Vélindabakflæði að nóttu, kæfisvefn og öndunarfærakvillar - verkefni lokið

Fréttatilkynning verkefnisstjóra


Nocturnal gastroesophageal reflux (nGER) is associated with respiratory symptoms and sleep-disordered breathing (SDB), but a causal relationship has not been established. We aimed to investigate the association between nGER and respiratory and SDB symptoms, as well as changes in lung function, sleep study and respiratory biomarkers.

Methods: Participants in three European general population cohorts were studied: The Burden of Obstructive Lung Disease (BOLD) cohort; the European Community Respiratory Health Survey (ECRHS) I and II cohort; and the ECRHS III nGER subcohort. Subjects were identified as having nGER if they reported nocturnal heartburn or regurgitation. Respiratory and SDB symptoms were assessed by questionnaires, blood samples drawn and spirometries performed. Only the ECRHS III nGER subcohort underwent a home sleep study, and collected exhaled breath condensate (EBC) and particles in exhaled air (PEx) samples. A subgroup underwent a 24 hours esophageal impedance-pH measurement.

Results: Asthma and bronchitis symptoms were more common among nGER subjects than controls, as were exacerbations of respiratory symptoms. SDB symptoms were more common among nGER subjects. Under a nine years follow-up, subjects with persistent nGER developed respiratory and SDB symptoms roughly twice as often as those without nGER. No consistent differences were found in lung function tests. Objectively measured snoring was more common among subjects with nGER. Pepsin, substance P and 8-isoprostane in EBC were higher among nGER subjects. Subjects with both nGER and nocturnal cough had increased substance P in EBC. Albumin and surfactant protein A in PEx was lower among nGER subjects. These findings were independent of BMI.

Conclusion: In the general population, nGER is associated with respiratory and SDB symptoms. Having persistent nGER increases the risk of developing respiratory and SDB symptoms. Also, nGER is associated with more measured snoring, indicating increased respiratory effort during sleep. Biomarker measurements in EBC, PEx and serum indicate that airway inflammation is a plausible underlying cause.

Thesis: Össur Ingi Emilsson

This thesis is based on the following original publications, which are referred to in the text by their Roman numerals (I-V [as needed]):

I.      OI Emilsson, C Janson, B Benediktsdottir, S Juliusson, T Gislason. “Nocturnal gastroesophageal reflux, lung function and symptoms of obstructive sleep apnea: Results from an epidemiological survey”. Respiratory Medicine 2012; 106 (3): 459-466

II.     OI Emilsson, A Bengtsson, KA Franklin, K Toren, B Benediktsdottir, A Farkhooy, J Weyler, S Dom, W De Backer, T Gislason, C Janson. “Nocturnal gastro-oesophageal reflux, asthma 

and symptoms of OSA: a longitudinal, general population study”. European Respiratory Journal 2013; 41 (6): 1347-1354.

III.           OI Emilsson, B Benediktsdottir, I Olafsson, E Cook, S Juliusson, S Berg, L Nordang, ES Bjornsson, S Gudlaugsdottir, AS Gudmundsdottir, C Janson, T Gislason. “Definition of nocturnal gastroesophageal reflux for studies on respiratory diseases”. Scandinavian Journal of Gastroenterology 2016; 51 (5): 524-530.

IV.   OI Emilsson, B Benediktsdóttir, I Olafsson, E Cook, S Juliusson, ES Bjornsson, S Gudlaugsdottir, AS Gudmundsdottir, E Mirgorodskaya, E Ljungstrom, ES Arnardottir, T Gislason, C Janson, AC Olin. „Respiratory symptoms, sleep apnea and biomarkers in nocturnal gastroesophageal reflux” Respir Res. 2016 Oct 18;17(1):130.

V.           OI Emilsson, T Gislason, AC Olin, C Janson, I Olafsson. “Biomarkers for gastroesophageal reflux in respiratory diseases”. Gastroenterology Research and Practice 2013; 2013: ID(148086).


Nocturnal gastroesophageal reflux, Obstructive sleep apnea, Asthma, Airway inflammation, Epidemiology

Heiti verkefnis: Vélindabakflæði að nóttu, kæfisvefn og öndunarfærakvillar
Enskt heiti: Nocturnal Gastroesophageal Reflux, Obstructive Sleep Apnea and Respiratory Illnesses
Verkefnisstjóri: Þórarinn Gíslason, Háskóla Íslands

Tegund styrks: Verkefnisstyrkur
Styrktímabil: 2013-2015
Fjárhæð styrks: 7,352 millj. kr. alls
Tilvísunarnúmer Rannís:  130684

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