ATLANTA—Chronic gastroesophageal reflux disease (GERD) is associated with various sleep disorders that might complicate the response to GERD treatment, according to an ongoing longitudinal analysis presented at the 143rd Annual Meeting of the American Neurological Association.
“We have little longitudinal information on GERD in the general population; the last published article on GERD incidence was 20 years ago,” said lead study author Maurice M. Ohayon, MD, DSc, PhD, Director of the Stanford Sleep Epidemiology Research Center in California. “As a sleep specialist, I am always interested to see how a specific medical condition may affect the sleep quality of the individuals with that condition. How we live our day has an impact on our night; it works together.”
Maurice M. Ohayon, MD, DSc, PhD
Proton-Pump Inhibitors Are Common Treatments
To examine the long-term effects of GERD on sleep disturbances, Dr. Ohayon and his colleagues used US Census data to identify a random sample of adults in Arizona, California, Colorado, Idaho, New York, Oregon, Pennsylvania, and Texas. The researchers conducted two waves of phone interviews with the subjects three years apart, beginning in 2004. They limited their analysis to 10,930 subjects with a mean age of 43 who participated in both interviews.
Between Wave 1 and Wave 2 of phone interviews, the proportion of adults who reported having GERD rose from 10.6% to 12.4%. The prevalence of new GERD cases was 8.5% per year, while the incidence was 3.2% per year. Chronic GERD, defined as GERD present during both interview periods, was observed in 3.9% of the sample.
The researchers found that 77.3% of subjects with GERD were taking a treatment, mostly proton-pump inhibitors, to alleviate their symptoms. Those with chronic GERD were more likely to report being dissatisfied with their sleep during Wave 2 of the study, compared with Wave 1 (24.2% vs 13.5%). In addition, compared with their counterparts without GERD, those with chronic GERD were more likely to wake up at night (33.9% vs 28.3%) and to have nonrestorative sleep (15.6% vs 10.5%).
“Discomfort related to GERD may happen while you are sleeping,” said Dr. Ohayon. “It may wake you up and, if not, it may make you feel unrested when you wake up. We observed both of these symptoms in our GERD participants. Insomnia disorders were also rampant in the chronic GERD group (24.5%, compared with 14.4% in non-GERD participants). An insomnia disorder is more than just having difficulty falling asleep or waking up at night, it means that your daytime functioning is affected by the poor quality of your night.”
GERD May Promote Weight Gain
Other findings from the study were “rather alarming,” said Dr. Ohayon. For example, individuals with GERD, especially those with the chronic form, weighed much more than those with no GERD did. “Over a three-year period, the chronic GERD individuals gained one point in the BMI, which for a six-foot tall man translates into a weight gain of 30 pounds,” he said. “Of course, with that follows high blood pressure, high cholesterol, diabetes, chronic pain, and heart disease.”
He concluded that GERD has its main manifestations when affected individuals are sleeping on their backs. “The impact of GERD on the quality of sleep is major,” he said. “Sleepiness and fatigue during the day are the consequences impacting work, family, and quality of life.”
Dr. Ohayon acknowledged certain limitations of the study, including the fact that the diagnosis of GERD was based on self-report. The study was supported by an unrestricted grant from Takeda.
—Doug Brunk