Gastroesophageal Reflux and Sleep Disturbances: A Bidirectional Association in a Population-Based Cohort Study, the HUNT Study

Abstract

Study Objectives: To investigate the potentially bidirectional association between gastroesophageal reflux symptoms (GERS) and sleep disturbances/ insomnia disorders. Methods: We assessed the incidence of new-onset of self-reported GERS, sleep disturbances, and insomnia disorders in a population-based longitudinal cohort study (HUNT), performed in Nord-Trøndelag County, Norway. Modified Poisson regression was used to estimate risk ratios (RRs) with 95% confidence intervals (CIs), adjusted for sex, age, body mass index, tobacco smoking, educational level, anxiety, and depression. Results: The study cohort included the 25,844 participants of the HUNT study who responded to health questionnaires in both 1995–1997 and 2006–2009. New-onset GERS, sleep disturbances, and insomnia disorders was reported in 396 (2%), 2,598 (16%), and 497 (3%) participants, respectively. Persistent sleep disturbances were associated with new-onset GERS (RR: 2.70, 95% CI: 1.93–3.76), persistent insomnia disorders were associated with new-onset GERS (RR: 3.42; 95% CI: 1.83–6.39) and persistent GERS was associated with new-onset sleep disturbances (RR: 1.41; 95% CI: 1.14–1.75). Conclusions: Sleep disturbances and GERS seem to be bidirectionally associated, and sleep disturbances seem to be a stronger risk factor for GERS than the reverse. Significance The present study found that sleep disturbances and gastroesophageal reflux symptoms (GERS) are bidirectionally associated, suggesting that sleep disturbances may lead to GERS and vice versa. The study indicates a stronger association between sleep disturbances and risk of GERS than the opposite. The results are supported by the longitudinal design that enabled assessment of new-onset sleep disturbances and GERS and an observed dose-response relation, with increased risk with longer exposure. The study highlights the need for research aiming at preventing or treating both of these disorders. Interventional studies addressing whether treatment of sleep disturbances decreases the risk of developing GERS and whether effective treatment of GERS counteracts sleep disturbances are warranted.