Extra-esophageal Reflux, NOSE score, and sleep quality in an adult clinic population

Authors

  • Supawan Laohasiriwong MD,

    1. Division of Sleep Medicine, Department of Otolaryngology & Communication Sciences, Medical College of Wisconsin, Milwaukee, Wisconsin, U.S.A
    2. Department of Otorhinolaryngology, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
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  • Nikki Johnston PhD,

    1. Department of Otolaryngology & Communication Sciences, Medical College of Wisconsin, Milwaukee, Wisconsin, U.S.A
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  • B. Tucker Woodson MD

    Corresponding author
    1. Division of Sleep Medicine, Department of Otolaryngology & Communication Sciences, Medical College of Wisconsin, Milwaukee, Wisconsin, U.S.A
    • Send correspondence to B. Tucker Woodson, MD, Division of Sleep Medicine, Department of Otolaryngology & Communication Sciences, Medical College of Wisconsin, 9200 W Wisconsin Avenue, Milwaukee, WI 53226. E-mail: bwoodson@mcw.edu

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  • Presented as an oral presentation at the AAO-HNSF Annual Meeting, Washington, DC, September 9–12, 2012; and at the OTO EXPO, Washington, DC, October 10, 2012.

  • B. Tucker Woodson is scientific advisor for Medtronic ENT and Inspire Medical Systems and received research support from Inspire Medical and a royalty from Medtronic, Inc. Nikki Johnston is consultant for Koufman Diagnostics, LLC. The authors have no other funding, financial relationships, or conflicts of interest to disclose.

Abstract

Objectives/Hypothesis

Gastroesophageal reflux disease and heartburn negatively impact sleep; the impact of extraesophageal reflux (EER) symptoms on sleep is unknown. This study's goal was to evaluate the association of EER and measures of nasal obstruction, mood, insomnia, hypersomnia, and obstructive sleep apnea (OSA) risk.

Study Design

Cross-sectional study.

Setting

Tertiary care hospital.

Subjects and Methods

A prospective cohort of adult patients was evaluated using validated questionnaires for insomnia (PSQI), hypersomnia (ESS), OSA risk (STOP-Bang), sleep quality of life (FOSQ-10), EER reflux symptoms (RSI), nasal symptoms (NOSE), and measures of mood (HADA). Pharyngeal saliva samples underwent Western blot immunoassay for pepsin.

Results

Ninety-three adults (mean age 50.2 ± 15.2 years, 43% female) were evaluated. Reflux Symptom Index (RSI) was elevated in 32% of patients and significant heartburn symptoms were reported in only 12% of patients. Prevalence of pepsin (+) was 27%. Both RSI and NOSE were significantly associated with sleep measures related to insomnia (r = 0.48 and r = 0.50; P < 0.001, respectively), Quality of Life (QOL) (r = 0.30 and r = 0.34; P < 0.001, respectively), and hypersomnolance (r = 0.18 and P < 0.04; r = 0.29 and P < 0.01, respectively), but not apnea risk (all P < 0.05). Nasal symptoms and mood were associated with all non-OSA sleep metrics (r = 0.24). In multivariate analysis, both NOSE and RSI remained significantly associated with sleep measures.

Conclusions

Insomnia, hypersomnia, and sleep QOL are associated with measures of EER, nasal symptoms, and mood but not OSA risk, supporting that disrupted sleep may be associated with EER and nasal symptoms independent of sleep apnea.

Level of Evidence

4. Laryngoscope, 123:3233–3238, 2013

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