Gastroesophageal Reflux During Sleep

Esophageal acid clearance is markedly delayed during sleep and requires an arousal response for clearance. The prevalence of sleep-related gastroesophageal reflux (GER) is 79% in GER patients and approximately 25% in the Sleep Heart Health Study participants. Sleep-related GER is associated with esophagitis, Barrett's esophagus, esophageal adenocarcinoma, arousals, poor sleep quality, excessive daytime sleepiness, impaired quality of life, and extraesophageal manifestations of GER. The possible association between GER and obstructive sleep apnea is currently being investigated. Diagnosis of sleep-related GER includes careful history taking and esophageal pH testing, which can also be integrated with polysomnography. Treatment includes conservative measures, medications (primarily proton pump inhibitors, H2 receptor antagonists, and prokinetic agents), and surgical fundoplication in selected patients.