Arousals in obstructive sleep apnea patients with laryngopharyngeal and gastroesophageal reflux

Objective: We hypothesized that differences exist in the effect of apnea severity and those of laryngopharyngeal reflex (LPR) versus gastroesophageal reflex (GER) on arousals during sleep in patients with obstructive sleep apnea syndrome (OSAS).Methods: Japanese patients having witnessed snoring or excessive daytime sleepiness with a frequency scale for symptoms of GER of 10 or more or with visualization of inflammatory changes on pharyngolaryngeal endoscopy underwent polysomnography with pH monitoring using double pH catheter in a sleep laboratory.Results: Most reflux events in patients with severe OSAS with LPR (n = 16) and GER (n = 21) were accompanied with respiratory arousals. On the other hand, among patients with mild-to-moderate OSAS, 64.0% and 24.8% of reflux events were accompanied with spontaneous arousals in those with LPR (n = 12) and GER (n = 12), respectively, and 9.4% and 8.3% of reflux events were not accompanied by arousals. There were no significant differences in other sleep parameters between mild-to-moderate OSAS patients with LPR versus GER and between severe OSAS patients with LPR versus GER.Conclusions: Among patients with reflux, the types of arousal differed significantly between those with mild-to-moderate versus severe OSAS. In patients with mild-to-moderate OSAS, LPR induces more spontaneous arousals than does GER.