Chest
Volume 121, Issue 1, January 2002, Pages 158-163
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Clinical Investigations
Sleep and Breathing
Respiratory Symptoms and Nocturnal Gastroesophageal Reflux: A Population-Based Study of Young Adults in Three European Countries

https://doi.org/10.1378/chest.121.1.158Get rights and content

Study objective

To estimate the possible association between reported symptoms of gastroesophageal reflux (GER) after bedtime, sleep-disordered breathing, respiratory symptoms, and asthma.

Design

Cross-sectional international population survey.

Participants

Participants consisted of 2,661 subjects (age range, 20 to 48 years) from three countries (Iceland, Belgium, and Sweden), of whom 2,202 were randomly selected from the general population and 459 were added because of reported asthma.

Measurements

The investigation included a structured interview, spirometry, methacholine challenge, peak flow diary, skin-prick tests, and a questionnaire on sleep disturbances.

Results

In the random population sample, 101 subjects (4.6%) reported GER, which was defined as the occurrence of heartburn or belching after going to bed at least once per week. Subjects with nocturnal GER more often were overweight and had symptoms of sleep-disordered breathing than participants not reporting GER. Participants with GER were more likely to report wheezing (adjusted odds ratio [OR], 2.5), breathlessness at rest (adjusted OR, 2.8), and nocturnal breathlessness (adjusted OR, 2.9), and they had increased peak flow variability compared to the subjects without GER. Physician-diagnosed current asthma was reported by 9% of subjects with GER compared to 4% of those not reporting GER (p < 0.05). Subjects with the combination of asthma and GER had a higher prevalence of nocturnal cough, morning phlegm, sleep-related symptoms, and higher peak flow variability than subjects with asthma alone.

Conclusion

The occurrence of GER after bedtime is strongly associated with both asthma and respiratory symptoms, as well as symptoms of obstructive sleep apnea syndrome. The partial narrowing or occlusion of the upper airway during sleep, followed by an increase in intrathoracic pressure, might predispose the patient to nocturnal GER and, consequently, to respiratory symptoms.

Section snippets

Study Areas and Target Populations

The subjects in this study came from the following four centers: Reykjavik, the capital of Iceland, and its surrounding suburbs (approximate population, 160,000 inhabitants); Uppsala, the fourth largest city in Sweden (approximate population, 170,000 inhabitants); Goïteborg, the second largest city in Sweden (the study area comprised the northern part of the city on the island of Hisingen; approximate population, 110,000 inhabitants); and Antwerp, the second largest city in Belgium (the study

Results

In the randomly selected population sample, nocturnal GER was reported by 3.4% in Reykjavik, 4.8% in Uppsala, 6.3% in Goïteborg, and 4.3% in Antwerp, for a total of 101 subjects (4.6%). The age and gender of these patients were similar to those subjects not reporting nocturnal GER, but they were more often overweight (ie, higher body mass index [BMI]) and more often reported both day and night symptoms related to sleep-disordered breathing (Table 2). Those subjects who reported GER after

Discussion

Our study, which was based on random samples of young adults in three European countries, shows that individuals who report GER after bedtime have an increased likelihood of having respiratory symptoms and asthma. This nocturnal GER group also had a much higher prevalence of symptoms related to sleep-disordered breathing, like snoring, nighttime sweating, reported apneas, and daytime sleepiness. Our results draw attention to the partial narrowing or the complete occlusion of the upper airway

ACKNOWLEDGMENT

We thank Mrs. Elsbeth Scholtes at the Department of Medicine, Uppsala University, for assistance with the translation of the sleep questionnaire into Dutch. Professor Wilfried de Backer is acknowledged for his help in carrying out the sleep survey in Antwerp.

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  • Cited by (0)

    The Icelandic part of this study was supported financially by the Icelandic Research Council. The Swedish part of this study was supported by the Swedish Heart and Lung Foundation, the Swedish Medical Research Council, and the Swedish Association Against Asthma and Allergy. The Belgian part of this study was

    supported by the Belgian Science Policy Office and the National Fund for Scientific Research.

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