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A proof of concept study describing extraoesophageal reflux in patients with obstructive sleep apnoea and asthma and the effects of continuous positive airway pressure

Introduction: Literature suggests that Asthma and Obstructive Sleep Apnoea (OSA) could worsen potential extraoesophageal (EER) reflux and microaspiration (MAS). There is little data on the potential effects of continuous positive airway pressure (CPAP) therapy. Aims: To examine EER and the impact of CPAP therapy in Asthma and OSA patients. Methodology: Patients were recruited at Newcastle upon Tyne hospitals, UK. The study included four groups; G1: Patients with OSA + asthma (n=10), G2: asthma alone (n=10), G3: OSA alone (n=10) and G4: healthy volunteers (n=12). All subjects at recruitment-completed questionnaires about symptoms of EER; Reflux Symptoms Index (RSI). Salivary pepsin samples were also obtained from all subjects (Peptest). All tests were repeated after 1-month CPAP treatment. Results: The RSI score discriminated reflux symptoms among groups at baseline (P=0.00). Salivary pepsin result showed no differences between groups at baseline. After 1-month CPAP, patient reported salivary pepsin concentration and RSI significantly reduced in OSA patients (P= 0.05), (P= 0.04) respectively (Fig. A & B) and in asthma + OSA patients (P=0.00), (P= 0.00) respectively (Fig. C & D). All OSA patients who were taking PPIs (n=10) discontinued these medications after 1-month CPAP, associated with the symptomatic resolution of their reflux (p=0.00). Conclusion: CPAP may modulate reflux and MAS in patients with Asthma and OSA. If confirmed, by formal powered studies, these novel proof of concept findings could be of translational significance in these patient populations.