Sleep-related breathing disorders in small children with nocturnal acid gastro-oesophageal reflux
Wasilewska J, Kaczmarski M

Purpose: Coincidence of gastroesophageal reflux disease with obstructive sleep apnea/hypopnea syndrome has been discussed in recent years. Treatment with nasal continuous positive airway pressure (nCPAP) reduces gastroesophageal reflux (GER) in adult patients with obstructive sleep apnea (OSA). Moreover, treatment of gastroesophageal reflux with omeprazole can reduce the severity of obstructive sleep in selected individuals. The aim of the study was to test the hypothesis that gastroesophageal reflux does not influence sleep quality and breathing pattern during sleep in children. 
Material and methods: 24 children (14 boys, 10 girls, aged 2 months-3 years) with sleep disturbances indicating GER were studied. Standard polysomnography with parallel recording of 24-h oesophageal monitoring was performed. Apnea/hypopnea index (AHI) in active/REM sleep and quiet/NREM sleep was compared between nocturnal acid GER children (13 children; 7 boys, 6 girls; aged 1.28±0.95y; FRT-18.63±11.83%) and nocturnal acid GER-free controls (11 children; 7 boys, 4 girls; aged 1.64±0.97y; FRT-2.93±2.08%). Exclusion criteria were: 1. laboratory signs of infection (OB, CRP, 2a-globulin); 2. clinical symptoms of infection in the respiratory tract, the alimentary tract or in the urinary tract. 
Results: In children with nocturnal GER higher incidence of obstructive apnea/hypopnea during REM sleep was found: AHI=23.35/h±19.1; (CI 95%11.81-34.89) vs AHI=4.99/h±3.12 in children without nocturnal GER. We found no differences between the groups in saturation <90% time during sleep.
Conclusions: The study confirms coincidence of nocturnal gastroesophageal reflux and sleep-related breathing disorders in children. Higher number of apnea/hypopnea during REM sleep was found in children with nocturnal gastroesophageal reflux.

Key words:   sleep apnea, gastroesophageal reflux disease, ALTE, SIDS, polysomnography.