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. 2016 Sep 20;17(1):115.
doi: 10.1186/s12931-016-0431-7.

Respiratory symptoms, sleep-disordered breathing and biomarkers in nocturnal gastroesophageal reflux

Össur Ingi Emilsson  1   2   3 , Bryndís Benediktsdóttir  4   5 , Ísleifur Ólafsson  6 , Elizabeth Cook  6 , Sigurður Júlíusson  4   7 , Einar Stefán Björnsson  4   8 , Sunna Guðlaugsdóttir  8 , Anna Soffía Guðmundsdóttir  8 , Ekaterina Mirgorodskaya  9 , Evert Ljungström  10 , Erna Sif Arnardóttir  4   5 , Thórarinn Gíslason  4   5 , Christer Janson  11 , Anna-Carin Olin  9
Affiliations

Respiratory symptoms, sleep-disordered breathing and biomarkers in nocturnal gastroesophageal reflux

Össur Ingi Emilsson et al. Respir Res. .

Erratum in

Abstract

Background: Nocturnal gastroesophageal reflux (nGER) is associated with respiratory symptoms and sleep-disordered breathing (SDB), but the pathogenesis is unclear. We aimed to investigate the association between nGER and respiratory symptoms, exacerbations of respiratory symptoms, SDB and airway inflammation.

Methods: Participants in the European Community Respiratory Health Survey III in Iceland with nGER symptoms (n = 48) and age and gender matched controls (n = 42) were studied by questionnaires, exhaled breath condensate (EBC), particles in exhaled air (PEx) measurements, and a home polygraphic study. An exacerbation of respiratory symptoms was defined as an episode of markedly worse respiratory symptoms in the previous 12 months.

Results: Asthma and bronchitis symptoms were more common among nGER subjects than controls (54 % vs 29 %, p = 0.01; and 60 % vs 26 %, p < 0.01, respectively), as were exacerbations of respiratory symptoms (19 % vs 5 %, p = 0.04). Objectively measured snoring was more common among subjects with nGER than controls (snores per hour of sleep, median (IQR): 177 (79-281) vs 67 (32-182), p = 0.004). Pepsin (2.5 ng/ml (0.8-5.8) vs 0.8 ng/ml (0.8-3.6), p = 0.03), substance P (741 pg/ml (626-821) vs 623 pg/ml (562-676), p < 0.001) and 8-isoprostane (3.0 pg/ml (2.7-3.9) vs 2.6 pg/ml (2.2-2.9), p = 0.002) in EBC were higher among nGER subjects than controls. Albumin and surfactant protein A in PEx were lower among nGER subjects. These findings were independent of BMI.

Conclusion: In a general population sample, nGER is associated with symptoms of asthma and bronchitis, as well as exacerbations of respiratory symptoms. Also, nGER is associated with increased respiratory effort during sleep. Biomarker measurements in EBC, PEx and serum indicate that micro-aspiration and neurogenic inflammation are plausible mechanisms.

Keywords: Asthma; Bronchitis; Exhaled breath condensate; Nocturnal gastroesophageal reflux; Particles in exhaled air; Sleep-disordered breathing.

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Figures

Fig. 1
Fig. 1
A flow diagram of selection of cases and controls. At the top are subjects at the time of first visit in the ECRHS III study, and at the bottom at follow-up around 5–8 months later. The groups in bold were used for further analysis: Subjects who were symptomatic at baseline and follow-up (persistent nGER), and subjects who were asymptomatic at baseline and follow-up (controls). nGER = nocturnal gastroesophageal reflux
Fig. 2
Fig. 2
Exacerbations of respiratory symptoms in the previous 12 months among subjects with or without nGER. * p = 0.02 by chi square test
Fig. 3
Fig. 3
A positive association was found between snoring and exacerbations of respiratory symptoms among subjects with nGER, but not among subjects without nGER. * p = 0.03 by linear regression
Fig. 4
Fig. 4
a Interleukin 8 levels in plasma among nGER subjects with or without exacerbations of respiratory symptoms. The transverse line represents median value. b Substance P levels in exhaled breath condensate among subjects with nGER with or without nocturnal cough. The transverse line represents median value. P-values calculated with Wilcoxon rank-sum test
See this image and copyright information in PMC

References

    1. Gislason T, Janson C, Vermeire P, et al. Respiratory symptoms and nocturnal gastroesophageal reflux: A population-based study of young adults in three European countries. Chest. 2002;121(1):158–163. doi: 10.1378/chest.121.1.158. - DOI - PubMed
    1. Emilsson OI, Bengtsson A, Franklin KA, et al. Nocturnal gastro-oesophageal reflux, asthma and symptoms of OSA: a longitudinal, general population study. Eur Respir J. 2013;41(6):1347–1354. doi: 10.1183/09031936.00052512. - DOI - PubMed
    1. Liang WT, Yan C, Wang ZG, et al. Early and Midterm Outcome After Laparoscopic Fundoplication and a Minimally Invasive Endoscopic Procedure in Patients with Gastroesophageal Reflux Disease: A Prospective Observational Study. J Laparoendosc Adv Surg Tech A. 2015;25(8):657–661. doi: 10.1089/lap.2015.0188. - DOI - PubMed
    1. Kuribayashi S, Kusano M, Kawamura O, et al. Mechanism of gastroesophageal reflux in patients with obstructive sleep apnea syndrome. Neurogastroenterol Motil 2010;22(6):611-e172. - PubMed
    1. Morse CA, Quan SF, Mays MZ, Green C, Stephen G, Fass R. Is there a relationship between obstructive sleep apnea and gastroesophageal reflux disease? Clin Gastroenterol Hepatol. 2004;2(9):761–768. doi: 10.1016/S1542-3565(04)00347-7. - DOI - PubMed

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