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Background & AimsNocturnal acid reflux is associated with complicated gastroesophageal reflux (GER) disease. Nocturnal GER initiates a protective arousal reflex, which induces a swallow to clear esophageal acid. The purpose of this study was to determine the effect of zolpidem on the sleep arousal mechanism and acid clearance in patients with documented GER, compared with control subjects with normal acid exposure. MethodsEight controls and 16 GER patients were enrolled in a randomized, double-blind, placebo-controlled study. Zolpidem or placebo was given on separate nights. Reflux events and reflux-associated arousals or awakenings were recorded using simultaneous esophageal pH recording and standard polysomnography. ResultsNocturnal acid exposure resulted in a sleep arousal 89% of the time in participants (with and without GER) given placebo but only 40% in those given zolpidem (P < .01). In controls given placebo, acid reflux events lasted 1.15 ± 0.28 seconds; in controls given zolpidem, they lasted 15.67 ± 12.42 seconds (P < .01). In GER patients given placebo, the acid reflux events lasted 37.8 ± 17.2 seconds compared with 363.3 ± 139.3 seconds with zolpidem (P < .01). With zolpidem reflux events lasted 630.6 ± 236.5 seconds when no arousal occurred and 49.2 ± 19.11 seconds when an arousal was recorded (P < .001). ConclusionsZolpidem reduced the arousal response to nocturnal acid exposure and increased the duration of each esophageal acid reflux event in healthy individuals and patients with GER. Because nocturnal acid exposure was prolonged, hypnotic use by patients with GER could lead to increased risk for complicated disease. Abbreviations used in this paper: ACT, acid clearance time, CNS, central nervous system, GER, gastroesophageal reflux, GERD, gastroesophageal reflux disease ⁎ Division of Gastroenterology and Hepatology, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania ‡ Jefferson Sleep Disorders Center, Thomas Jefferson University, Philadelphia, Pennsylvania
Conflicts of interest Karl Doghramji, MD, serves as a consultant for Sandolfi-Aventis. The remaining authors disclose no conflicts. Funding This research was supported mainly through a grant from the Commonwealth of Pennsylvania with approximately 20% support from the Investigators Sponsored Study Program of AstraZeneca. PII: S1542-3565(09)00431-5 doi:10.1016/j.cgh.2009.04.026 © 2009 AGA Institute. Published by Elsevier Inc. All rights reserved.
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ABSTRACT
Effect of Zolpidem on the Sleep Arousal Response to Nocturnal Esophageal Acid Exposure