Subjects and setting
Patients with sleep disturbances and LPR symptoms were prospectively recruited from Augustus 2019 to June 2020 from the Polyclinique Elsan (Poitiers, France) and CHU Saint-Pierre (Brussels, Belgium). The primary reason of patient consultation was sleep disturbance. We included those with both sleep disturbance and LPR symptoms. All patients underwent simultaneously 24-hour HEMII-pH (Versaflex Z®, Digitrapper pH-Z testing System, Medtronic, Europe) and polysomnography (Cidelec LXe, Loire, France). Only patients with confirmed diagnoses of LPR and OSAS were included. Gastrointestinal (GI) endoscopy was proposed to patients with GERD-related symptoms and elderly patients (>55 yo) who are known to less feel GERD-symptoms.8 The following exclusion criteria were considered: smoker, alcohol dependence, use of anti-reflux treatment(s), neurological or psychiatric illness, head and neck malignancy, history of head and neck radiotherapy, active seasonal allergies and asthma. Symptoms of patients were evaluated with reflux symptom score (RSS).9 A group of patients with LPR symptoms and positive HEMII-pH without sleep disturbances was composed throughout the same period respecting the same exclusion criteria. The IRB approved the study protocol (n°BE076201837630). The informed consent was obtained.