阻塞性睡眠呼吸暂停与胃食管反流的关系及对抗反流治疗的效果

The Relationship of Obstructive Sleep Apnea with Gastroesophageal Reflux and Its Response to Antireflux Therapy

为研究阻塞性睡眠呼吸暂停(OSA)与胃食管反流(GER)的关系及对抗反流药物的治疗效果;18例有睡眠打鼾和反流症状的患者接受了昼夜食管pH和压力监测并在夜间睡眠时与多导睡眠图(PSG)同步监测;对同时有GER和OSA患者予以西沙必利(10mg,4/日)和洛赛克(20mg,2/日)治疗1周后重复以上检查。结果表明,7例(38.9％)同时合并有OSA及重度GER,除1例外,不仅存在夜间GER,还有白天GER;夜间GER发生之后常伴有吞咽动作(58.6％,对照=20.6％,P<0.005)、醒觉反应(26.8％.对照=16.8％,P<0.05)、大的躯体活动(18.6％,对照=4.8％,P<0.005);GER前30秒内其平均最低食管体部压力为-15.2±9.6mmHg(M±SD),GER后30秒内为-18.6±10.1mmHg,两者明显低于对照期(-10.6±8.1mmHg,P<0.005)。抗GER治疗显示,总的呼吸暂停时间从52.7±27.1分钟缩短至21.6±21.2分钟(P<0.002),呼吸暂停/低通气指数从38.9±17.6次/小时缩短至15.2±12.3次/小时(P<0.002)。证实GER与呼吸暂停/低通气、躯体活动、吞咽及醒觉反应的发生密切相关;GER可能是OSA的高危因素,两者可相互并存、互为加重;药物抗反流为GER合并OSA患者提供了另一种简便的、有效的治疗措施。

Background/Aims: To evaluate the relationship between gastroesophageal reflux (GER) and obstructive sleep apnea syndrome (OSAS) and the effects of cisapride combined with omeprazole. Methods: 24-h esophageal pH and manometric monitoring and polvsomnography (PSG) were performed on 18 patients with snoring, daytime sleepiness and acid reflux, heartburn and regurgitation. Cisapride 10mg tid combined with omeprazole 20mg q12h was given to patients with GERD and OSAS and 24-h esophageal pH and manometric monitoring and PSG was repeated on the 7th day. Results: 7 of 18 patients were confirmed having OSAS and severe GER. These subjects had daytime GER as well as nocturnal GER (all except one). Nocturnal recordings were analyzed and found that pH below 4.0 were frequently followed by swallow (58.6%, control = 20.6%, P<0.005), gross body movement (18.6%, control = 4.8%, P<0.05) and arousal (26.8%, control = 16.8%, P<0.05). The mean lowest esophageal pressure before ( - 15.2±9.6mmHg) and after (- 18.6±10.1mmHg) pH drops were significantly lower than that during control periods (- 10.6±8.1mmHg, P<0.005). There were dramatical improvements in total apnea time from 52.7±27.1min to 21.6 ±21.2min (P<0.002), apnea hypopnea index (AHI) from 38.9 ±17.6 /h to 15.2±12.3 /h (P<0.002), longest apnea time from 57.1 ± 27.lsec to 25.4±15.7sec (P<0.002) except one patient. Conclusions: There is significant association between GER and esophageal body pressure, apnea/hypopnea, gross body movement, swallow and arousal. GER is the predisposing factor to OSA, both may coexist and worse each other. Cisapride combined with omeprazole becomes a new, simple and effective method on GER with OSA.