内镜证实的胃食管反流病与阻塞性睡眠呼吸暂停的严重程度的相关性
2017/10/09
摘要
目的：阻塞性睡眠呼吸暂停（OSA）是胃食管反流病（GERD）的重要危险因素。然而，两者之间的相关性未曾直接或完全阐明。本研究旨在应用多导睡眠监测仪（PSG）和食道胃十二指肠镜（EGD）检查来评估OSA与GERD之间的关系。
方法：所有纳入者均于2013年10月至2015年7月在首尔大学Bundang医院进行PSG与EGD两项检查，根据洛杉矶分类标准结合患者的EGD检查结果有无黏膜损伤分为非GERD组及GERD组。此外，研究还搜集了患者有无烧心、反酸、反流相关咳嗽等GERD相关症状。
结果：研究共纳入患者216人，其中99人（45.8%）纳入GERD组，68人（31.5%）纳入微小改变型GERD组，49人（22.7%）纳入GERD LA-A/B组（洛杉矶分级A-A/B）。OSA相关结果在GERD LA-A/B组较非GERD组差，即睡眠呼吸暂停指数（AHI）为33.6±25.5 VS. 22.0±17.2 (p=0.01)；最长呼吸暂停时间为50.7±24.0 VS. 41.6±23.3s (p=0.03)；最低血氧饱和度为80.2±7.9 VS. 83.2±7.5% (p=0.02)；氧减指数为25.1±22.4 VS. 16.1±15.5 (p=0.01)。在睡眠效率方面，伴有GERD组相关症状患者较无症状者差（81.2±10.8% VS.85.1±11.4% (p=0.03)）。
结论：内镜证实的GERD与较严重的OSA相关，GERD组症状与睡眠质量下降相关。
Associations between obstructive sleep apnea severity and endoscopically proven gastroesophageal reflux disease.
Kim Y, Lee YJ, Park JS, Cho YJ, Yoon HI, Lee JH, Lee CT, Kim SJ
Abstract
PURPOSE:Obstructive sleep apnea (OSA) is believed to be an important risk factor for gastroesophageal reflux disease (GERD). However, the association between OSA and GERD is not straightforward and has been incompletely characterized. The aim of this study was to assess the relationship between OSA and GERD by performing both polysomnography (PSG) and esophagogastroduodenoscopy (EGD).
METHODS:The enrolled patients underwent both PSG and EGD from October 2003 to July 2015 at Seoul National University Bundang Hospital. All patients were checked for the presence of mucosal injury in the EGD findings and divided into a no-GERD group and a GERD group according to the Los Angeles (LA) classification. In addition, the GERD symptoms of heartburn, acid regurgitation, and reflux-related cough were recorded.
RESULTS:A total of 216 patients were enrolled. Ninety-nine patients (45.8%) were in the GERD group, 68 (31.5%) were the minimal-change GERD group, and 49 (22.7%) were in the GERD LA-A/B group. The OSA-related findings were worse in the GERD LA-A/B group than in the no-GERD group: the apnea-hypopnea index was 33.6 ± 25.5 versus 22.0 ± 17.2 (p = 0.01), the longest apnea duration was 50.7 ± 24.0 versus 41.6 ± 23.3 s (p = 0.03), the lowest oxygen saturation was 80.2 ± 7.9 versus 83.2 ± 7.5% (p = 0.02), and the oxygen desaturation index was 25.1 ± 22.4 versus 16.1 ± 15.5 (p = 0.01), respectively. Sleep efficiency was significantly worse in patients with GERD symptoms (81.2 ± 10.8%) than in those without GERD symptoms (85.1 ± 11.4%) (p = 0.03).
CONCLUSIONS:Endoscopically proven GERD was associated with more severe OSA. GERD symptoms were also associated with deteriorated sleep quality.
