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Predictors of Heartburn During Sleep in a Large Prospective Cohort Study.
ABSTRACT
Background and aims: Nocturnal gastroesophageal reflux, which may result in
nocturnal heartburn, has been demonstrated to be associated with a more severe form of gastroesophageal
reflux disease (GERD). The aim of this study was to determine the clinical predictors of heartburn during
sleep in a large prospective cohort study.
Methods: Study subjects were members of the parent cohorts from which the Sleep Heart Health Study
(SHHS) recruited participants. SHHS is a multicenter, longitudinal, cohort study of the cardiovascular
consequences of sleep-disordered breathing. As part of the recruitment process, parent cohort members
completed a questionnaire that permitted an assessment of the relationships between heartburn during sleep,
and patient demographics, sleep abnormalities, medical history, and social habits in nine community-based
parent cohorts across the United States. All variables, significant at the p < 0.05 level, were included as
independent variables in multivariate logistic regression models with heartburn during sleep status included
as the dependent variable.
Results: A total of 15,314 subjects completed the questions about heartburn during sleep, and of
these, 3,806 subjects (24.9%) reported having this symptom. In four increasingly comprehensive multivariate
models, increased body mass index (BMI), carbonated soft drink consumption, snoring and daytime sleepiness
(Epworth sleepiness scale score), insomnia, hypertension, asthma, and usage of benzodiazepines were strong
predictors of heartburn during sleep. In contrast, college education decreased the risk of reporting heartburn
during sleep.
Conclusions: Heartburn during sleep is very common in the general population. Reports of this type of
symptom of GERD are strongly associated with increased BMI, carbonated soft drink consumption, snoring and
daytime sleepiness, insomnia, hypertension, asthma, and usage of benzodiazepines. Overall, heartburn during
sleep may be associated with sleep complaints and excessive daytime sleepiness.
Keywords: cohort studies • gastroesophageal reflux • heartburn • sleep
