24-HOUR INTRAESOPHAGEAL PH IMPEDANCE TESTING INDICES IN PATIENTS WITH EROSIVE ESOPHAGITIS ASSOCIATED WITH OBSTRUCTIVE SLEEP APNEA SYNDROME
Abstract
Background. Gastroesophageal reflux disease (GERD) is one of the most common diseases of the upper gastrointestinal tract. 24-hour intraesophageal pH-impedance measurement (IEP-IM) is generally recognized as the gold standard for diagnosing GERD. Obstructive sleep apnea syndrome (OSAS) is regarded as a comorbid condition accompanying GERD. Numerous studies demonstrate a high incidence of GERD among patients with OSAS. However, data on the prevalence of OSAS among patients with erosive esophagitis (EE) are less common, and therefore this issue is under investigation. Obective. To study the findings of IEP-IM in patients with erosive esophagitis associated with obstructive sleep apnea syndrome and to identify the correlation of the studied indices with the results of respiratory monitoring. Material and methods. For this purpose, 75 people with EE with/without OSAS who had signed a voluntary informed
consent to participate in the study were examined. Instrumental diagnostics of EE was performed using EGD. The severity of EE was determined according to the Los Angeles classification (1999). OSAS was confirmed by respiratory monitoring taking into account the existing recommendations. 33 patients from this group additionally underwent 24-hour intraesophageal pH impedance monitoring with a single-night recording of breathing patterns to determine the
severity and main parameters of OSAS. Statistical analysis of the data was performed using the program “jamovi 2.5”. The threshold value of the statistical significance level was assumed to be 0.05. Results. As compared with EE patients without sleep apnea in OSAS-associated EE patients the indices of 24-hour intraesophageal pH impedance testing shifted towards greater intra-esophageal «acidification» with an increase in the number of horizontal and proximal acid reflux events and with a decrease in the level of mean nocturnal baseline impedance (MNBI). Conclusion. 24-hour intraesophageal pH impedance testing findings have proved the negative effect of sleep apnea on EE course, with a shift of the studied indices towards greater "acidification" in OSAS-associated EE patients. A correlation was established between a decrease in the level of MNBI and an increase in the desaturation index, an increase in the desaturation time when blood oxygen saturation is less than 85% (tSpO2 < 85%), an index of respiratory effort-related arousals and an autonomic arousal index. Therefore, these indices are significant in assessing the severity of esophageal mucosa damage in OSAS-associated EE patients.
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