TREATING GERD HELPS SLEEP, ACCORDING TO NEW STUDY LED BY MEMBER OF OUR ENT TEAM
Findings of News-Making Report Offer Hope for Many Afflicted with Sleep Disturbance Disorder
The use of proton pump inhibitors (PPIs) improves the sleep and daytime quality of life for sufferers of gastroesophageal reflux disease (GERD), according to a systematic literature review conducted by Elliot Regenbogen, MD, of our Otolaryngology-Head and Neck Surgery (ENT) Division, and colleagues here at Stony Brook Medicine. This research demonstrates our commitment to advancing patient care.
The report, titled "Esophageal Reflux Disease Proton Pump Inhibitor Therapy Impact upon Sleep Disturbance," was just published in the April issue of Otolaryngology-Head and Neck Surgery.
A 2003 Gallup survey linked GERD — also known as heartburn or reflux esophagitis — with frequent sleep disturbances. PPIs have proven to be an effective treatment therapy, and there are established criteria for treating reflux. However, there are no well-established clinical guidelines on how to treat the sleep disturbances with the resulting quality-of-life issues.
The objective of Dr. Regenbogen's review was to evaluate the impact of PPI treatment of GERD on sleep disturbance-related outcomes, as documented in the medical literature.
In addition to Dr. Regenbogen who is the first author, the co-authors of the report are Alex Helkin and Rachel Georgopoulos, two senior medical students in the School of Medicine; Tajender Vasu, MD, of the Pulmonary, Critical Care and Sleep Medicine Division; and A. Laurie W. Shroyer, PhD, MSHA, vice chair for research in the Department of Surgery.
Together, the authors performed a systematic literature review using three databases — PubMed, Web of Science, and Cochrane Library — of all randomized placebo-controlled clinical trials from 1989 (when omeprazole became available) to October 2011. Additional relevant publications were identified based on the articles' citations.
The search strategy identified all randomized placebo-controlled clinical trials published in English; both PPI use and outcome measures of sleep disturbance were reported for GERD patients. Using a pre-established systematic review protocol and data extraction format, the four co-authors independently reviewed all articles.
Findings of our study support the use of PPI medications as a treatment
to improve GERD symptoms and associated quality-of-life
sleep disturbance-related outcomes.
Based on the review findings, the authors state in the report: "The existing evidence supports the use of PPI medications as a treatment to improve esophageal reflux disease symptoms and associated quality-of-life sleep disturbance-related outcomes."
"Although the improvements are likely secondary gains from reduction or elimination of nocturnal GERD symptoms, further research appears warranted to evaluate PPI treatment impact on polysomnography outcomes, as well as to examine the relationship of polysomnography versus nonpolysomnography outcomes, for GERD patients with sleep disturbance and sleep-disordered breathing," they add.
Dr. Regenbogen explains the value of the approach he used to conduct the study, as it relates to evidence-based medicine and high-quality healthcare:
"A systematic review of the literature presents a structured summary and critical appraisal of high-quality research evidence relevant to a focused question. Systematic reviews of high-quality randomized controlled trials are crucial to evidence-based medicine, and have become a cornerstone in the development of high-quality healthcare. The scope of systematic reviews is not limited to direct medical interventions but may also concern issues regarding public health and economic impact.
"To achieve this level of quality, the search strategy of a systematic review is clearly described, exhaustive, transparent, and reproducible. The databases and citation indexes, in this case PubMed, Web of Science, and the Cochrane Library, are searched, and studies meeting pre-stated criteria pertaining to the research question are included.
"By using an objective and transparent approach for research synthesis interpretation of results by the multiple reviewers involved are less prone to bias. The purpose of a review is synthesis: combine the reports from to create a 'greater whole.'"
Otolaryngology-Head and Neck Surgery is the official scientific journal of the American Academy of Otolaryngology-Head and Neck Surgery (AAO-HNS), one of the oldest medical associations in the nation, which represents nearly 12,000 physicians and allied health professionals who specialize in the diagnosis and treatment of disorders of the ears, nose, throat, and related structures of the head and neck.
About Dr. Elliot Regenbogen
Dr. Regenbogen joined our Otolaryngology-Head and Neck Surgery Division in 2009 as assistant professor of surgery. He came to Stony Brook from Westchester County, where he had practiced general otolaryngology for 17 years, and also served as chairman of the otolaryngology department at Northern Westchester Hospital.
Dr. Regenbogen focuses his clinical practice on general otolaryngology-head and neck surgery, as well as on advanced diagnosis and treatment of voice and swallowing disorders. His practice also includes the diagnosis and treatment of chronic sinus conditions, postnasal drip, nasal obstruction, allergy, loss of smell and taste, reflux esophagitis, snoring and sleep apnea, hearing loss, and ear infections.
In addition to reflux esophagitis and its related sleep disturbance, Dr. Regenbogen's research interests include the development of ultra-high resolution immunofluorescent-based imaging systems for the detection and treatment of benign and malignant disorders of the vocal cords, head and neck, and paranasal sinuses.
The news-making report on PPIs and GERD, which is a model
of the systematic literature review, reflects the specialized training
Dr. Regenbogen gained as a Cochrane Scholar.
Dr. Regenbogen received his MD in 1986 from Albert Einstein College of Medicine, where he subsequently completed his residency training. His training included a preceptorship at Japan's Kurume University Hospital under Minoru Hirano, MD, PhD, one of the founders of modern concepts in laryngology, as well as collaboration with Wilbur J. Gould, MD, and Stanley M. Blaugrund, MD, at the Ames Vocal Dynamics Laboratory of Lenox Hill Hospital in New York.
In 2010, Dr. Regenbogen was honored by his selection to receive a Cochrane Colloquium Grant and work as a Cochrane Scholar. The AAO-HNS annually provides three competitive travel grants to facilitate attendance at the annual Cochrane Colloquium for training in the conduct and publication of systematic literature reviews, with focus on state-of-the-art techniques for producing systematic reviews and meta-analyses.
Click here to see the abstract of the Regenbogen report on PubMed provided by the National Library of Medicine. And, watch this short video (0:54 min) to see how PPIs work:
