CLINICAL AND FUNCTIONAL FEATURES OF COMORBIDITY OF GASTROESOPHAGEAL REFLUX DISEASE AND OBSTRUCTIVE SLEEP APNEA SYNDROME

Objective. To evaluate the clinical and functional features of GERD and OSAS comorbidity.

Materials and methods. The study included 144 patients with verified GERD. All participants underwent medical history taking, anthropometry, questionnaire surveys (GERDQ, Berlin Questionnaire for apnea), esophagogastroduodenoscopy and 24-hour esophageal pH-impedance monitoring. Patients identified as high risk for OSAS by the questionnaire underwent cardiorespiratory monitoring to confirm the diagnosis. Using multivariate discriminant analysis, we identified a set of features and developed a mathematical model to determine the probability of reflux-associated sleep apnea in patients with GERD. To confirm the results of discriminant analysis and adjust for initial differences in anthropometric parameters, multivariate logistic regression analysis was additionally applied.

Results. Patients with GERD and OSAS comorbidity had significantly higher BMI, waist circumference, and a higher prevalence of otolaryngological pathology. According to pH-impedance monitoring, this group showed statistically significant differences: higher total AET, a higher number of proximal mixed weakly acidic reflux episodes, longer bolus exposure time in the supine position, as well as lower index PSPW and MNBI in the proximal esophagus. Multivariate discriminant analysis identified 8 key predictive features and developed two functions (F₁ > F₂). The method demonstrated a sensitivity of 98,43% and specificity of 97,44%. Multivariate logistic regression analysis adjusted for BMI and waist circumference confirmed the preservation of significant differences in key reflux parameters between the groups.

Conclusion. The obtained data confirm the potential significance of impaired volume and chemical esophageal clearance (decreased PSPW index, increased bolus exposure time), disrupted epithelial barrier integrity in the proximal esophagus (decreased proximal MNBI), and the predominance of proximal weakly acidic nocturnal reflux in GERD and OSAS comorbidity.

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