Effect of continuous positive airway pressure on gastroesophageal reflux in patients with obstructive sleep apnea: a meta-analysis

Abstract

Purpose: Gastroesophageal reflux disease (GERD) often occurs in patients with obstructive sleep apnea (OSA). Although continuous positive airway pressure (CPAP) is considered to be the preferred treatment for OSA, the effect of CPAP therapy on reflux events remains controversial. In this study, we utilized meta-analysis to investigate whether or not CPAP treatment reduces the incidence of reflux.

Methods: Two independent reviewers obtained the data sources from the database of PubMed, Elsevier, Cochrane library, and CNKI using search terms, and then filtered the target articles based on the inclusion and exclusion criteria. RevMan (version 5.3) and STATA (version 12.0) were used for data synthesis. The effect of CPAP treatment on GERD was studied by calculating the weighted mean difference (WMD) and standard deviation (SD) before and after CPAP treatment.

Results: Ten studies involving a total of 272 participants were included in this study. The results showed that the total of WMD before and after CPAP was - 17.68 (95% CI - 30.67 to - 4.69) for percentage time pH < 4, - 24.66 (95% CI - 36.15 to - 13.18) for the longest reflux duration, - 27.53 (95% CI - 49.53 to - 5.52) for number of reflux events, - 49.76 (95% CI - 60.18 to - 39.35) for DeMeester score, - 1.85 (95% CI - 3.00 to - 0.71) for reflux diseases questionnaire (RDQ) score, and - 8.95 (95% CI - 16.00 to - 1.89) for reflux symptom index (RSI). The subgroup analysis demonstrated that the improvement of reflux symptoms was more obvious with the extension of treatment time.

Conclusions: This meta-analysis showed that CPAP treatment significantly reduces the incidence of reflux events in patients with OSA.

Keywords: Continuous positive airway pressure; Gastroesophageal reflux disease; Meta-analysis; Obstructive sleep apnea.