Refluxassoziierte Schlafstörungen

Zusammenfassung

Ein- und Durchschlafstörungen treten mit einer großen Häufigkeit in der Bevölkerung auf. Die Auswirkungen auf die psychische und physische Lebensqualität sind erheblich. Die Ursachen sind vielschichtig, doch in letzter Zeit mehren sich die Belege, dass ein kausaler Zusammenhang zwischen gastroösophagealer Refluxkrankheit (GERD) und Schlafstörungen bei einem Teil der Patienten besteht. Ein Großteil der Patienten mit GERD berichtet auch über Refluxsymptome in der Nacht, und gerade der nächtliche Reflux zeichnet sich durch eine längere ösophageale Säureexposition aus. Aktuelle Studienergebnisse zeigen, dass sich die beobachteten Schlafstörungen durch eine effektive antisekretorische Therapie deutlich verbessern lassen. Insbesondere sollte auch bei Patienten mit Schlafstörungen ohne bislang diagnostizierte GERD gezielt nach einer solchen gefahndet und diese effizient therapiert werden.

Andere schwerwiegende schlafassoziierte Erkrankungen, wie das obstruktive Schlafapnoesyndrom (OSAS), zeigen eine Assoziation mit der ösophagealen Säureexposition. Vermutlich ist der schlafapnoe-assoziierte Reflux multifaktoriell bedingt: Liegen weitere prädisponierende Bedingungen vor, so begünstigt OSAS die Entstehung des Reflux. Auch hier konnte gezeigt werden, dass eine antisekretorische Therapie das OSAS verbessert.

In dieser Übersicht werden die aktuelle Literatur über die GERD-assoziierten Schlafstörungen und die möglichen pathophysiologischen Zusammenhänge diskutiert.

Summary

Difficulties of initiating or maintaining sleep are very common in the general population. Individuals with clinical sleep disorders have a greatly impaired quality of life. The causes for sleeping disorders are complex, but evidence has recently come from different trials supporting a causal relationship between gastro-esophageal reflux disease (GERD) and sleep disorders in some patients. The majority of patients with GERD report reflux symptoms during the night. It is well known that especially at night reflux is characterized by prolonged esophageal acid exposure. Recent data have indicated that sleep disorders significantly improve while on efficacious antisecretory treatment. In particular in patients with sleep disorders but no previously known GERD, the search for it is recommended and should be followed by adequate antisecretory treatment.

In other severe diseases associated with sleep, like the obstructive sleep apnoea syndrome (OSAS), an association with esophageal acid exposure has been proven. The sleep apnea-associated reflux has probably a multifactorial etiology: in cases with other predisposing conditions for gastro-esophageal reflux, OSAS promotes the development of reflux. Antisecretory treatment has been able to improve the severity of OSAS.

The purpose of this review has been to survey of recent publications in GERD-associated sleep disorders, as well as the possible pathophysiological basis of the observed phenomena.

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