Impedance-pH monitoring Profile of Patients with Reflux and Obstructive
Sleep Apnea Syndrome: A Controlled Study.
Abstract
Objective: To study the profile of patients with obstructive sleep apnea
syndrome (OSAS) and laryngopharyngeal reflux (LPR) at the
hypopharyngeal-esophageal multichannel intraluminal impedance-pH
monitoring (HEMII-pH) and to compare their reflux findings with LPR
patients without OSAS. Design: Prospective controlled study. Methods:
Patients with LPR and OSAS were prospectively recruited from Augustus
2019 to June 2020. The profile of hypopharyngeal reflux events (HRE) of
patients was studied through a breakdown of the HEMII-pH findings over
the 24-hour of testing. Reflux symptom score (RSS), gastrointestinal and
HEMII-pH outcomes were compared between LPR patients and patients with
LPR and OSAS. Multivariate analysis was used to study the relationship
between reflux data and the following sleep outcomes: Apnea-Hypopnea
Index, Epworth Slippiness Scale (ESS) and paradoxical sleep data.
Results: A total of 89 patients completed the study. There were 45
patients with LPR and 44 subjects with both OSAS and LPR. The numbers of
upright and daytime HREs and the otolaryngological RSS were
significantly higher in patients with LPR compared with those with OSAS
and LPR. There was a significant positive association between RSS
quality of life score and ESS (p=0.001). The occurrence of HREs in the
evening was associated with higher ESS (p=0.015). Patients with OSAS,
LPR and GERD had higher number of nocturnal HREs compared with those
without GERD (p=0.001). Conclusion: The presence of OSAS in LPR patients
is associated with less severe HEMII-pH and ear, nose and throat
symptoms. There may have different OSAS patient profiles according to
the occurrence of GERD.