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In a prospective study designed to determine whether people who can’t get a good night’s sleep have a problem that is not related to sleeping, researchers at Jefferson Medical College have found that many of these people may be awakened from their sleep by gastroesophageal reflux (GERD).

The study, which is reported in the September 2005 issue of Alimentary Pharmacology and Therapeutics, followed 16 people who said they had a history of difficult sleeping. Subjects were excluded if they had any known medical problems that might cause their sleep difficulties or had been previously diagnosed or treated for GERD.

Subjects who met the study criteria were asked to complete a sleep assessment questionnaire as well as one designed to detect the presence of reflux during the day. The questionnaire helped the researchers determine which subjects might be suffering from GERD.

Eight subjects who experienced daytime symptoms compatible with acid reflux were chosen along with eight subjects who most likely did not suffer from reflux. The subjects then spent two nights over a three-week span in the Jefferson Sleep Disorders Center laboratory with simultaneous esophageal pH monitoring to indicate acid reflux during sleep.

After the first overnight say, the subjects who had acid reflux during the day were given 20 mg. of the acid-reducing drug omeprazone to take twice daily for the next two to three weeks. The subjects then returned for a second overnight stay where they were once again monitored during sleep.

Six subjects who have reflux and who experienced the worst sleep efficiency--the ratio of total sleep time to time spent in bed--benefited most from the reflux treatment. The remaining two study participants who have reflux also benefited but to a lesser degree.

For all participants, the number of awakenings from sleep (a period of wakefulness lasting for at least 15 seconds) preceded by reflux events decreased from 7.7 to 3.7 per night. The number of arousals from sleep (abrupt frequency increase on EEG  or wakefulness, lasting between 3 and 15 seconds) preceded by reflux events decreased from between 11.6  and 1.5 per night.

“We believe that this was the first objective study of its kind—where sleep events were correlated with reflux episodes,” said Anthony DiMarino, M.D., professor of Medicine and director, Division of Gastroenterology and Hepatology, at Jefferson Medical College of Thomas Jefferson University and lead author of the study. “It indicates that there may be a correlation between having a poor night’s sleep and acid reflux episodes during the night in patients who were not previously diagnosed with GERD. The authors suggest the need for additional research into the topic.

“Based on our studies,” Dr. DiMarino says, “before a person begins taking sleeping pills to achieve a more restful night’s sleep, he or she should check with a family practice physician or a gastroenterologist to see if they may have GERD.”

Other authors on the paper include Kuldip S. Banwait, M.D., Eric Eschinger, M.D., Andra Greenberg, M.D., Michael DiMarino, M.D. and Sidney Cohen, M.D., Division of Gastroenterology and Hepatology at Thomas Jefferson University and Karl Doghramji, M.D., director, Sleep Center, Thomas Jefferson University, Philadelphia.

For information about treatment for gastrointestinal problems or to make an appointment with a Jefferson digestive disease specialist, call 1-800-JEFF-NOW.