Gastroesophageal Reflux Common in Patients With Sleep Apnea Rather Than Snorers Without Sleep Apnea

In a recent issue of CHEST (June 2002) Valipour and coworkers1 reported that symptomatic gastroesophageal reflux (GER) is common in subjects with a breathing sleep disorder, but that there was no difference between those with obstructive sleep apnea (OSA) and subjects who snore. We agree with the authors that GER is common in subjects with a breathing sleep disorder. However, we do not agree with the second conclusion that the symptoms of GER are not different between a patient with OSA and a snorer without OSA. First, because a pathologic link between GER and OSA has been suggested by us and others,2–8 the interrelationship between GER and OSA is not totally due to snoring, but primarily to sleep apneas. Second, the authors assessed the severity of GER by the degree of GER-related symptoms alone. However, outcomes after the treatment of GERD are usually measured by symptoms, pH monitoring, and health-related quality of life.9 Thus, the current study did not complete the assessment of the severity of GER in both OSA patients and snorers. Furthermore, conventional GER is effectively treated by, but is not cured by, continuous positive airway pressure (CPAP). This suggests that the disease state of GER in OSA patients is not equal to that of GER alone. Third, we have already reported10 that GER symptoms in OSAS patients were reversed by nasal CPAP treatment. Kerr and coworkers11 also reported that treatment with nasal CPAP at night can correct sleep apnea-related GER in patients with OSA. These results indicate that OSAS is more associated with the symptoms of GER than with snoring alone. Fourth, Senior and coworkers12 have reported that the treatment of GER with omeprazole improves the apnea index and respiratory disturbance index in patients with obstructive sleep apnea. Fifth, when snoring patients have a spectrum of symptoms, featuring upper airway resistance syndrome (UARS), the GER symptoms may be similar between snoring patients with UARS and patients with OSA. Considering the points listed above, GER seems to associate with sleep apnea rather than snoring alone.