Endoscopic assessment of reflux esophagitis concurrent with hiatal hernia in male Japanese patients with obstructive sleep apnea

Abstract

Objective. The pathogenetic relationship underlying the high prevalence of gastroesophageal reflux disease (GERD) in patients with obstructive sleep apnea (OSA) remains unclear. In addition, GERD has not been adequately assessed by endoscopy in patients with OSA. The purpose of this study was to use endoscopy to investigate potential interactions among reflux esophagitis, hiatal hernia (HH) and OSA. Material and methods. A total of 243 consecutive male Japanese participants who underwent both overnight ambulatory polygraphic monitoring and esophagogastroduodenoscopy were retrospectively evaluated in a cross-sectional study. The prevalence and severity of HH and reflux esophagitis were assessed according to the Los Angeles classification and the Makuuchi classification, respectively. Associations among reflux esophagitis, HH and OSA were examined by univariate and multivariate analyses. Results. OSA was diagnosed in 98 individuals (40.3%). Endoscopy-confirmed esophagitis (p = 0.027) and HH (p < 0.001) were significantly more prevalent among patients with OSA. Multivariate regression model analysis adjusted for age, body mass index, visceral obesity represented by waist circumference, presence of OSA, concurrence of OSA and HH, smoking, and alcohol consumption yielded OSA as the only variable significantly associated with HH (odds ratio [OR], 2.60; 95% confidence interval [CI], 1.35–4.99; p = 0.004), while concurrence of OSA and HH was related to reflux esophagitis (OR, 3.59; CI, 1.87–6.92; p < 0.001). Conclusions. OSA was associated with HH and concurrent OSA and HH with reflux esophagitis in male Japanese patients with OSA. Our results support the hypothesis that complicating HH may link reflux esophagitis to OSA.

Key Words::

• endoscopy
• gastroesophageal reflux disease
• hiatal hernia
• obstructive sleep apnea
• reflux esophagitis

Acknowledgements

The authors are grateful to Ayako Suzuki (Department of Medicine, University of Arkansas for Medical Sciences) for her valuable comments on and criticism of the relationship between visceral adiposity and hiatal hernia and to Tetsuo Shimura (Hokuriku Central Hospital) and Tadashi Moriuchi (Hokuriku Central Hospital) for their helpful creation and management of the database.

Declaration of interest: The authors report no conflicts of interest. The authors alone are responsible for the content and writing of the paper.