睡眠障碍对胃食管反流病患者异常酸反流及食管动力的影响

The effect of sleep disorders on abnormal acid reflux and esophageal motility in patients with gastroesophageal reflux disease

目的探讨睡眠障碍对胃食管反流病(GERD)患者临床症状、焦虑/抑郁、酸反流和食管动力的影响。方法纳入2020年6月至2023年3月在南京医科大学第一附属医院消化科拟诊为GERD的患者,同时行食管24 h pH-阻抗监测及高分辨率食管测压(HRM),根据匹兹堡睡眠质量指数(PSQI)分为睡眠障碍组和睡眠正常组,比较两组患者胃食管反流病问卷评分(GerdQ)、内镜下食管炎程度、焦虑/抑郁评分(SAS/SDS)、24 h pH-阻抗监测及HRM参数,并分析年龄、BMI、SAS/SDS、PSQI与酸暴露时间(AET)之间的关系。Logistic回归分析评估GERD患者发生异常酸反流的影响因素。结果共纳入拟诊GERD患者92例,其中睡眠障碍组39例(42.4%),睡眠正常组53例(57.6%)。相较于睡眠正常组,睡眠障碍组GerdQ评分更高(P<0.01),且睡眠障碍组反流、烧心症状及额外服药频率更高(均P<0.05)。睡眠障碍组SAS评分显著高于睡眠正常组(P=0.009)。与睡眠正常组相比,睡眠障碍组异常酸反流(AET>6%)比例及AET均值更高,酸反流次数及总反流次数均显著增加(均P<0.05)。两组患者上食管括约肌(UES)静息压、下食管括约肌(LES)静息压、LES长度、腹段LES长度、无效吞咽百分比、无效食管动力患者比例和胃食管连接部收缩积分(EGJ-CI)比较差异无统计学意义(均P>0.05)。BMI、PSQI评分与AET呈正相关(均P<0.05),多因素logistic分析结果表明BMI偏高及睡眠障碍是异常酸反流的独立危险因素(OR=1.223,1.139,均P<0.05)。结论睡眠障碍与患者反酸、烧心症状相关,并且独立于焦虑/抑郁加重患者酸暴露,但不影响食管动力。

Objective To explore the effects of sleep disorders on clinical symptoms,anxiety/depression,acid reflux,and esophageal motility in patients with gastroesophageal reflux disease(GERD).Methods Patients who were diagnosed with GERD at the Gastroenterology Department of the First Affiliated Hospital with Nanjing Medical University from June 2020 to March 2023 were included in the study.Esophageal 24-hour pH impedance monitoring and high-resolution esophageal manometry(HRM)were performed simultaneously.They were divided into a sleep disorder group and a normal sleep group based on the Pittsburgh Sleep Quality Index(PSQI).The GerdQ score,endoscopic esophagitis degree,Anxiety/Depression Score(SAS/SDS),24-hour pH impedance monitoring,and HRM parameters were compared between the two groups.The relationship between age,body mass index(BMI),SAS/SDS,PSQI,and acid exposure time(AET)was analyzed.Logistic regression analysis was used to evaluate the influencing factors of abnormal acid reflux in GERD patients.Results A total of 92 patients with GERD were included,including 39 cases(42.4%)in the sleep disorder group and 53 cases(57.6%)in the normal sleep group.Compared to the normal sleep group,the GerdQ score of the sleep disorder group was higher(P<0.01),and the sleep disorder group had higher reflux,heartburn symptoms,and additional medication frequency(all P<0.05).The SAS score of the sleep disorder group was significantly higher than that of the normal sleep group(P=0.009).Compared with the normal sleep group,the sleep disorder group had a higher proportion of abnormal acid reflux(AET>6%)and mean AET,with a significant increase in acid reflux frequency and total reflux frequency(all P<0.05).There was no statistically significant difference in the resting pressure of the upper esophageal sphincter(UES),lower esophageal sphincter(LES),LES length,abdominal LES length,percentage of ineffective swallowing,proportion of ineffective esophageal motility patients,and gastroesophageal junction contraction score(EGJ-CI)between the two groups of patients(all P>0.05).BMI and PSQI scores were positively correlated with AET(all P<0.05).The results of multivariate logistic analysis showed that high BMI and sleep disorders were independent risk factors for abnormal acid reflux(OR=1.223,1.139,all P<0.05).Conclusions Sleep disorders are associated with acid reflux and heartburn symptoms in patients,and are independent of increased acid exposure in patients with anxiety/depression,but do not affect esophageal motility.