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Volume 15 No. 10
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Accepted Papers

Scientific Investigations

Temporal Association Between Respiratory Events and Reflux in Patients With Obstructive Sleep Apnea and Laryngopharyngeal Reflux

Sandra Doria Xavier, PhD1; Claudia Alessandra Eckley, PhD1; André Campos Duprat, PhD1; Luiz Henrique de Souza Fontes, PhD2; Tomás Navarro-Rodriguez, PhD2; Julio Patrocínio, MD3; Daniela Tridente, MD4; Geraldo Lorenzi-Filho, PhD5
1Otolaryngology Department,Santa Casa São Paulo, São Paulo, Brazil; 2Esophagus and Digestive Motility of Gastroenterology, Department of Hospital Clínicas, São Paulo University, São Paulo, Brazil; 3Head and Neck Department, Santa Casa São Paulo, São Paulo, Brazil; 4Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts; 5InCor Sleep Center Laboratory Director, São Paulo, Brazil

Study Objectives:

The aim of the current study was to test the hypothesis that there is a temporal correlation between reflux episodes and respiratory events in patients with laryngopharyngeal reflux and obstructive sleep apnea.


Adults with clinically diagnosed laryngopharyngeal reflux confirmed by two validated instruments (reflux symptom index ≥ 13 and reflux finding score ≥ 7) and obstructive sleep apnea (OSA) underwent full polysomnography with concomitant and synchronized multichannel intraluminal impedance-pH esophageal monitoring. The apnea-hypopnea and arousal indexes that occurred 15, 30, and 45 minutes before and after each reflux episode were recorded and compared to full-night apnea and hypopnea and arousal index.


We studied 27 patients (14 males, age 51.7 ± 9.1 years, body mass index 32.4 ± 4.2 kg/m2) with laryngopharyngeal reflux (reflux symptom index 16 ± 2 and reflux finding score 12 ± 3) and OSA (apnea-hypopnea index = 32.3 ± 28.4 events/h). We evaluated 102 reflux episodes. Almost half of the reflux episodes occurred while awake (43.1%) and only five reflux episodes (4.9%) occurred during an obstructive respiratory event. The apnea and hypopnea and arousal indexes 15, 30, and 45 minutes before and after reflux episodes were lower than full-night apnea and hypopnea and arousal indexes, respectively.


Among patients with well-established laryngopharyngeal reflux and OSA, there is no temporal association between reflux and obstructive respiratory events. Even though the data comprised a small sample size, it seems that a more complex mechanism is involved with these two highly prevalent diseases.


Xavier SD, Eckley CA, Duprat AC, de Souza Fontes LH, Navarro-Rodriguez T, Patrocínio J, Tridente D, Lorenzi-Filho G. Temporal association between respiratory events and reflux in patients with obstructive sleep apnea and laryngopharyngeal reflux. J Clin Sleep Med. 2019;15(10):1397–1402.

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