Stuart F

AU - Dekel, Roy

AU - Risner-Adler, Sara

AU - Fass, Ronnie

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N2 - Background: Nighttime reflux has been shown to be associated with esophageal mucosal injury, complications, and extra-esophageal manifestations. However, few studies have assessed the impact of gastroesophageal reflux on reported quality of sleep and quality of sleep on gastroesophageal reflux. Aims: The aims of this study were (1) to determine the correlation between the severity of gastroesophageal reflux disease (GERD) symptoms and esophageal acid contact time and subjects' perceived quality of sleep; (2) to investigate the correlation between reported quality of sleep of the night prior and severity of GERD symptoms and esophageal acid contact time the following day; and (3) to define in a sleep laboratory the correlation between acid reflux events and sleep architecture. Methods: Subjects with typical GERD symptoms ≥3 times a week underwent upper endoscopy and pH monitoring. These subjects subsequently completed the GERD Symptom Assessment Score (GSAS), and the Sleep Heart Health Study Sleep Habits (SHHS) Questionnaire to assess baseline sleep symptoms and GERD symptoms, including an index of GERD symptom severity (GERD symptom index). Before and after the pH test, the patients completed a different instrument, the Sleep Quality Questionnaire, utilized specifically to assess the quality of each subject's sleep before and after pH testing. Fifteen randomly selected subjects also underwent a polysomnographic study during the pH test. Results: Forty-eight (33 males/15 females, mean age 48.8 ± 17.1 y) subjects were prospectively recruited. Using data from the GSAS and SHHS questionnaires, disorders of initiating and maintaining sleep were found to be positively associated with greater severity of the GERD symptom index (r = 0.33, p <0.05). More frequent awakenings also correlated with a higher GERD symptom index (r = 0.4, p <0.01). Correlations between the Sleep Quality Questionnaire on the night before sleep testing and pH monitoring data showed that subjects with poorer sleep quality had longer acid reflux events (r=-0.34, p<0.05). More perceived awakenings also were correlated with the number of supine acid reflux events > 5 min (r=0.31, p<0.05) and the duration of the longest supine acid reflux event (r = 0.28, p = 0.05). Inverse correlations were observed between overall sleep quality on the pH testing night and a higher percentage of time spent with pH<4 supine (r=-0.432, p <0.002), and the duration of the longest acid reflux event during the entire night (r = -0.38, p <0.01) and supine (r=-0.37, p<0.02). Conclusions: Persons with worse GERD symptoms report poorer subject sleep quality. Poor sleep quality on the night prior to pH testing was associated with more acid exposure the following day. Greater acid exposure at night was related to a worse perception of sleep quality the next day. These findings suggest important interactions between GERD and sleep quality.

AB - Background: Nighttime reflux has been shown to be associated with esophageal mucosal injury, complications, and extra-esophageal manifestations. However, few studies have assessed the impact of gastroesophageal reflux on reported quality of sleep and quality of sleep on gastroesophageal reflux. Aims: The aims of this study were (1) to determine the correlation between the severity of gastroesophageal reflux disease (GERD) symptoms and esophageal acid contact time and subjects' perceived quality of sleep; (2) to investigate the correlation between reported quality of sleep of the night prior and severity of GERD symptoms and esophageal acid contact time the following day; and (3) to define in a sleep laboratory the correlation between acid reflux events and sleep architecture. Methods: Subjects with typical GERD symptoms ≥3 times a week underwent upper endoscopy and pH monitoring. These subjects subsequently completed the GERD Symptom Assessment Score (GSAS), and the Sleep Heart Health Study Sleep Habits (SHHS) Questionnaire to assess baseline sleep symptoms and GERD symptoms, including an index of GERD symptom severity (GERD symptom index). Before and after the pH test, the patients completed a different instrument, the Sleep Quality Questionnaire, utilized specifically to assess the quality of each subject's sleep before and after pH testing. Fifteen randomly selected subjects also underwent a polysomnographic study during the pH test. Results: Forty-eight (33 males/15 females, mean age 48.8 ± 17.1 y) subjects were prospectively recruited. Using data from the GSAS and SHHS questionnaires, disorders of initiating and maintaining sleep were found to be positively associated with greater severity of the GERD symptom index (r = 0.33, p <0.05). More frequent awakenings also correlated with a higher GERD symptom index (r = 0.4, p <0.01). Correlations between the Sleep Quality Questionnaire on the night before sleep testing and pH monitoring data showed that subjects with poorer sleep quality had longer acid reflux events (r=-0.34, p<0.05). More perceived awakenings also were correlated with the number of supine acid reflux events > 5 min (r=0.31, p<0.05) and the duration of the longest supine acid reflux event (r = 0.28, p = 0.05). Inverse correlations were observed between overall sleep quality on the pH testing night and a higher percentage of time spent with pH<4 supine (r=-0.432, p <0.002), and the duration of the longest acid reflux event during the entire night (r = -0.38, p <0.01) and supine (r=-0.37, p<0.02). Conclusions: Persons with worse GERD symptoms report poorer subject sleep quality. Poor sleep quality on the night prior to pH testing was associated with more acid exposure the following day. Greater acid exposure at night was related to a worse perception of sleep quality the next day. These findings suggest important interactions between GERD and sleep quality.

KW - GERD

KW - Heartburn

KW - pH test

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