Medical treatment may improve sleep apnea syndrome due to non acid GERD: Case report
Carlos O'Connor-Reina and colleagues from the Otorhinolaryngology Department, Hospital Quiron Salud Marbella, Marbella, Spain have recently studied a case report where they found out that non-acid gastroesophageal reflux disease (GERD) can be a potential cause of obstructive sleep apnea syndrome in some patients and that medical treatment should be considered prior to surgery.
The report has been published in the Journal of Otolaryngology- Head and Neck Surgery.
Non-acid reflux is defined as gastroesophageal reflux disease episodes resulting in an esophageal pH drop to ~ 4.0. It is associated with refractory reflux symptoms in gastroesophageal reflux disease with proton-pump inhibitor (PPI) failure and other extraesophageal symptoms, including coughing.
The authors studied 54-year-old man where drug induced sleep endoscopy was helpful to suspect a non-acid reflux disease and showed a marked improvement in a swollen epiglottis after treatment. The patient ameliorated significantly his disease only with medical therapy.
The patient reported without significant anatomical findings with obstructive sleep apnea syndrome and non-acid gastroesophageal reflux disease (GERD) disease whose Apnea- hypopnea index (AHI) was significantly reduced with the intake of 500 mg of sodium alginate twice a day for 6 months.
Conventional digestive tests such as esophagoscopy and simple- and double-channel 24-h pH-metry suggested mild gastroesophageal reflux disease. Conventional proton-pump inhibitor treatment with pantoprazole (40 mg daily) was started without any improvement in his sleep.
Multichannel intraluminal 24-h impedanciometry indicated the presence of severe pathological gastroesophageal reflux of gaseous origin. It was observed that the patient's Apnea- hypopnea index decreased from 25.3 at baseline to 8 after treatment with sodium alginate.
A drug-induced sleep endoscopy study showed the changes before and after this treatment and was helpful for the diagnosis.
As a result, the researchers concluded that medical treatment can be a therapeutic option in some patients with obstructive sleep apnea syndrome. Multichannel 24-h impedanciometry should be performed when nonacid gastroesophageal reflux disease is suspected.
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O'Connor-Reina, C., Garcia, J.M.I., Baptista, P. et al. Non-acid reflux and sleep apnea: the importance of drug induced sleep endoscopy. J of Otolaryngol - Head & Neck Surg 50, 42 (2021). https://doi.org/10.1186/s40463-021-00526-w
