Frequency and duration of gastroesophageal reflux disease (GERD) symptoms are associated with increased risk for poor sleep quality among women, according to study findings published in JAMA Network Open.
Researchers theorized a bidirectional relationship between GERD symptoms and poor sleep quality. Nocturnal GERD symptoms may provoke sleep disturbances, and supine positioning during sleep may trigger GERD symptoms due to the lack of gravity against the reflux and other sleep factors that increase likelihood of reflux.
To explore this relationship between GERD symptoms and sleep quality, the researchers conducted a prospective cohort study using data obtained from the Nurses’ Health Study II of female nurses across the United States.
The researchers included data from 48,536 nurses aged between 48 and 69 years (White, 95.2%), who self-reported the frequency and duration of GERD symptoms starting in June 2005. New updated data was collected every 4 years until June 2015. The final 4-year follow-up was completed in June 2019, and data analysis took place between November 2022 to June 2023.
Between June 2017 and June 2019, respondents completed a detailed sleep questionnaire adapted from the Pittsburgh Sleep Quality Index, assessing the ability to fall asleep, restlessness during sleep, daytime sleepiness, sleep disturbances, and sleep duration with scores ranging from 0 (no difficulty) to 3 (severe difficulty). The researchers deemed respondents with scores above 7 to have poor sleep quality.
Of the 48,536 female nurses included in this study, 7726 (15.9%) reported GERD symptoms occurring at least twice a week at baseline. During the 4-year follow-up period, 7929 (16.3%) of the women developed poor sleep quality according to their modified Pittsburgh Sleep Quality Index scores.
Increased weekly frequency of GERD symptoms was associated with progressive risk for declines in sleep quality. Compared with nurses who reported GERD symptoms occurring less than once per month, nurses with GERD symptoms occurring between 1 to 3 times per month demonstrated increased risk for poor sleep quality (relative risk [RR], 1.15; 95% CI, 1.06-1.25). Nurses with GERD symptoms occurring once a week demonstrated an even higher risk for poor sleep quality (RR, 1.31; 95 % CI, 1.24-1.38) and nurses with GERD symptoms occurring more than twice weekly demonstrated the highest risk for poor quality sleep (RR, 1.53; 95% CI, 1.45-1.62; P <.001 for trend).
In particular, the women with higher frequency of weekly GERD symptoms (>2 times per week) scored higher on the difficulty falling asleep (RR, 1.49; 95% CI, 1.39-1.58), excessive daytime sleepiness (RR, 1.47; 95% CI, 1.39-1.56), and restlessness of sleep (RR, 1.44; 95% CI, 1.36-1.53) categories when compared with women who reported no GERD symptoms.
Women with longer duration of GERD symptoms once or more per week were more likely to experience poor sleep quality than women who did not have GERD symptoms once or more per week (RR, 1.36 for duration ≥8 years; RR, 1.38 for duration between 4-7 years; RR, 1.22 for duration <4 years).
While more frequent GERD symptoms increased risk for poor sleep quality across all sleep categories regardless of use of proton pump inhibitors (PPIs) and/or histamine-2 receptor antagonists (H2RAs), women who did not regularly use PPIs and/or H2RAs demonstrated increased risk for poor sleep quality than women who regularly used these treatments (RR, 1.31; 95% CI, 1.16-1.47; P <.001 for interaction).
“Because poor sleep quality has been associated with incidence of chronic disease and mortality, these results further highlight the importance of promptly assessing and effectively treating patients with GERD,” study authors noted.
Study limitations include the restricted generalizability of findings, the inability to distinguish between daytime and nocturnal GERD symptoms, lack of data on objective testing for physiologic reflux used to strictly diagnose GERD, and the observational design of the study which predisposed to residual confounding factors, such as comorbidities and psychiatric conditions.
Disclosures: Several study authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of authors’ disclosures.
This article originally appeared on Gastroenterology Advisor
Ha J, Mehta RS, Cao Y, Huang T, Staller K, Chan AT. Assessment of gastroesophageal reflux symptoms and sleep quality among women in the Nurses’ Health Study II. JAMA Netw Open. Published online July 19, 2023. doi:10.1001/jamanetworkopen.2023.24240