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Laryngopharyngeal Reflux Diagnosis in Obstructive Sleep Apnea Patients Using the Pepsin Salivary Test

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Laryngopharyngeal Reflux Diagnosis in Obstructive Sleep Apnea Patients Using the Pepsin Salivary Test

Giannicola Iannella et al. Int J Environ Res Public Health.

Abstract

Background: To investigate the presence of laryngopharyngeal reflux in patients with obstructive sleep apnea (OSA) employing the salivary pepsin concentration method. To compare the results of pepsin concentration with the severity of the pathology.

Methods: Seventy-five OSA patients (44 males, 31 females) were enrolled in the study. For each patient, the AHI (apnea-hypopnea index) and the BMI (body mass index) were initially evaluated. All the patients enrolled were assessed using the reflux symptom index (RSI) and the reflux finding score (RFS) in order to perform a clinical diagnosis of laryngopharyngeal reflux. In all patients a salivary sample was taken to estimate the presence of pepsin and its concentration.

Results: The incidence of LPR (laryngopharyngeal reflux) in OSA patients, evaluated using the salivary pepsin concentration test (PEP-test), was found to be 32% of cases. Linear regression testing did not show any correlation between AHI and pepsin concentration in salivary samples (p = 0.1).

Conclusion: A high number of patients with OSA seem to show positivity for salivary pepsin, correlated to an LPR. There does not appear to be a correlation between the severity of apnea and the grade of salivary pepsin reflux. On the other hand, direct correlation between BMI and the value of pepsin in salivary specimens was observed.

Keywords: Obstructive Sleep Apnea Syndrome; PEP-test; laryngopharyngeal reflux; obstructive sleep apnea.

Conflict of interest statement

The authors declare no conflicts of interest

Figures

Figure 1
Figure 1
The salivary pepsin concentration test (PEP-test): The existence of the T band indicates that pepsin is present in the tested sample and, furthermore, the intensity of the T band is directly proportional to the pepsin quantity.
Figure 2
Figure 2
The PEP-test Cube: A small electronic device that displays the result of pepsin concentration analysis in different fluids directly in ng/mL.
Figure 3
Figure 3
Histogram: Patients positive in reflux symptom index (RSI) (blue column), reflux finding score RFS (yellow column), and PEP-test (gray column) evaluations. Patients with only RSI and RFS columns were those that showed positivity to clinical investigation but negativity for salivary pepsin presence (negative PEP-test).
Figure 4
Figure 4
Liner regression scatterplot between apnea–hypopnea index (AHI) and salivary pepsin concentration. No statistical correlation resulted (p = 0.19, R2 = 0.07).
Figure 5
Figure 5
Box plot: Correlation between BMI (body max index) values of LPR (laryngopharyngeal reflux) + and LPR− patients.
Figure 6
Figure 6
Liner regression scatterplot between BMI and salivary pepsin concentration. Statistically significant correlation (p = 0.05, R2 = 0.2).

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