ACG: Sleep and Quality of Life Suffer with Nighttime GERD

PHILADELPHIA, Oct. 17 -- Half of all patients with nighttime symptoms of gastroesophageal reflux disease have sleep problems and such patients also score lower on quality of life measures, including mental and physical function, according to studies reported here. All patients with GERD reported more sleep disturbance than controls who did not have reflux problems, but those with nighttime symptoms were significantly more likely, at P=0.0003, to have impaired sleep than those who experience GERD only during the day, Ronnie Fass, M.D., of the University of Arizona in Tucson, told attendees at the American College of Gastroenterology meeting.
Nighttime GERD is also associated with atypical manifestations that are particularly disruptive to sleep, and patients with nighttime reflux tend to have more severe GERD, Dr. Fass and colleagues found.
"Nighttime GERD affects a large number of patients, and the impact on sleep and quality of life should not be underestimated," said Dr. Fass. "Better awareness of this problem should lead to more thorough evaluation of patients and more effective treatment."
The findings came from a survey of 2,603 adults living in the United States. The sample included 701 participants who reported a history of GERD, 668 of whom had symptomatic disease. Dr. Fass and colleagues determined that 303 patients had nighttime GERD and 365 had GERD symptoms only during the day.
As compared with the non-GERD control group, significantly more GERD patients reported sleep impairment (41.9% versus 19.4%, P=0.0001). Patients with GERD at night were more likely to report impaired sleep compared with patients who had symptoms only during the day (49.5% versus 36.7%, P=0.0003).
The survey results also showed that the severity of GERD symptoms had an inverse relationship (P<0.05) with health-related quality of life, including mental and physical functioning. Differences in quality of life scores between patients with moderate and severe symptoms were twice as great as the differences between patients with mild and moderate symptoms, Dr. Fass and colleagues reported.
Comparison of patients with daytime versus nighttime GERD revealed similar differences in quality of life, as patients with symptoms at night had significantly lower scores on indices of mental and physical functioning (P<0.05).
A third analysis of data from the survey focused on the relationship between atypical nighttime GERD manifestations and sleep impairment. Atypical symptoms included fullness in the throat, sinusitis, coughing, throat clearing, wheezing, choking. Among all patients with a history of GERD, 74% reported at least one atypical manifestation, said Dr. Fass, and more than 20% reported having atypical GERD symptoms two or more times a week.
Comparison of GERD patients with frequent manifestations of atypical symptoms versus infrequent or no atypical manifestations showed that all but one symptom (snoring) was significantly more likely to be associated with sleep impairment (P<0.0005 to P<0.0001).
Patients with nighttime GERD should be advised to avoid eating within three to four hours before going to bed, said Dr. Fass. They should also avoid foods and drinks that can provoke or exacerbate GERD symptoms. The dosing schedule for proton pump inhibitor therapy can be revised to provide better symptom control, he added.
Dr. Fass disclosed that he is a consultant for TAP, Wyeth, AstraZeneca, Altana, Esai, and GlaxoSmithKline, a member of the speakers bureau for AstraZeneca and GlaxoSmithKline, and has received research support from TAP, Wyeth, and AstraZeneca. The study was supported by Wyeth. Primary source: American College of GastroenterologySource reference: McGuigan J et al. "Frequent nighttime symptoms and increased GERD symptom severity are associated with impaired functioning." American College of Gastroenterology Annual Meeting and Postgraduate Course. Oct. 12-17, 2007. Philadelphia. Abstract P590. Additional source: American College of GastroenterologySource reference: Fass R et al. "The relationship between atypical GERD manifestations and sleep impairment." American College of Gastroenterology Annual Meeting and Postgraduate Course. Oct. 12-17, 2007. Philadelphia. Abstract P591. Additional source: American College of GastroenterologySource reference: Orr W et al. "Prevalence of sleep impairment among adults with GERD." American College of Gastroenterology Annual Meeting and Postgraduate Course. Oct. 12-17, 2007. Philadelphia. Abstract P592.