目的：阻塞性睡眠呼吸暂停（OSA）是胃食管反流病（GERD）的重要危险因素。然而，两者之间的相关性未曾直接或完全阐明。本研究旨在应用多导睡眠监测仪（PSG）和食道胃十二指肠镜（EGD）检查来评估OSA与GERD之间的关系。
方法：所有纳入者均于2013年10月至2015年7月在首尔大学Bundang医院进行PSG与EGD两项检查，根据洛杉矶分类标准结合患者的EGD检查结果有无黏膜损伤分为非GERD组及GERD组。此外，研究还搜集了患者有无烧心、反酸、反流相关咳嗽等GERD相关症状。
结果：研究共纳入患者216人，其中99人（45.8%）纳入GERD组，68人（31.5%）纳入微小改变型GERD组，49人（22.7%）纳入GERD LA-A/B组（洛杉矶分级A-A/B）。OSA相关结果在GERD LA-A/B组较非GERD组差，即睡眠呼吸暂停指数（AHI）为33.6±25.5 VS. 22.0±17.2 (p=0.01)；最长呼吸暂停时间为50.7±24.0 VS. 41.6±23.3s (p=0.03)；最低血氧饱和度为80.2±7.9 VS. 83.2±7.5% (p=0.02)；氧减指数为25.1±22.4 VS. 16.1±15.5 (p=0.01)。在睡眠效率方面，伴有GERD组相关症状患者较无症状者差（81.2±10.8% VS.85.1±11.4% (p=0.03)）。
结论：内镜证实的GERD与较严重的OSA相关，GERD组症状与睡眠质量下降相关。
（中国医科大学附属一院呼吸与危重症学科 李文扬 摘译 杨 冬 审校）
（Sleep Breath. 2017 Jul 7. doi: 10.1007/s11325-017-1533-2. [Epub ahead of print]）
（Sleep Breath. 2017 Jul 7. doi: 10.1007/s11325-017-1533-2. [Epub ahead of print]）
Associations between obstructive sleep apnea severity and endoscopically proven gastroesophageal reflux disease.
Kim Y, Lee YJ, Park JS, Cho YJ, Yoon HI, Lee JH, Lee CT, Kim SJ
Abstract
PURPOSE:Obstructive sleep apnea (OSA) is believed to be an important risk factor for gastroesophageal reflux disease (GERD). However, the association between OSA and GERD is not straightforward and has been incompletely characterized. The aim of this study was to assess the relationship between OSA and GERD by performing both polysomnography (PSG) and esophagogastroduodenoscopy (EGD).
METHODS:The enrolled patients underwent both PSG and EGD from October 2003 to July 2015 at Seoul National University Bundang Hospital. All patients were checked for the presence of mucosal injury in the EGD findings and divided into a no-GERD group and a GERD group according to the Los Angeles (LA) classification. In addition, the GERD symptoms of heartburn, acid regurgitation, and reflux-related cough were recorded.
RESULTS:A total of 216 patients were enrolled. Ninety-nine patients (45.8%) were in the GERD group, 68 (31.5%) were the minimal-change GERD group, and 49 (22.7%) were in the GERD LA-A/B group. The OSA-related findings were worse in the GERD LA-A/B group than in the no-GERD group: the apnea-hypopnea index was 33.6 ± 25.5 versus 22.0 ± 17.2 (p = 0.01), the longest apnea duration was 50.7 ± 24.0 versus 41.6 ± 23.3 s (p = 0.03), the lowest oxygen saturation was 80.2 ± 7.9 versus 83.2 ± 7.5% (p = 0.02), and the oxygen desaturation index was 25.1 ± 22.4 versus 16.1 ± 15.5 (p = 0.01), respectively. Sleep efficiency was significantly worse in patients with GERD symptoms (81.2 ± 10.8%) than in those without GERD symptoms (85.1 ± 11.4%) (p = 0.03).
CONCLUSIONS:Endoscopically proven GERD was associated with more severe OSA. GERD symptoms were also associated with deteriorated sleep quality.
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胃食管反流与慢性呼吸疾病
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慢性阻塞性肺疾病的一种特殊表型：由生物燃料烟雾引起的COPD
