某三级医院老年胃食管反流病患者夜间反流与睡眠障碍关系分析

Relationship between night reflux and sleep disturbance in elderly patients with gastroesophageal reflux disease in a tertiary hospital

背景胃食管反流病(gastroesophageal reflux disease,GERD)反流症状严重影响患者生活质量,日间反流明显,但反流时间较短,对生活质量影响较小;而夜间反流虽频率低,但持续时间较长,严重影响患者睡眠质量.因此,GERD夜间反流影响睡眠已成为临床医护人员研究的热点之一,也是当前急需解决的重要问题.目的观察某三级医院老年GERD患者夜间反流与睡眠障碍关系分析.方法选择2017-02/2019-08在浙江省金华市第二医院就诊的老年胃食管反流患者240例为研究对象进行调查,包括夜间反流症状发生率,睡眠障碍的表现及夜间反流与睡眠障碍的关系.结果240例老年GERD患者中无夜间反流者36例(15.0%),有夜间反流者204例(85.0%);过去1 mo内,204例夜间反流GERD患者平均每周夜间反流发生次数≤1次者34例(16.67%),2次者78例(38.24%),>2次者52例(25.49%).36例无夜间反流症状者中9例(25.0%)存在睡眠障碍.204例有夜间反流症状者204例(100.0%),均存在睡眠障碍,睡眠障碍发生率明显高于无夜间反流症状者,差异比较有统计学意义(P<0.05).77.94%的患者存在睡眠质量下降;70.10%的患者存在日间残留效应;55.88%的患者睡眠潜伏期延长;潜伏期延长时以入睡时间30-40 min为主;53.92%的患者总睡眠时间缩短,多为4-5 h;51.96%的患者存在睡眠维持障碍,每周夜醒4-7次.204例GERD患者夜间反流有106例(51.96%)需要药物治疗,其中口服雷贝拉唑36例(33.96%),口服奥美拉唑20例(18.87%),口服西咪替丁片30例(28.30%),口服安眠药20例(18.87%),有效率达96.23%(102/106).结论夜间反流可能是影响老年GERD患者睡眠障碍的原因之一,在临床中应重视质子泵抑制剂的治疗.

BACKGROUND The reflux symptoms of gastroesophageal reflux disease(GERD)seriously affect the quality of life of patients.Daytime reflux is obvious,but the duration of reflux is short,which has little impact on the quality of life.Although the frequency of nocturnal regurgitation is low,its duration is long,which seriously affects the sleep quality of patients.Therefore,GERD nocturnal regurgitation has become one of clinical research hotspots and an important problem to be solved.AIM To observe the relationship between night reflux and sleep disturbance in elderly patients with GERD in a tertiary hospital.METHODS Two hundred and forty elderly patients with gastroesophageal reflux admitted to the Second Jinhua Hospital of Zhejiang Province from February 2017 to August 2019 were selected as subjects for investigation of the incidence of nocturnal reflux symptoms,manifestations of sleep disorders,and the relationship between nocturnal reflux and sleep disorders.RESULTS Of 240 cases of GERD included,36(15.0%)had no nocturnal reflux and 204(85.0%)had.In the past 1 mo,nocturnal reflux developed on average once a week or less in 34(16.67%)of 204 patients with nocturnal reflux,twice a week in 78(38.24%),and>2 times in 52(25.49%).Of 36 cases without nocturnal reflux symptoms,9(25.0%)had a sleep disorder,while all 204(100.0%)cases with nocturnal reflux suffered from a sleep disorder.The incidence of sleep disorder was significantly higher in patients with nocturnal reflux than in those without(P<0.05).Approximately 77.94%of the patients had decreased sleep quality.Daytime residual effect was found in 70.10%of patients.Sleep latency was prolonged in 55.88%of patients.When the latency was prolonged,the time to sleep was mainly 30-40 min.The total sleep time was shortened in 53.92%of patients,most of whom had a sleep time of 4-5 h.Among the 204 GERD patients,106(51.96%)needed drug therapy for nocturnal reflux,including 36(33.96%)patients taking rabeprazole orally,20(18.87%)taking omeprazole orally,30(28.30%)taking cimetidine orally,and 20(18.87%)taking sleeping pills orally,with an effective rate of 96.23%(102/106).CONCLUSION Nocturnal reflux may be one of the reasons affecting sleep disorders in elderly GERD patients.Proton pump inhibitor therapy can be administered in clinical practice.