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Clin Gastroenterol Hepatol. 2015 Jan;13(1):94-9. doi: 10.1016/j.cgh.2014.05.017. Epub 2014 Jun 4.

Naps are associated more commonly with gastroesophageal reflux, compared with nocturnal sleep.

Author information

1
Southern Arizona VA Health Care System, University of Arizona Health Sciences Center, Tucson, Arizona.
2
MetroHealth Medical Center, Case Western Reserve University, Cleveland, Ohio.
3
Division of Sleep Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts.
4
MetroHealth Medical Center, Case Western Reserve University, Cleveland, Ohio. Electronic address: ronnie.fass@gmail.com.

Abstract

BACKGROUND & AIMS:

Acid reflux during nighttime sleep has been associated with more severe gastroesophageal reflux disease (GERD). Napping is common, especially after lunch time, in many cultures. We aimed to compare reflux characteristics between nighttime sleep and naps in patients with GERD.

METHODS:

We performed a study of 15 patients (mean age, 58.5 ± 18.4 y; 10 men) with heartburn and/or regurgitation at least 3 times/week for the past 3 months, who experienced a nap in addition to regular nighttime sleep. All were evaluated using the demographics and GERD Symptoms Checklist questionnaires. Patients underwent pH testing concomitantly with actigraphy when they were not receiving antireflux treatment; only patients with abnormal results from pH tests were included in the study. Raw data from actigraphy analyses were superimposed over those collected from pH monitoring, matched by time. Integrative software was used to determine recumbent-awake, recumbent-asleep, and naps alongside pH monitoring data.

RESULTS:

The mean duration of nocturnal sleep time and nap time were 446.0 ± 100.7 minutes and 61.9 ± 51.8 minutes, respectively. The mean number of reflux events per hour was significantly greater during nap than nocturnal sleep time (40.1 ± 69.9/h vs 3.5 ± 4.2/h; P < .05). The mean duration of reflux events was longer during nap than nocturnal sleep time (1.9 ± 2.8 min vs 1.5 ± 2.7 min). The percentage of time spent at a pH less than 4 was significantly greater during naptime than nocturnal sleep time (36.2% ± 38.8% vs 8.9% ± 11.6%; P < .05). Arousals from naps were rare, compared with nocturnal sleep (mean, 0.7 ± 1.1 vs 4.2 ± 2.9; P < .05). Patients also experienced more acid reflux associated with symptoms during nap than nocturnal sleep (mean, 8.08% vs 0.45%; P < .05).

CONCLUSIONS:

We associated naps with significantly greater numbers of, and duration of, esophageal acid exposure and symptoms, compared with nocturnal sleep. Naps therefore might have important effects on disease severity.

KEYWORDS:

Awakening; GERD; Heartburn; Recumbency

Comment in

PMID:
24907504
DOI:
10.1016/j.cgh.2014.05.017
[Indexed for MEDLINE]

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