Gastroesophageal reflux and snoring are related to asthma and respiratory symptoms: Results from a Nordic longitudinal population survey

Rima Mir Fakhraei; Eva Lindberg; Bryndís Benediktsdóttir; Cecilie Svanes; Ane Johannessen; Mathias Holm; Lars Modig; Karl A Franklin; Andrei Malinovschi; Thorarinn Gislason; Rain Jõgi; Christine Cramer; Christer Janson; Össur Ingi Emilsson

doi:10.1016/j.rmed.2023.107495

Gastroesophageal reflux and snoring are related to asthma and respiratory symptoms: Results from a Nordic longitudinal population survey

Respir Med. 2024 Jan:221:107495. doi: 10.1016/j.rmed.2023.107495. Epub 2023 Dec 14.

Authors

Affiliations

¹ Department of Medical Sciences, Respiratory, Allergy and Sleep Research, Uppsala University, Uppsala, Sweden.
² Faculty of Medicine, University of Iceland, Reykjavik, Iceland.
³ Centre for International Health, Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway; Department of Occupational Medicine, Haukeland University Hospital, Bergen, Norway.
⁴ Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway.
⁵ Department of Occupational and Environmental Medicine, University of Gothenburg, Sweden.
⁶ Department of Public Health and Clinical Medicine, Sustainable Health, Umeå University, Umeå, Sweden.
⁷ Department of Surgical and Perioperative Sciences, Umeå University, Umeå, Sweden.
⁸ Department of Medical Sciences: Clinical Physiology, Uppsala University, Uppsala, Sweden.
⁹ Faculty of Medicine, University of Iceland, Reykjavik, Iceland; Department of Sleep, Landspitali, University Hospital, Reykjavik, Iceland.
¹⁰ The Lung Clinic, Tartu University Hospital, Tartu, Estonia.
¹¹ Department of Public Health, Aarhus University, Aarhus, Denmark; Department of Occupational Medicine, Aarhus University Hospital, Aarhus, Denmark.
¹² Department of Medical Sciences, Respiratory, Allergy and Sleep Research, Uppsala University, Uppsala, Sweden; Faculty of Medicine, University of Iceland, Reykjavik, Iceland. Electronic address: ossur.emilsson@medsci.uu.se.

PMID: 38101459
DOI: 10.1016/j.rmed.2023.107495

Abstract

Aim: To study if individuals with nocturnal gastroesophageal reflux (nGER) and habitual snoring are more likely to develop asthma and respiratory symptoms (i.e. wheeze, cough, chest tightness, breathlessness) than those without these conditions, and if these associations are additive.

Methods: We used data from the population-based prospective questionnaire study Respiratory Health in Northern Europe (RHINE) (11,024 participants), with data from 1999 and 2011. Participants with heartburn or belching after going to bed, at least 1 night/week, were considered to have nGER. Participants reporting loud snoring at least 3 nights/week were considered to have habitual snoring. Participants were grouped into four groups by their nGER and snoring status: "never"; "former"; "incident"; "persistent". Incident respiratory symptoms were analyzed among participants without respective symptom at baseline.

Results: Snoring and nGER were independently associated with incident asthma and respiratory symptoms. The risk of incident wheeze was increased in subjects with incident or persistent snoring (adjusted odds ratio (95 % CI): 1.44 (1.21-1.72)), nGER (2.18 (1.60-2.98)) and in those with both snoring and nGER (2.59 (1.83-3.65)). The risk of developing asthma was increased in subjects with incident or persistent snoring (1.44 (1.15-1.82)), nGER (1.99 (1.35-2.93)) and in those with both snoring and nGER (1.72 (1.06-2.77)). No significant interaction was found between snoring and nGER. A similar pattern was found for the incidence of all other respiratory symptoms studied, with the highest risk among those with both incident or persistent nGER and snoring.

Conclusion: The risk of developing asthma and respiratory symptoms is increased among subjects with nGER and habitual snoring. These associations are independent of each other and confounding factors. Snoring and nGER together are additive on respiratory symptoms.

Keywords: Asthma; Epidemiology; Habitual snoring; Nocturnal gastroesophageal reflux; Respiratory symptom.

MeSH terms

Asthma* / complications
Asthma* / diagnosis
Asthma* / epidemiology
Gastroesophageal Reflux* / complications
Gastroesophageal Reflux* / diagnosis
Gastroesophageal Reflux* / epidemiology
Humans
Prospective Studies
Respiratory Sounds / etiology
Risk Factors
Snoring / complications
Snoring / epidemiology
Surveys and Questionnaires