The effect of nasal CPAP on nocturnal reflux in patients with aperistaltic esophagus

It has been shown that nasal continuous positive airway pressure (nasal CPAP) significantly reduces nocturnal reflux both in patients with sleep apnea and in patients without sleep apnea but consistent abnormal nocturnal reflux. The mechanism by which CPAP is thought to reduce reflux includes the el...

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Bibliographic Details
Published inChest Vol. 106; no. 3; p. 738
Main Authors Shoenut, J P, Kerr, P, Micflikier, A B, Yamashiro, Y, Kryger, M H
Format Journal Article
LanguageEnglish
Published United States 01.09.1994
Subjects
Adult
Aged
Aged, 80 and over
Esophageal Achalasia - physiopathology
Esophageal Achalasia - therapy
Esophagus - physiopathology
Evaluation Studies as Topic
Female
Gastroesophageal Reflux - physiopathology
Gastroesophageal Reflux - therapy
Humans
Hydrogen-Ion Concentration
Middle Aged
Nose
Peristalsis
Polysomnography
Positive-Pressure Respiration
Raynaud Disease - physiopathology
Raynaud Disease - therapy
Scleroderma, Systemic - physiopathology
Scleroderma, Systemic - therapy
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Summary:It has been shown that nasal continuous positive airway pressure (nasal CPAP) significantly reduces nocturnal reflux both in patients with sleep apnea and in patients without sleep apnea but consistent abnormal nocturnal reflux. The mechanism by which CPAP is thought to reduce reflux includes the elevation of the resting lower esophageal sphincter (LES) pressure. In this study, we tested the effect of nasal CPAP in two groups of patients with aperistaltic esophagus but with different resting LES pressure. Seven patients with scleroderma esophagus and six patients treated for achalasia were tested over a 48-h period. On the first night, the patients were untreated; on the second night, both groups received applied nasal CPAP at 8 cm H2O pressure. The percentage of time the pH < 4.0, the number of reflux events > 5 min, and the length of the longest reflux event were all significantly reduced in the patients with achalasia (p < 0.03), but not in the scleroderma group (p > 0.20). These results suggest that a residual resting LES pressure greater than that demonstrated by patients with scleroderma (> 10 mm Hg) may be necessary for nasal CPAP to affect nocturnal reflux.
ISSN:0012-3692
1931-3543
DOI:10.1378/chest.106.3.738