Acid Reflux More Frequent During Naps than Nighttime Sleep

Ronnie Fass, M.D., FACG, Professor of Medicine Case Western Reserve University Director, Division of Gastroenterology and Hepatology, Head, Esophageal and Swallowing Center, Metro Health Medical Center Cleveland, OHMedicalResearch.com Interview with:
Ronnie Fass, M.D., FACG, Professor of Medicine
Case Western Reserve University
Director, Division of Gastroenterology and Hepatology, Head, Esophageal and Swallowing Center, Metro Health Medical Center
Cleveland, OH

MedicalResearch: What are the main findings of the study?

Dr. Fass: This is the first study to compare the extent of acid reflux between nighttime sleep and daytime naps in patients with Gastroesophageal reflux disease. The results of our study show that naps are associated with significantly greater esophageal acid exposure compared to sleep. Acid reflux events were more frequent and their total duration was longer during naps when compared with acid reflux events during nighttime sleep. Additionally, the fraction of time that the subjects were experiencing acid reflux with pH < 4 was significantly higher during naps than nighttime sleep and subjects experienced more symptoms due to acid reflux during their nap than their sleep.

MedicalResearch: Were any of the findings unexpected?

Dr. Fass: The degree of esophageal acid exposure during nap time was much greater than originally anticipated when compared with the degree of esophageal acid exposure during nighttime sleep.

MedicalResearch: What should clinicians and patients take away from your report?

Dr. Fass: The study suggests that napping is a more vulnerable period of acid reflux events and GERD-related symptoms than sleep time, probably because it is primarily comprised of stages N1 and N2 sleep. Nighttime sleep on the other hand, is also comprised of periods of deep sleep that appear to be suppressive of acid reflux events. Thus, in as much as acid reflux is worse during napping, the often occurring habit of napping after meals may result in more severe clinical sequelae of GERD than if sleep confined to the usual nocturnal bedtime. Furthermore, the common practice in many cultures of taking a nap immediately after a heavy meal during lunchtime, may in fact increase patients’ risk of developing GERD-related complications. Further studies are needed to establish this hypothesis.

MedicalResearch: What recommendations do you have for future research as a result of this study?

Dr. Fass: Studies have demonstrated that Gastroesophageal reflux during recumbancy is more commonly associated with a much more severe and complicated GERD. Our study suggests that napping may drive even further the severity of GERD and the likelihood that patients will develop GERD-related complications. Future studies need to look into the impact of napping on the severity of GERD, both at the symptoms and mucosal level. In addition, assessment of the different domains of GERD-related symptoms (frequency, severity and duration), should be pursued in a prospective fashion in those that nap versus those who do not nap on a daily basis.

 Citation:

Naps are More Commonly Associated with Gastroesophageal Reflux, Compared With Nocturnal Sleep
Laya Nasrollah, MD, Carla Maradey-Romero, Lokesh K. Jha, MD1Rakshith Gadam, MD, Stuart F. Quan, MD, Ronnie Fass, MD

Clinical Gastroenterology and Hepatology
Available online 4 June 2014

 

 

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