Clinical and functional correlations between gastroesophageal reflux disease and obstructive sleep apnea syndrome
Abstract. Comorbidity between gastroesophageal reflux disease (GERD) and obstructive sleep apnea syndrome (OSAS) is a pressing interdisciplinary problem. Pathophysiological mechanisms underlying their mutual influence remain incompletely understood, and data on the clinical and functional characteristics of the combined course are contradictory.B.B. Dambaeva, E.V. Onuchina, I.V. Temnikova
The aim: to determine the clinical peculiarities, pH-impedance data, and cardiorespiratory monitoring parameters in patients with GERD and OSAS comorbidity.
Material and methods. A cross-sectional analytical study was performed involving 203 patients divided into three groups: Group 1 – patients with isolated GERD (n = 79), Group 2 – with isolated OSAS (n = 94), and Group 3 – with comorbid GERD and OSAS (n = 30). All patients underwent a clinical examination with questionnaires (GERDQ, Berlin Questionnaire, SF-36), esophagogastroduodenoscopy with biopsy, 24-hour esophageal pH-impedance monitoring, and cardiorespiratory monitoring. The diagnosis of GERD was established according to the recommendations of the Russian Gastroenterological Association (2024) and Lyon Consensus 2.0, while OSAS was diagnosed according to the recommendations of the Eurasian Association of Cardiology and the Russian Society of Somnologists (2024).
Results. In the group of patients with comorbidities, compared to participants with isolated GERD, nocturnal symptoms (86.6 vs. 36.7%, p = 0.00001), regurgitation (93.3 vs. 60.8%, p = 0.0009), erosive esophagitis (50 vs. 22.8%, p = 0.006), papillary elongation (89.5 vs. 57.9%, p=0.04), and intraepithelial cell infiltration (73.7 vs. 44.7%, p=0.04) were more frequently detected. In addition, pH-impedance monitoring revealed an increase in esophageal AET (6.9 vs. 1.9%, p = 0.01), a predominance of nocturnal weakly acidic and mixed reflux episodes, and a decrease in the PSPW index (31.5 vs. 54.6%, p = 0.00001) and mean nocturnal baseline impedance in the proximal segment (2.9 vs. 5.3 kOhm, p = 0.000001) in comorbid patients.
Conclusion. The comorbidity of GERD and OSAS creates a phenotype that is qualitatively different from either of these pathologies, characterized by a specific symptom complex, a distinct reflux pattern, and impaired esophageal defense mechanisms. Comparatively with patients with isolated OSAS, comorbid patients had less severe obesity (BMI 28.7 vs. 37.2 kg/m², p = 0.00001) and less severe apnea (AHI 9.7 vs. 13.9, p = 0.03), but more often associated apnea with food intake (60%) and GERD symptoms.
Keywords
gastroesophageal reflux disease
obstructive sleep apnea syndrome
comorbidity
24-hour pH-impedance monitoring
cardiorespiratory monitoring
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About the Authors
Bairma B. Dambaeva, MD, assistant at the Department of therapy, Irkutsk State Medical Academy of Postgraduate Education – a branch of the Russian Medical Academy of Continuous Professional Education, Irkutsk, Russian Federation.E-mail: lapsus5678calami@gmail.com
ORCID: https://orcid.org/0009-0008-7667-6548. eLibrary SPIN: 6356-3913
Elena V. Onuchina, MD, Dr. Sci. (Medicine), professor of the Department of therapy, Irkutsk State Medical Academy of Postgraduate Education – a branch of the Russian Medical Academy of Continuous Professional Education, Irkutsk, Russian Federation.
E-mail: elonu@mail.ru
ORCID: https://orcid.org/0000-0003-1954-6639. eLibrary SPIN: 3802-9332
Irina V. Temnikova, MD, PhD (Medicine), otolaryngologist at the Department of otolaryngology, Clinical Hospital “RZhD-Medicine Irkutsk”, Irkutsk, Russian Federation Irkutsk, Russian Federation.
E-mail: 4ivt@mail.ru
ORCID: https://orcid.org/0009-0002-7112-6527
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