Reflux and Sleep Apnea in Children - Its a two way street!

This is a very interesting article. For years we have known that sleep apnea exacerbates reflux. Also, we know the treatment of reflux reduces fragmentation of sleep. This is exciting article showing an improved response  in sleep apnea due to reflux treatment. JR

Original Article

Respiratory response to proton pump inhibitor treatment in children with obstructive sleep apnea syndrome and gastroesophageal reflux disease

• Jolanta Wasilewska^a, , , 
• Janusz Semeniuk^a, 
• Beata Cudowska^a, 
• Mark Klukowski^b, 
• Katarzyna Dębkowska^c, 
• Maciej Kaczmarski^a

• ^a Department of Pediatrics, Gastroenterology and Allergology, Medical University of Bialystok, Waszyngtona Street 17, 15-274 Bialystok, Poland
• ^b Department of Pharmacology, Medical University of Bialystok, Waszyngtona Street 17, 15-274 Bialystok, Poland
• ^c Department of Business Informatics and Logistics, Technical University of Bialystok, Tarasiuka Street 2, 16-001 Kleosin, Poland

• Received 31 December 2011. Revised 8 April 2012. Accepted 25 April 2012. Available online 20 June 2012.

• http://dx.doi.org/10.1016/j.sleep.2012.04.016 , How to Cite or Link Using DOI

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 Link to abstract

Abstract

Objective

Evaluation of the respiratory response to proton pump inhibitors (PPI) in children with obstructive sleep apnea syndrome (OSAS) and gastroesophageal reflux disease (GERD).

Methods

Of 131 children diagnosed with OSAS (Apnea Hypopnea Index, AHI >1/h), 37 children (6.9 years; 28.24%) with GERD symptoms (>3 times/week) were included. Overnight polysomnography with 24 h pH-metry was performed before and after 4–8 weeks of PPI treatment (omeprazole once a day, 1 mg/kg).

Results

Of 37 children, 21 were diagnosed with acid GERD where pre- and post-treatment reflux indexes were 14.09 ± 1.47 vs. 7.73 ± 1.36; (p < 0.001). The number of obstructive apneas and hypopneas decreased after PPI treatment, resulting in an AHI reduction from 13.08 ± 3.11/h to 8.22 ± 2.52/h; (p < 0.01). Respiratory response to PPI ranged from complete resolution of OSA (three children with mild OSA; AHI < 5/h; 10.31 years; 14.29%) to lack of significant AHI change (six children with severe OSA; AHI > 10/h; 3.62 years; 28.57%). Post-treatment AHI was predicted by pre-treatment reflux index (adjusted R² = 0.487;p < 0.001).

Conclusions

Reduction of obstructive respiratory events following short-term PPI treatment in children with both GERD and OSAS may suggest a causal relationship between apnea and reflux in some children. Questionnaire screening for GERD in children with OSAS may be of benefit.

Keywords

• Obstructive sleep apnea syndrome; 
• Gastroesophageal reflux disease; 
• Omeprazole; 
• Polysomnography; 
• pH metry; 
• Reflux Index