Are GERD and Sleep Apnea Related?
Sleep Arousal May Result From Reflux, but Could Acid Reflux Result in Sleep Apnea?
This is good news for millions of people with GERD, which is most common after middle age, when the valve at the bottom of the esophagus weakens -- making acid more likely to flow upward. The risks for GERD are similar to those for obstructive sleep apnea, and obesity is one reason people develop GERD.
Obstructive sleep apnea is also more common after middle age, especially in obese people. It is caused by relaxation of tissues in the neck, resulting in a temporary obstruction of the air passages. A person with sleep apnea may have as many as 50 or more episodes of breathing stoppage in a single night, raising their risk of high blood pressure and heart attack.
Mulhall's preliminary results do show what researchers have long suspected: reflux does cause people to wake up from sleep. Yet it may be a reflux of other backflowing liquids and not just stomach acids.
So far, the first stage of his study involved 50 adults, 30 of whom have been diagnosed with sleep apnea. Of those, 10 also have GERD. The next phase of his research will involve 280 patients, who will also be evaluated with a new test that measures all contents that flow into the esophagus, including non-acidic liquids that may produce fewer symptoms.
This is important because if the next phase of his research does show a stronger association between sleep apnea and any type of refluxed material, doctors may be better able to help prevent possible esophageal damage in patients not previously recognized to be at increased risk. For instance, it could be the amount of liquids that are regurgitated, not necessarily its acidity level.
"Many patients with obstructive sleep apnea have no symptoms of heartburn," Mulhall says. "What we will be doing is to evaluate whether these patients are having more esophageal injuries than are expected. It may turn out that if you have obstructive sleep apnea, you need to be examined for reflux -- even if you have no symptoms of GERD."