Reflux-Related Sleep Disturbances

Clinical Recognition and Diagnosis

• Up to 75% of patients with reflux-related extraesophageal manifestations may lack typical symptoms such as heartburn or regurgitation, according to the American Gastroenterological Association 1
• Consider objective testing before empiric PPI therapy in patients with extraesophageal manifestations who lack typical symptoms, as recommended by the American Gastroenterological Association, since 50-60% will not have GERD 4
• pH-impedance monitoring off PPI is the preferred test, as it detects both acid and non-acid reflux episodes that can cause arousals, according to the American Gastroenterological Association 4
• Global clinical assessment is required, as no single test conclusively identifies reflux as the cause, and diagnosis requires integrating symptoms, endoscopy findings, reflux monitoring results, and treatment response, as stated by the American Gastroenterological Association 2, 3

Treatment Approach

• Extraesophageal manifestations typically require 8-12 weeks of treatment, longer than typical GERD, according to the American College of Gastroenterology 1
• If one PPI trial fails (up to 12 weeks), pursue objective testing rather than trying additional PPIs, as further empiric trials are low yield, as recommended by the American Gastroenterological Association 4, 5