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. 2023 Sep 10;9(5):00387-2023.
doi: 10.1183/23120541.00387-2023. eCollection 2023 Sep.

Positive airway pressure treatment affects respiratory symptoms and gastro-oesophageal reflux: the Icelandic Sleep Apnea Cohort Study

Össur Ingi Emilsson  1   2   3 , Thor Aspelund  4 , Christer Janson  3 , Bryndis Benediktsdottir  1   2 , Sigurdur Juliusson  5 , Greg Maislin  6 , Allan I Pack  6 , Brendan T Keenan  6 , Thorarinn Gislason  1   2
Affiliations

Positive airway pressure treatment affects respiratory symptoms and gastro-oesophageal reflux: the Icelandic Sleep Apnea Cohort Study

Össur Ingi Emilsson et al. ERJ Open Res. .

Abstract

Aim: To study the effect of positive airway pressure (PAP) treatment on nocturnal gastro-oesophageal reflux (nGOR) and respiratory symptoms among clinical obstructive sleep apnoea (OSA) patients.

Methods: 822 patients newly diagnosed with OSA referred for PAP treatment were recruited. 732 patients had a 2-year follow-up visit with continuous PAP compliance data (366 full PAP users, 366 partial/non-PAP users). They answered questionnaires, including reporting of nGOR, sleep and respiratory symptoms and general health. Patients with nGOR symptoms once a week or more were defined as "with nGOR". Those without nGOR symptoms and nGOR medication were defined as "no nGOR". Others were defined as "possible nGOR".

Results: At 2-year follow-up, PAP treatment among full users resulted in decreased nGOR (adjusted OR 0.58, 95% CI 0.40-0.86) and wheezing (adjusted OR 0.56, 95% CI 0.35-0.88) compared with partial/non-PAP users. Decreased nGOR, among both full and partial/non-users of PAP treatment, was associated with a decrease in productive morning cough (adjusted OR 4.70, 95% CI 2.22-9.99) and a decrease in chronic bronchitis (adjusted OR 3.86, 95% CI 1.74-8.58), but not decreased wheezing (adjusted OR 0.90, 95% CI 0.39-2.08). A mediation analysis found that PAP treatment directly led to a decrease in wheezing, not mediated through nGOR. Conversely, PAP treatment decreased productive cough mediated through a decrease in nGOR.

Conclusion: In an unselected group of OSA patients, PAP treatment for 2 years was associated with a decrease in nGOR and respiratory symptoms. The PAP treatment itself was associated with less wheezing. A decrease in nGOR through PAP treatment was associated with a decrease in productive cough.

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Conflict of interest statement

Conflict of interest: All authors have nothing to disclose.

Figures

FIGURE 1
FIGURE 1
Theoretical model for the association between positive airway pressure (PAP) treatment, nocturnal gastro-oesophageal reflux (nGOR) and respiratory symptoms, where nGOR is a mediator for the association between PAP treatment and respiratory symptoms.
FIGURE 2
FIGURE 2
Flow chart of the study population. OSA: obstructive sleep apnoea; PAP: positive airway pressure; nGOR: nocturnal gastro-oesophageal reflux.
FIGURE 3
FIGURE 3
Hypothetical model of the association between obstructive sleep apnoea (OSA), nocturnal gastro-oesophageal reflux (nGOR) and respiratory symptoms (wheezing and productive cough).
See this image and copyright information in PMC

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