Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

Keynote webinar | Spotlight on medication adherence

LIVE: Thursday 27th June 2024, 18:00-19:30 (CEST)
Join our expert panel to discover why you need to understand the drivers of non-adherence in your patients, and how you can optimize medication adherence in your clinics to drastically improve patient outcomes.
ADVANCED SEARCH
Log in
Top
Obesity Surgery
Published in: Obesity Surgery 11/2008

01-11-2008 | Research Article

Gastroesophageal Reflux in Patients with Morbid Obesity: A Role of Obstructive Sleep Apnea Syndrome?

Authors: J. M. Sabaté, P. Jouët, M. Merrouche, J. Pouzoulet, D. Maillard, F. Harnois, S. Msika, B. Coffin

Published in: Obesity Surgery | Issue 11/2008

Login to get access

Abstract

Background

Obesity is a risk factor for gastroesophageal reflux disease (GERD) and for obstructive sleep apnea (OSA). Our aim was to evaluate in morbidly obese patients the prevalence of OSA and GERD and their possible relationship.

Methods

Morbidly obese patients [body mass index (BMI) >40 or >35 kg/m2 in association with comorbidities] selected for bariatric surgery were prospectively included. Every patient underwent a 24-h pH monitoring, esophageal manometry, and nocturnal polysomnographic recording.

Results

Sixty-eight patients [59 women and 9 men, age 39.1 ± 11.1 years; BMI 46.5 ± 6.4 kg/m2 (mean ± SD)] were included. Fifty-six percent of patients had an abnormal Demester score, 44% had abnormal time spent at pH <4, and 80.9% had OSA [apnea hypopnea index (AHI) >10] and 39.7% had both conditions. The lower esophageal sphincter (LES) pressure was lower in patients with GERD (11.6 ± 3.4 vs 13.4 ± 3.6 mm Hg, respectively; P = 0.039). There was a relationship between AHI and BMI (r = 0.337; P = 0.005). Patients with OSA were older (40.5 ± 10.9 vs 33.5 ± 10.4 years; P = 0.039). GERD tended to be more frequent in patients with OSA (49.1% vs 23.1%, respectively; P = 0.089). There was no significant relationship between pH-metric data and AHI in either the 24-h total recording time or the nocturnal recording time. In multivariate analysis, GERD was significantly associated with a low LES pressure (P = 0.031) and with OSA (P = 0.045) but not with gender, age, and BMI.

