Sleep apnoea, also known as sleep apnea, is a common condition affecting millions worldwide, disrupts normal breathing during sleep due to the relaxation and narrowing of the throat’s walls.

Sleep apnoea is characterised by interrupted breathing during sleep, causing breathing pauses that can last from a few seconds to minutes. These pauses are usually followed by gasping or choking as the body tries to restore normal breathing.

The two primary types of sleep apnoea are obstructive sleep apnoea (OSA) and central sleep apnoea. OSA, the more common type, occurs when the muscles at the back of the throat fail to keep the airway open.

In the UK alone, nearly 1.5 million individuals battle this disorder, as reported by The Sleep Apnoea Trust Association.

Experts have long debated the link between sleep apnoea and reflux – some believe sleep apnoea causes reflux, while others suggest reflux triggers sleep apnoea. Recent research sheds light on this complex relationship, offering new insights into how these conditions might influence each other.

The two theories

Sleep apnoea leads to reflux:

One theory suggests that obstructive sleep apnoea could induce changes in airway pressure, leading to reflux. The struggle to breathe effectively can create a vacuum effect, pulling stomach and oesophageal contents into the throat. This reflux-induced inflammation may then narrow the airways, worsening sleep apnoea symptoms.

Reflux leads to sleep apnea:

The second notion proposes that reflux of stomach contents triggers spasms of the vocal cords, potentially causing sleep apnoea. Stomach juices, rich in bile, digestive enzymes, and bacteria, also contain pepsin – a digestive enzyme produced only in the stomach. If pepsin refluxes into the oesophagus, it can lead to irritation and swelling, particularly in the sensitive squamous tissue lining the oesophagus. This inflammation could contribute to sleep apnoea symptoms.

Research studies

Recent studies have revealed a significant connection between the treatment of gastroesophageal reflux disease (GERD) and the reduction of sleep apnoea symptoms.

A 2023 study aimed to investigate how positive airway pressure (PAP) treatment for sleep apnoea could impact nocturnal gastroesophageal reflux (nGER) and related respiratory symptoms.

In this study, a group of 822 newly diagnosed obstructive sleep apnoea patients were recruited. The researchers focused on positive airway pressure (PAP) treatment, a common therapy for sleep apnea. A total of 732 subjects participated in a two-year follow-up, with data collected on PAP compliance and various symptoms.

Patients who fully used PAP treatment showed a reduced presence of nocturnal gastroesophageal reflux and respiratory symptoms like wheezing and coughing. Interestingly, the study found that the decrease in reflux was associated with a decrease in productive morning cough and chronic bronchitis. PAP treatment itself was connected to less wheezing.

This study’s findings suggest a connection between treating sleep apnoea with PAP therapy and a decrease in both nocturnal gastroesophageal reflux and certain respiratory symptoms.

The treatment seemed to have a direct impact on wheezing, reducing it. Additionally, a decrease in reflux due to PAP treatment was linked to a decrease in productive cough.

Peptest’s role in understanding reflux

Whether sleep apnea exacerbates reflux or vice versa, understanding this relationship can lead to more targeted approaches in managing both conditions. As studies continue to unfold, advancements in diagnostics, like Peptest, contribute to a clearer understanding of these interconnected health challenges.

Peptest, an accurate, rapid, and painless diagnostic test, plays a crucial role in objectively assessing the presence of reflux. It measures the stomach enzyme pepsin in a saliva sample, providing valuable insights for diagnosing reflux.

With clinical measurement of pepsin, healthcare professionals can gain a comprehensive understanding of a patient’s reflux status and make informed decisions regarding treatment.

In a recent study, researchers conducted investigated the relationship between OSA and laryngopharyngeal reflux (LPR). LPR is a type of acid reflux that affects the throat and voice box, causing symptoms like chronic cough, hoarseness, and throat clearing.

To explore this link, patients with sleep disturbances and reflux symptoms participated in the study. They underwent various tests, including polysomnography (a sleep study), 24-hour oropharyngeal pH-monitoring, and saliva pepsin collections.

The patients’ saliva was collected twice: once in the morning (before eating) and again at bedtime. Peptest was used to measure pepsin concentration in the saliva samples.

If found:

  • LPR was detected in a significant number of participants—92 per cent using oropharyngeal pH monitoring and 85 per cent through pepsin measurements.
  • Among patients diagnosed with OSA (81 per cent of the group), 93 per cent had evidence of LPR, suggesting a strong connection between the two conditions.
  • Pharyngeal reflux events were most common during the night and when patients were in a supine (lying down) position. This implies that reflux is more likely to occur while you sleep.

The study concluded that people with OSA often experience a lot of reflux events in the throat, as shown by tests that measure acidity in the throat and the amount of a specific stomach enzyme in their saliva.

These tests are quite helpful in connecting reflux issues with sleep problems in OSA patients. however, more extensive studies with larger groups of people are necessary to fully understand how often this happens in OSA and in people without sleep problems.

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