J Neurogastroenterol Motil  https://doi.org/10.5056/jnm20071
The Influence of Gastroesophageal Reflux Disease on Daytime Sleepiness and Depressive Symptom in Patients With Obstructive Sleep Apnea
Hyeon Hui Kang,1 Chul-Hyun Lim,2* Jung Hwan Oh,2 Min-Jae Cho,2 and Sang Haak Lee2
1Department of Internal Medicine, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea; and 2Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea
Correspondence to: Chul-Hyun Lim, MD, PhD
Division of Gastroenterology, Department of Internal Medicine, Eunpyeong St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, 1021, Tongil-ro, Eunpyeong-gu, Seoul 03312, Korea
Tel: +82-2-2030-4316, Fax: +82-2-2030-4641, E-mail: diluck@catholic.ac.kr
Received: April 10, 2020; Revised: June 1, 2020; Accepted: June 15, 2020; Published online: August 6, 2020.
© The Korean Society of Neurogastroenterology and Motility. All rights reserved.

Abstract
Background/Aims
As there is insufficient evidence for a relationship between gastroesophageal reflux disease (GERD) and obstructive sleep apnea (OSA), we investigated whether OSA diagnosed by polysomnography (PSG) is related to GERD.
Methods
A total of 402 subjects was evaluated. Overnight PSG was performed and a few questionnaires on GERD, anxiety, depression, and daytime sleepiness were administered. An apnea-hypopnea index < 5 was the classification criterion for subjects without OSA. Subjects with heartburn or acid regurgitation at least once a week were classified as having GERD.
Results
Among the 402 subjects, 318 had OSA and 84 did not. The prevalence of GERD was 12.9% among patients with OSA and 10.7% among those without (P = 0.590). The prevalence of GERD did not correlate with OSA severity (P = 0.474). Patients with OSA with GERD had higher Stanford Sleepiness Scale (P = 0.004), Epworth Sleepiness Scale (P = 0.001), and depression (P < 0.001) scores than patients with OSA without GERD. Subjects with nocturnal gastroesophageal reflux symptoms had a higher body mass index, waist-to-height ratio, and waist circumference-to-height index than those without symptoms. Multiple logistic regression showed that higher Epworth Sleepiness Scale and depression scores were independent factors associated with GERD in patients with OSA.
Conclusions
The prevalence of GERD in patients with OSA was 12.9%. The prevalence of GERD did not correlate with OSA severity. Daytime sleepiness and depression seem to be associated with GERD in patients with OSA, while nocturnal reflux symptoms seem to be related to obesity in OSA.
Keywords: Depression; Gastroesophageal reflux; Obesity; Polysomnography; Sleep apnea, obstructive


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