Wake up to gastro‐oesophageal reflux disease: The interplay between arousal and night‐time reflux

Abstract

SummaryThis review examines the temporal association between nocturnal gastro‐oesophageal reflux and sleep‐arousal cycles. Most nocturnal gastro‐oesophageal reflux events occur during the awake cycle, and arousals precede most nocturnal gastro‐oesophageal reflux events, indicating that arousal from sleep predisposes to nocturnal gastro‐oesophageal reflux. This sheds light on the complex relationship between nocturnal gastro‐oesophageal reflux and sleep, and has implications for managing nocturnal gastro‐oesophageal reflux symptoms. The appearance of symptoms and the pathophysiology of nocturnal gastro‐oesophageal reflux are influenced by sleep hygiene, sleep disturbances and the misalignment of circadian rhythms. Nocturnal gastro‐oesophageal reflux and its related sleep disorders are prevalent and negatively impact the quality of life. There is conflicting evidence on whether nocturnal gastro‐oesophageal reflux and sleep disturbances are causally linked, and whether sleep disturbances drive nocturnal gastro‐oesophageal reflux. Poor sleep quality increases oesophageal hypersensitivity and overall acid exposure. The nocturnal gastro‐oesophageal reflux is linked to the more severe forms of gastro‐oesophageal reflux disease, especially with atypical/extra‐oesophageal manifestations and complications of mucosal damage such as oesophagitis and stricture, Barret's oesophagus, and oesophageal adenocarcinoma. This review highlights the role of sleep problems in presenting nocturnal gastro‐oesophageal reflux, and the potential benefits of treating sleep disturbances in enhancing patient care and quality of life.