Treat the GERD and Sleep Will Follow

Because so many of our patients have sleep disturbance, it’s tempting to hope that we can treat an underlying condition to alleviate the sleep problem rather than resort to sleep medications. Gastroesophageal reflux disease (GERD) is an attractive candidate, because it’s worsened by the recumbent position and many patients can’t or won’t adjust the angle of their beds to alleviate symptoms.

Often, GERD is asymptomatic, which raised an interesting question for Aimi and colleagues: Does sleep improve in asymptomatic patients with GERD when their reflux is treated aggressively?

They presented the results of the study they conducted to find the answer at Digestive Disease Week 2014 in Chicago.

In this study, “Effects of omeprazole on sleep disturbance: randomized, multicenter, double-blind, placebo-controlled trial,” the Japanese investigators looked at the efficacy of proton pump inhibitor (PPI) therapy in improving sleep disturbance in persons with symptomatic and asymptomatic GERD. Subjects complaining of insomnia (N=171) were randomized to receive 14 days of omeprazole, 20 mg/d, or placebo. At the end of the study period, they were asked to complete 4 self-reporting questionnaires, QOLRAD-J (the Japanese translation of the Quality of Life in Reflux and Dyspepsia questionnaire), PSQI (Pittsburgh Sleep Quality Index), ESS (Epworth Sleepiness Scale), and a sleep diary.

Of the 171 patients, 69 had typical reflux symptoms and 102 did not. Of the 69 patients who had reflux symptoms, 34 received omeprazole and 35 received placebo. Omeprazole improved GERD-related quality of life and significantly improved insomnia compared with placebo. Among the 102 patients without reflux symptoms, there was no difference between the omeprazole and placebo groups.

So PPIs are a reasonable choice for insomnia, but only in patients with symptomatic GERD. This study does not support the use of this relatively expensive medication as a therapeutic trial in the insomnia population not complaining of GERD symptoms.