阻塞性睡眠呼吸暂停低通气综合征与胃食管反流病发生的相关性研究

Correlation between obstructive sleep apnea hypopnea syndrome and gastroesophageal reflux disease

目的探讨胃食管反流病（gastroesophageal reflux disease，GERD）与阻塞性睡眠呼吸暂停低通气综合征（obstructive sleep apnea hypopnea syndrome，OSAHS）的关系。方法分析43例怀疑咽喉反流病患者的高精度食管压力检测、24h食管双极阻抗pH监测、便携式多道睡眠监测数据，根据各检测结果进行分组，比较组间各测量指标差异，研究两疾病的相互关系。结果全体受试者中，可诊为GERD的14例（32．6％），可诊为OSAHS的26例（60．5％），同时患有OSAHS和GERD者10例，占OSAHS患者人数的38．5％，占GERD患病人数的71．4％。在仅患有OSAHS组、仅患有GERD组、同时患有GERD和OSAHS组以及阴性对照组之间，体质量指数（BMI）和下食管括约肌（10weresophagealsphincter，LES）残余压差异有统计学意义（P值均〈0．05），但未发现LES残余压与两疾病严重程度的线性相关关系。在OSAHS患者中，呼吸暂停低通气指数（AHI）与DeMeester评分（r=0．457）、远端食管酸暴露时间百分比（r=0．491）呈正相关趋势（P值均〈0．05）。在GERD患者中，未发现反流指标与睡眠指标和食管功能指标的线性相关关系。同时患有OSAHS和GERD组内未见反流指标、睡眠指标、食管功能指标的线性相关关系（P值均〉0．05）。结论GERD与OSAHS在发病率、疾病的严重程度方面有一定的相互影响，反酸可能加重OSAHS患者的病情，两种疾病可能在食管功能，特别是在LSE肌张力的调节上有一定的相关关系。

Objective To discuss the correlation between obstructive sleep apnea hypopnea syndrome（ OSAHS ） and gastroesophageal reflux disease （GERD）. Methods Forty-three patients with suspected laryngopharyngeal reflux disease underwent combined multichannei intraluminal impedance and esophageal manometry （MII-EM）, twenty-four - hour esophageal and pharyngeal pH and impedance monitoring and PSG. Subjects were grouped according to the detections. The difference of the measurement between groups were compared. The possible relationship between the two diseases was analyzed. Results Fourteen subjects could be diagnosed to have GERD （ 32.6% ）. Twenty-six could be diagnosed to have OSAHS（60.5% ）. Ten patients had both OSAHS and GERD simultaneously, which took over 38.5% of the OSAHS group, and 71.4% of the GERD group. BMI（ P = O. 000） and lower esophageal sphincter（LES） residual pressure （P = 0. 021 ） were significantly different among the four groups OSAHS, GERD, OSAHS and GERD, and control （non-OSAHS and non-GERD）, but no linear relationship between LES residual pressure and prevalence or severity of the two diseases was found. In OSAHS group, AHI were positively correlated with the following indictors： the DeMeester score （ r = 0. 457 ） , acid exposure of the distal esophagus（ r =0. 491 ）. There seemed to be no Linear correlation among reflux indicators, sleep indicators, and esophageal functional indicators in GERD group. Linear correlation was not found among reflux indicators, sleep indicators, and esophageal functional indicators in OSAHS and GERD group （ P 〉 0.05 ）.Conclusions The incidence and the severity of GERD and OSAHS were related to each other. Reflux events may aggravate OSAHS. The two diseases may have some relationship on the esophageal function, especially on the regulation of the LES pressure.