The effect of acid suppression on upper airway anatomy and obstruction in patients with sleep apnea and gastroesophageal reflux disease.

OBJECTIVE

This study was designed to assess the effect of acid suppression on upper airway structure and function in patients with obstructive sleep apnea syndrome (OSAS) and gastroesophageal reflux disease (GERD).

METHODS

This is a single-site within-subjects design. Twenty five patients with documented mild OSAS and objectively documented GERD via 24-hour pH measurement were included in the study. Patients were studied before and after 8 weeks of treatment with rabeprazole, 20 mg, twice a day. Subjects underwent laryngoscopy, polysomnography, and 24-hour pH monitoring. Subjective assessments of sleep obtained included the Pittsburg Sleep Quality Index and the Epworth Sleepiness Scale.

RESULTS

Posterior commissure edema was significantly reduced (p < 0.05), and the Reflux Finding Score was improved (p < 0.07). Objective and subjective sleep parameters were significantly improved, sleep-onset latency was significantly reduced (26.2 vs 11.2, p < 0.05), and sleep-related acid contact time was significantly reduced (8.0% vs 1.7% p < 0.001). There was no significant change in the apnea-hypopnea index.

CONCLUSIONS

In patients with mild OSAS and documented GERD, acid suppression improves upper airway abnormalities, as well as objective and subjective measures of sleep quality. Aggressive treatment of GERD in patients with OSAS may be helpful in the overall treatment of this select patient population.