Esophageal Reflux Disease Proton Pump Inhibitor Therapy Impact on Sleep Disturbance: A Systematic Review

Regenbogen, Elliot MD
Helkin, Alex
Georgopoulos, Rachel
Vasu, Tajender MD
Shroyer, Laurie A. W. PhD, MSHA

¹Division of Otolaryngology Head and Neck Surgery, Stony Brook University Medical Center, Stony Brook, New York, USA
²Division of Pulmonary, Critical Care and Sleep Medicine, Stony Brook University Medical Center, Stony Brook, New York, USA
³Department of Surgery, Stony Brook University School of Medicine, Stony Brook, New York, USA

Corresponding Author:

Elliot Regenbogen, MD, Division of Otolaryngology Head and Neck

Surgery, Stony Brook University Medical Center, HSC T19-065, Stony

Brook, NY 11794-8191, USA

Email: [email protected]

Sponsorships or competing interests that may be relevant to content are disclosed at the end of this article.

Received October 31, 2011; revised December 5, 2011; accepted January 6, 2012.

Otolaryngology - Head & Neck Surgery 146(4):p 524-532, April 2012. | DOI: 10.1177/0194599812436933

Abstract

Objective.

To perform a systematic literature review that evaluates the impact of proton pump inhibitor treatment of gastroesophageal reflux disease on sleep disturbance-related outcomes.

Data Sources.

PubMed, Web of Science, and Cochrane databases were searched from 1989 (when omeprazole became available) to present; additional references gleaned from citations.

Review Methods.

The search strategy identified all randomized placebo-controlled clinical trials published in English; both proton pump inhibitor use and outcome measures of sleep disturbance were reported for esophageal reflux disease patients. Using a preestablished systematic review protocol and data extraction format, 4 coauthors independently reviewed all articles.

Results.

The original search identified 20 articles; 9 were not directly relevant, and 3 were not placebo controlled. Sample sizes varied from 15 to 642; mean age was 47.4 ± 4.56 years; mean body mass index was 29.4 ± 2.9; the proportion of women varied widely across studies. Esomeprazole was studied most frequently. More than 50% of publications permitted rescue antacids. Two studies reported polysomnography outcomes, without statistically significant improvement. All studies reported non-polysomnography outcomes; 7 identified statistically significant improvements demonstrating drug treatment superiority over placebo.

Conclusion.

The existing evidence supports the use of proton pump inhibitors as a treatment for esophageal reflux disease to improve quality-of-life sleep disturbance-related outcomes. Given the wide variability in proton pump inhibitor treatments and sleep disturbance-related outcomes reported, however, study-specific results cannot be directly compared or aggregated. This conclusion appears robust not only for 7 of 8 studies included but also for the 3 highest quality studies.