Sleeping Pill May Worsen Reflux Symptoms

"As many as 15 percent to 30 percent of patients with disturbed sleep may have undiagnosed gastroesophageal reflux disease. If the effect of blunted arousals or awakenings by sleep aids is substantiated, this would suggest caution in the use of sleep aids without first considering gastroesophageal reflux disease as a cause in patients with complaints of disturbed sleep," said Anthony J. DiMarino Jr., MD, of Thomas Jefferson University and lead author of the study.

A total of eight controls and 16 gastroesophageal reflux disease patients were enrolled in a randomized, double-blind, placebo-controlled study. They were given zolpidem or placebo on separate nights; the number of reflux events and reflux-associated arousals or awakenings was recorded.

"The drug had the effect of enabling subjects to 'sleep through' reflux events, thereby increasing nocturnal acid exposure. This suggests that hypnotic use by gastroesophageal reflux disease patients could lead to increased risk for complicated disease. In fact, nocturnal reflux is the leading cause of Barrett's esophagus, a recognized cause of esophageal cancer," added Dr. DiMarino.

Researchers found that acid refluxing at night resulted in sleep arousal 89 percent of the time in participants (with and without gastroesophageal reflux disease) given placebo but only 40 percent in those given zolpidem. In controls given placebo, acid reflux events lasted approximately one to two seconds; in controls given zolpidem, they lasted roughly three to 30 seconds. In gastroesophageal reflux disease patients given placebo, the acid reflux events lasted about 20 to 55 seconds as compared to about four to eight minutes with zolpidem. With zolpidem, reflux events lasted approximately seven to 15 minutes when no arousal occurred and 30 to 68 seconds when an arousal was recorded.

By American Gastroenterological Association