Original Contribution

American Journal of Gastroenterology (1999) 94, 2069–2073; doi:10.1111/j.1572-0241.1999.01279.x

Influence of spontaneous sleep positions on nighttime recumbent reflux in patients with gastroesophageal reflux disease

Ramez M Khoury MD1, Luciana Camacho-Lobato MD1, Philip O Katz MD1, Muhammad A Mohiuddin MD1 and Donald O Castell MD1

1Department of Medicine, Graduate Hospital, Philadelphia, Pennsylvania, USA

Correspondence: Philip O Katz, MD, Department of Medicine, Suite 501, Pepper Pavilion, Graduate Hospital, One Graduate Plaza, 1800 Lombard Street, Philadelphia, PA 19146

Received 7 October 1998; Revised  0000; Accepted 7 April 1999.

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Abstract

OBJECTIVE:

 

Body position has been shown to influence postprandial and fasting gastroesophageal reflux (GER) in patients and normal volunteers when they are assigned to lie in a prescribed position. No published studies have evaluated the effect of spontaneous sleeping positions on recumbent reflux in patients with GER.

METHODS:

 

Ten patients, three female and seven male (mean age 47.6 yr, range 30–67 yr) with abnormal recumbent esophageal pH <4 on 24-h pH-metry participated. A standardized high fat dinner (6 PM) and a bedtime snack (10 PM) were administered to all patients. GER during spontaneous sleep positions was assessed with a single channel pH probe placed 5 cm above the lower esophageal sphincter (LES) and with a position sensor taped to the sternum. Data were recorded with a portable digital data logger (Microdigitrapper-S, Synectics Medical) and analyzed for recumbent percent time pH <4 and esophageal acid clearance time in each of four sleeping positions. Time elapsed between change in sleeping position and GER episodes was also calculated.

RESULTS:

 

Right lateral decubitus was associated with greater percent time pH <4 (p < 0.003) and longer esophageal acid clearance (p < 0.05) compared to the left, supine, and prone. GER episodes were more frequent in the supine position (p < 0.04) and occurred within 1 min after change in sleeping position 28% of the time.

CONCLUSIONS:

 

The left lateral decubitus position is preferred in patients with nocturnal GER. Measures to aid patients in sleeping in this position should be developed.