Gastroesophageal reflux disease and sleep disorders: evidence for a causal link and therapeutic implications

Abstract

Gastroesophageal reflux disease (GERD) and sleep disturbances are both common health problems. There is a significant association between disturbed sleep and GERD, and this may be bidirectional. Sleep disorders may induce gastrointestinal (GI) disturbances, while GI symptoms also may provoke or worsen sleep derangements. Reflux of gastric acid is a less frequent event during sleep, however, acid clearance mechanisms (including swallowing, salivation and primary esophageal motility) are impaired during sleep resulting in prolongation of acid contact time. Nighttime reflux can lead to sleep disturbance and sleep disturbance may further aggravate GERD by prolonged acid contact time and heightened sensory perception. This may facilitate the occurrence of complicated GERD and decreased quality of life. However, the interplay between sleep problems and GERD is complex, and there are still relatively limited data on this issue. Further investigation of sleep-related GERD may identify common pathophysiological themes and new therapeutic targets.

Keywords: Gastroesophageal reflux disease; Sleep.

Figure 1

Epidemiologic data show the adjusted odds ratios (ORs) from case-control studies examining the association between sleep disturbance and gastroesophageal reflux disease. Upper four studies show a consistent and significant association with sleep disturbance among GERD. Chen et al.^* shows the association between sleep disturbance and reflux esophagitis. Bottom shows that increased ORs for GERD among individuals with sleep disturbance.

Figure 2

Possible pathophysiology of sleep disturbance and gastroesophageal reflux disease (GERD).