Conclusion

In this population of morbidly obese patients, OSA and GERD were frequent, associated in about 40% of patients. GERD was significantly associated with LES hypotonia and OSA independently of BMI.
Literature
1.
Dent J, El Serag HB, Wallander MA, et al. Epidemiology of gastro-oesophageal reflux disease: a systematic review. Gut. 2005;54:710–7.PubMedCrossRef
2.
Bretagne JF, Richard-Molard B, Honnorat C, et al. Gastroesophageal reflux in the French general population: national survey of 8000 adults. Presse Med. 2006;35:23–31.PubMedCrossRef
3.
Basdevant A. Obesity: epidemiology and public health. Ann Endocrinol (Paris). 2000;61 Suppl 6:6–11.
4.
Jacobson BC, Somers SC, Fuchs CS, et al. Body-mass index and symptoms of gastroesophageal reflux in women. N Engl J Med. 2006;354:2340–8.PubMedCrossRef
5.
Wajed SA, Streets CG, Bremner CG, et al. Elevated body mass disrupts the barrier to gastroesophageal reflux. Arch Surg. 2001;136:1014–9.PubMedCrossRef
6.
Merrouche M, Sabate JM, Jouet P, et al. Gastro-esophageal reflux and esophageal motility disorders in morbidly obese patients before and after bariatric surgery. Obes Surg. 2007;17:894–900.PubMedCrossRef
7.
8.
Vgontzas AN, Tan TL, Bixler EO, et al. Sleep apnea and sleep disruption in obese patients. Arch Intern Med. 1994;154:1705–11.PubMedCrossRef
9.
Frey WC, Pilcher J. Obstructive sleep-related breathing disorders in patients evaluated for bariatric surgery. Obes Surg. 2003;13:676–83.PubMedCrossRef
10.
Samelson CF. Gastroesophageal reflux and obstructive sleep apnea. Sleep. 1989;12:475–6.PubMed
11.
Bortolotti M, Gentilini L, Morselli C, et al. Obstructive sleep apnoea is improved by a prolonged treatment of gastrooesophageal reflux with omeprazole. Dig Liver Dis. 2006;38:78–81.PubMed
12.
Orr WC, Heading R, Johnson LF, et al. Review article: sleep and its relationship to gastro-oesophageal reflux. Aliment Pharmacol Ther. 2004;20 Suppl 9:39–46.PubMedCrossRef
13.
Chitturi S, Abeygunasekera S, Farrell GC, et al. NASH and insulin resistance: insulin hypersecretion and specific association with the insulin resistance syndrome. Hepatology. 2002;35:373–9.PubMedCrossRef
14.
Armstrong D, Bennett JR, Blum AL, et al. The endoscopic assessment of esophagitis: a progress report on observer agreement. Gastroenterology. 1996;111:85–92.PubMedCrossRef
15.
Johnson LF, DeMeester TR. Development of the 24-hour intraesophageal pH monitoring composite scoring system. J Clin Gastroenterol. 1986;8 Suppl 1:52–8.PubMedCrossRef
16.
Lavie P, Herer P, Hoffstein V. Obstructive sleep apnoea syndrome as a risk factor for hypertension: population study. BMJ. 2000;320:479–82.PubMedCrossRef
17.
Suter M, Dorta G, Giusti V, et al. Gastro-esophageal reflux and esophageal motility disorders in morbidly obese patients. Obes Surg. 2004;14:959–66.PubMedCrossRef
18.
O’Keeffe T, Patterson EJ. Evidence supporting routine polysomnography before bariatric surgery. Obes Surg. 2004;14:23–6.PubMedCrossRef
19.
Jouet P, Sabate JM, Maillard D, et al. Relationship between obstructive sleep apnea and liver abnormalities in morbidly obese patients: a prospective study. Obes Surg. 2007;17:478–85.PubMedCrossRef
20.
Spitzer AR, Boyle JT, Tuchman DN, et al. Awake apnea associated with gastroesophageal reflux: a specific clinical syndrome. J Pediatr. 1984;104:200–5.PubMedCrossRef
21.
Valipour A, Makker HK, Hardy R, et al. Symptomatic gastroesophageal reflux in subjects with a breathing sleep disorder. Chest. 2002;121:1748–53.PubMedCrossRef
22.
Kim HN, Vorona RD, Winn MP, et al. Symptoms of gastro-oesophageal reflux disease and the severity of obstructive sleep apnoea syndrome are not related in sleep disorders center patients. Aliment Pharmacol Ther. 2005;21:1127–33.PubMedCrossRef
23.
Graf KI, Karaus M, Heinemann S, et al. Gastroesophageal reflux in patients with sleep apnea syndrome. Z Gastroenterol. 1995;33:689–93.PubMed
24.
Penzel T, Becker HF, Brandenburg U, et al. Arousal in patients with gastro-oesophageal reflux and sleep apnoea. Eur Respir J. 1999;14:1266–70.PubMedCrossRef
25.
Morse CA, Quan SF, Mays MZ, et al. Is there a relationship between obstructive sleep apnea and gastroesophageal reflux disease? Clin Gastroenterol Hepatol. 2004;2:761–8.PubMedCrossRef
26.
Senior BA, Khan M, Schwimmer C, et al. Gastroesophageal reflux and obstructive sleep apnea. Laryngoscope. 2001;111:2144–6.PubMedCrossRef
27.
Kerr P, Shoenut JP, Millar T, et al. Nasal CPAP reduces gastroesophageal reflux in obstructive sleep apnea syndrome. Chest. 1992;101:1539–44.PubMedCrossRef
28.
Green BT, Broughton WA, O’Connor JB. Marked improvement in nocturnal gastroesophageal reflux in a large cohort of patients with obstructive sleep apnea treated with continuous positive airway pressure. Arch Intern Med. 2003;163:41–5.PubMedCrossRef
29.
Ing AJ, Ngu MC, Breslin AB. Obstructive sleep apnea and gastroesophageal reflux. Am J Med. 2000;108 Suppl 4a:120S–5S.PubMedCrossRef
30.
Demeter P, Visy KV, Magyar P. Correlation between severity of endoscopic findings and apnea–hypopnea index in patients with gastroesophageal reflux disease and obstructive sleep apnea. World J Gastroenterol. 2005;11:839–41.PubMed
31.
Ozturk L, Pelin Z. Is the severity of obstructive sleep apnea or the magnitude of respiratory effort associated with gastroesophageal reflux? World J Gastroenterol. 2005;11:4769.PubMed
32.
Grunstein RR, Stenlof K, Hedner JA, et al. Two year reduction in sleep apnea symptoms and associated diabetes incidence after weight loss in severe obesity. Sleep. 2007;30:703–10.PubMed
33.
Haines KL, Nelson LG, Gonzalez R, et al. Objective evidence that bariatric surgery improves obesity-related obstructive sleep apnea. Surgery. 2007;141:354–8.PubMedCrossRef
Metadata
Title
Gastroesophageal Reflux in Patients with Morbid Obesity: A Role of Obstructive Sleep Apnea Syndrome?
Authors
J. M. Sabaté
P. Jouët
M. Merrouche
J. Pouzoulet
D. Maillard
F. Harnois
S. Msika
B. Coffin
Publication date
01-11-2008
Publisher
Springer-Verlag
Published in
Obesity Surgery / Issue 11/2008
Print ISSN: 0960-8923
Electronic ISSN: 1708-0428
DOI
https://doi.org/10.1007/s11695-008-9508-9

Other articles of this Issue 11/2008

Obesity Surgery 11/2008 Go to the issue

Research Article

The Eradication of Helicobacter pylori is Affected by Body Mass Index (BMI)

Research Article

Buttressing Staples with Cholecyst-derived Extracellular Matrix (CEM) Reinforces Staple Lines in an Ex Vivo Peristaltic Inflation Model

Research Article

Inadequate Weight Loss vs Secondary Weight Regain: Laparoscopic Conversion from Gastric Banding to Roux-en-Y Gastric Bypass

Research Article

What is the Quality of Information About Bariatric Surgery on the Internet?

Research Article

Bariatric Therapy with Intragastric Balloon Improves Liver Dysfunction and Insulin Resistance in Obese Patients

Research Article

Predictors of Weight Loss and Effectiveness of Roux-en-Y Gastric Bypass in the Morbidly Obese Hispano-American Population