Abstract:
Objective : To study the profile of patients with obstructive
sleep apnea syndrome (OSAS) and laryngopharyngeal reflux (LPR) at the
hypopharyngeal-esophageal multichannel intraluminal impedance-pH
monitoring (HEMII-pH) and to compare their reflux findings with LPR
patients without OSAS.
Design: Prospective controlled study.
Methods : Patients with LPR and OSAS were prospectively
recruited from Augustus 2019 to June 2020. The profile of hypopharyngeal
reflux events (HRE) of patients was studied through a breakdown of the
HEMII-pH findings over the 24-hour of testing. Reflux symptom score
(RSS), gastrointestinal and HEMII-pH outcomes were compared between LPR
patients and patients with LPR and OSAS. Multivariate analysis was used
to study the relationship between reflux data and the following sleep
outcomes: Apnea-Hypopnea Index, Epworth Slippiness Scale (ESS) and
paradoxical sleep data.
Results : A total of 89 patients completed the study. There were
45 patients with LPR and 44 subjects with both OSAS and LPR. The numbers
of upright and daytime HREs and the otolaryngological RSS were
significantly higher in patients with LPR compared with those with OSAS
and LPR. There was a significant positive association between RSS
quality of life score and ESS (p=0.001). The occurrence of HREs in the
evening was associated with higher ESS (p=0.015). Patients with OSAS,
LPR and GERD had higher number of nocturnal HREs compared with those
without GERD (p=0.001).
Conclusion: The presence of OSAS in LPR patients is associated
with less severe HEMII-pH and ear, nose and throat symptoms. There may
have different OSAS patient profiles according to the occurrence of
GERD.
Key words : Laryngopharyngeal; Reflux; Laryngitis; pH
monitoring; impedance; Reflux episode; Pharyngeal; Sleep; Apnea;
Obstructive; Profile; Polysomnography.Introduction :
Laryngopharyngeal reflux (LPR) is an inflammatory condition of the upper
aerodigestive tract tissues related to direct and indirect effect of
gastroduodenal content reflux, which induces morphological changes in
the upper aerodigestive tract.1 Currently, the
hypopharyngeal-esophageal multichannel intraluminal impedance-pH
monitoring (HEMII-pH) is the best way to diagnose LPR through the
identification of hypopharyngeal-esophageal reflux events
(HRE).2,3 Patients with LPR-related symptoms and
findings mainly have upright and daytime HREs and only a low proportion
of patients have nighttime and supine episodes.4 The
deposit of pepsin and other gastroduodenal enzymes into the respiratory
tract leads to the development of an inflammatory reaction of the mucosa
and respiratory symptoms. Many studies reported the coexistence between
LPR and obstructive sleep apnea syndrome (OSAS) but the exact role of
reflux in the pathogenesis of OSAS is still unclear.5-7
In this study, we explored the profile of patients with OSAS and LPR at
the HEMII-pH and we compared the reflux features of patients with both
LPR and OSAS with those with only LPR. Among patients with OSAS and LPR,
we investigated the relationship between hypopharyngeal reflux events
and the occurrence of arousals.
Methods :