http://www.ncbi.nlm.nih.gov/pubmed/10445529
Abstract
OBJECTIVE: Body position has been shown to influence postprandial and fasting gastroesophageal reflux (GER) in patients and normal volunteers when they are assigned to lie in a prescribed position. No published studies have evaluated the effect of spontaneous sleeping positions on recumbent reflux in patients with GER.
METHODS: Ten patients, three female and seven male (mean age 47.6 yr, range 30-67 yr) with abnormal recumbent esophageal pH <4 on 24-h pH-metry participated. A standardized high fat dinner (6 PM) and a bedtime snack (10 PM) were administered to all patients. GER during spontaneous sleep positions was assessed with a single channel pH probe placed 5 cm above the lower esophageal sphincter (LES) and with a position sensor taped to the sternum. Data were recorded with a portable digital data logger (Microdigitrapper-S, Synectics Medical) and analyzed for recumbent percent time pH <4 and esophageal acid clearance time in each of four sleeping positions. Time elapsed between change in sleeping position and GER episodes was also calculated.
RESULTS: Right lateral decubitus was associated with greater percent time pH <4 (p < 0.003) and longer esophageal acid clearance (p < 0.05) compared to the left, supine, and prone. GER episodes were more frequent in the supine position (p < 0.04) and occurred within 1 min after change in sleeping position 28% of the time.
CONCLUSIONS:
The left lateral decubitus position is preferred in patients with nocturnal GER. Measures to aid patients in sleeping in this position should be developed.
http://www.ncbi.nlm.nih.gov/pubmed/15520695
Relationships among nocturnal jaw muscle activities, decreased esophageal pH, and sleep positions.
Miyawaki S, Tanimoto Y, Araki Y, Katayama A, Imai M, Takano-Yamamoto T.
Department of Orthodontics and Dentofacial Orthopedics, Okayama University Graduate School of Medicine and Dentistry, Okayama, Japan.
Abstract
The purpose of this study was to examine the relationships among nocturnal jaw muscle activities, decreased esophageal pH, and sleep positions. Twelve adult volunteers, including 4 bruxism patients, participated in this study. Portable pH monitoring, electromyography of the temporal muscle, and audio-video recordings were conducted during the night in the subjects' homes. Rhythmic masticatory muscle activity (RMMA) episodes were observed most frequently, with single short-burst episodes the second most frequent. The frequencies of RMMA, single short-burst, and clenching episodes were significantly higher during decreased esophageal pH episodes than those during other times. Both the electromyography and the decreased esophageal pH episodes were most frequently observed in the supine position. These results suggest that most jaw muscle activities, ie, RMMA, single short-burst, and clenching episodes, occur in relation to gastroesophageal reflux
mainly in the supine position.
http://www.ncbi.nlm.nih.gov/pubmed/11829782
Zhonghua Wai Ke Za Zhi. 1999 Feb;37(2):71-3, 3.
[Can esophagogastric anastomosis prevent gastroesophageal reflux].
[Article in Chinese]
Wang Q, Liu J, Zhao X, Lei J, Cong Q, Li W, Li B, Wang F, Cao F, Zhang X, Zhang H, Zhang H.
Depatment of Thoracic Surgery, Fourth Hospital of Hebei Medical University, Shijiazhuang 050011.
Abstract
OBJECTIVE: To investigate the possible anti-reflux function of esophagogastric anastomosis in the patients after receiving resection of cardiac cancer.
METHODS: One hundred and ninety-two patients were studied by video-assisted gastroscopy, manometry, 24-h pH esophageal monitoring, radioscintigraphy and scanning electron microscopy.
RESULTS: Abnormalities were found in 90.2% of patients through endoscopy. Resting pressure in esophageal body was higher than that in normal controls, and in the stomach, lower. Twenty-four hour pH monitoring demonstrated that gastroesophageal reflux (GER) did not occur when the patients slept in semi-reclining position, and occurred in all patients when slept in supine position. Scintigraphic study showed that 2/3 of the patients had reflux, occurrence of which was not affected by the length of postoperative period. Scanning electron microscopic examination showed that degeneration, exfoliation of esophageal mucosal epithelial cell, and derangement of micro-fold and inflammatory oedema of cytomembrane may be directly caused by reflux.
CONCLUSIONS: GER exists in the majority of the patients after esophagogastrectomy and esophagogastrostomy for cardiac cancer. The occurrence of GER is not affected by the length of postoperative period. Some detecting methods fail to show the existence of GER, and 24-h pH monitoring is the most reliable method for detecting GER.
Sleep in semireclining position is an effective method of preventing GER in postoperative patients.
http://www.ncbi.nlm.nih.gov/pubmed/18487262
Age Ageing. 2008 Sep;37(5):526-9. Epub 2008 May 16.
Severe nocturnal hypoxaemia in geriatric inpatients.
Hjalmarsen A, Hykkerud DL.
Department of Medicine, Pulmonary Division, University Hospital of North Norway, N 9038 Tromsø, Norway.
audhild.hjalmarsen@unn.no
Abstract
BACKGROUND:
oxygen levels are decreased in older people especially in the supine position, and during sleep. Geriatric inpatients often suffer from stroke and heart disease. Respiratory control may be substantially affected.
OBJECTIVE: the aim of this study was to examine oxygen levels during night in inpatients on geriatric medical wards to find out if they needed nocturnal oxygen therapy.
DESIGN: prospective observational study. Setting/Participants: we consecutively examined 133 patients with SpO(2) >or=92% in sitting position by an overnight -8-h pulse oximetry. Patients with severe obesity, dementia or pulmonary disease were excluded. The test was performed at least 4 days after the event in stroke cases. Outcome Variables: ninety two patients, m/f 43/49, with mean age 78.3 +/- 6.9 SD completed the test. Sixty six patients suffered from stroke; 34 left-sided and 19 right-sided stroke. Nine patients suffered from a heart disease only, and 17 patients suffered from other diseases.
RESULTS: according to the guidelines for long-term oxygen therapy recommendations for nocturnal oxygen therapy, we found that 26% of the patients fulfilled the criteria of SpO(2) <or=90% for >or=30% of the time. There was a significant positive correlation between age and the amount of time with SpO(2) between 80 and 84% (0.215, P < 0.05). Diagnosis or severeness of disease did not significantly affect nocturnal SpO(2) %. The 1-year survival rate was 75% in group I (hypoxaemic) versus 84% in group II (normoxaemic) (NS).
CONCLUSION: nearly 30% of the inpatients in geriatric medical wards suffered from severe oxygen-requiring nocturnal hypoxaemia irrespective of diagnosis.