Reflux esophagitis as one of the manifestations of obstructive sleep apnea syndrome

Obstructive sleep apnea syndrome is one of the causes of reflux esophagitis – inflammation of the esophageal mucosa, which is caused by the reflux of gastric contents into it. The main signs of reflux esophagitis are heartburn, sour taste in the mouth, pain in the chest and upper abdomen, discomfort when eating, hiccups and belching.

The probability of occurrence of reflux esophagitis in patients with sleep apnea is 76%, and this is due to the following mechanism. During an episode of apnea (stopping breathing during sleep), the walls of the pharynx collapse . In this case, the person tries to breathe intensively, straining the respiratory muscles. The diaphragm is actively involved in this process, which leads to an increase in intra-abdominal pressure and, as a result, compression of the stomach. Conditions are created for the reflux (reflux) of the acidic contents of the stomach into the esophagus.

Refluxes may recur several times a night. The mucous membrane of the esophagus does not have a protective barrier against aggressive gastric contents, and the development of an inflammatory process in the esophagus is sometimes accompanied by the appearance of erosions. In endoscopic examination of the esophagus of patients with esophagitis, deep lesions of the mucosa and cicatricial changes are sometimes noticeable. Reflux esophagitis can be complicated by an esophageal ulcer and cicatricial narrowing – esophageal stricture. The long course of reflux esophagitis contributes to the development of esophageal cancer .

With obstructive sleep apnea syndrome, not only reflux esophagitis is noted. It is also possible to reflux gastric contents into the pharynx with the development of laryngospasm, there is a reflux of stomach acid into the trachea, bronchi. In such cases, attacks of coughing and choking develop, recurrent bronchitis or even aspiration pneumonia occurs . It is noted that deeper lesions of the esophageal mucosa are more often combined with respiratory disorders.

How to find out about the ingestion of gastric contents into the respiratory tract? During apnea, the brain wakes up, and it gives a command to inhale and resume breathing. If at this time there is a reflux of the contents of the stomach into the esophagus, then it simultaneously enters the larynx and trachea, causing irritation of the vocal cords and their reflex spasm. Laryngospasm further aggravates breathing, the patient wakes up sharply from suffocation, wheezing gasps for air. The development of laryngospasm after prolonged sleep apnea can cause loss of consciousness from suffocation. Then the reflex laryngospasm passes, breathing is gradually restored, but the patient remains hoarse and sour in the mouth.

With a combination of reflux with a violation of the peristalsis of the esophagus, periodic entry of gastric contents into the trachea and bronchi is possible. In this case, patients are worried about a constant cough, it is combined with heartburn, belching and a sour taste in the mouth. Entry of large amounts of gastric contents into the lungs causes suffocation and is fatal.

Because obstructive sleep apnea has been associated with reflux esophagitis, patients with belching, heartburn, esophageal discomfort, chest pain, and nocturnal breathlessness should be evaluated for sleep apnea. You should consult a somnologist for polysomnography .

Treatment of sleep apnea using CPAP therapy allows you to eliminate the reflux of gastric contents into the esophagus and respiratory organs. CPAP therapy effectively helps from the first night of treatment.

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