Consistent CPAP use lowers odds for gastroesophageal reflux, wheeze, cough
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Key takeaways:
- Consistent users of positive airway pressure had reduced nocturnal gastroesophageal reflux after 2 years of treatment.
- There is a direct link between positive airway pressure and less wheezing.
The likelihood for nocturnal gastroesophageal reflux, wheeze and cough declined with use of positive airway pressure for 2 years in patients with obstructive sleep apnea, according to results published in ERJ Open Research.
“[Clinicians should] be aware of OSA — it is not only causing sleepiness and cardiovascular disease,” Thorarinn Gislason, MD, PhD, professor in the department of sleep at Landspitali – The National University Hospital of Iceland in Reykjavik, told Healio. “OSA can also contribute to respiratory symptoms.”
Using data from the Icelandic Sleep Apnea Cohort study, Gislason and colleagues assessed 732 patients with a new diagnosis of OSA and 2-year follow-up data on CPAP adherence to determine how positive airway pressure (PAP) impacts self-reported nocturnal gastroesophageal reflux (nGER) and respiratory symptoms including wheeze and productive cough.
Researchers classified a patient with nGER if they reported experiencing heartburn or belching when going to bed at least one time a week, whereas patients without nGER reported no symptoms or nGER medications.
Most patients (77.6%) used a PAP device that tracked adherence from the past 4 weeks; the remaining patients self-reported their PAP compliance.
Of the total cohort, 366 patients had full PAP use — defined as use for at least 20 days for 4 or more hours a day based on device data, or use for at least 5 nights a week for 60% or more of the night based on questionnaire responses — 103 patients had partial PAP use not meeting these standards and 263 patients did not use their PAP device.
At baseline, 43 patients (11.8%) with full PAP use had nGER compared with 59 patients (16.3%) with partial/no PAP use. After 2-years of PAP treatment, researchers found that only six patients (14%) from the full PAP group had nGER compared with 21 patients (36%) from the lower adherence groups (P < .01).
Further, wheeze occurred among more patients with full PAP use vs. those with partial/no PAP use at baseline (34.6% vs. 29%), but fewer patients from the highest adherence group had wheeze at the 2-year follow-up (48% vs. 61%; P = .02).
For other respiratory symptoms, including productive morning cough, daytime cough and chronic bronchitis, researchers noted comparable rates between the two PAP compliances groups at baseline.
“The high prevalence of respiratory symptoms — coughing/wheezing — among untreated OSA subjects was unexpected,” Gislason told Healio. “The decrease in reported respiratory symptoms on CPAP treatment was also larger than expected.”
Researchers observed that patients who demonstrated full PAP compliance at 2 years had lower odds for nGER (adjusted OR = 0.58; 95% CI, 0.4-0.86), wheezing (aOR = 0.56; 95% CI, 0.35-0.88) and productive morning cough (aOR = 0.62; 95% CI, 0.39-0.98) vs. those with partial/no PAP use following adjustment for baseline symptom status, BMI changes and propensity score-based weights.
For all PAP compliance groups, persistent nGER at follow-up increased likelihood for productive morning cough (aOR = 4.71; 95% CI, 2.22-9.99), productive daytime cough (aOR = 2.82; 95% CI, 1.29-6.16) and chronic bronchitis (aOR = 3.86; 95% CI, 1.74-8.58).
Notably, results of a mediation analysis showed a direct tie between treatment with PAP and less wheezing, whereas the relationship between PAP and reduced productive cough was mediated by a reduction in nGER following adjustments for the same variables outlined above.
“The nGER was strongly associated with respiratory symptoms, but it was a surprise that there seem to be other mechanisms involved,” Gislason told Healio.
“[Future studies will focus on] finding reliable markers of what has been happening during the night and identify risk factors that can easily be assessed and used to determine whom to refer for a sleep study and to follow treatment.” Gislason told Healio. “OSA and respiratory symptoms are both common disorders — it’s important to keep the causal relationship in mind.”
Reference:
- Treatment for problematic snoring can also reduce night-time heartburn and respiratory symptoms. https://www.eurekalert.org/news-releases/999911. Published Aug. 30, 2023. Accessed Aug. 30, 2023.