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.





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.



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.



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.



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