Xiangxia Zeng,1,2 Shijia Wang,1,2 Peiting Zhang1,2 

1Department of Nutrition, School of Public Health, Guangzhou Medical University, Guangzhou, 511436, People’s Republic of China; 2The Key Laboratory of Advanced Interdisciplinary Studies, The First Affiliated Hospital, Guangzhou Medical University, Guangzhou, 511436, People’s Republic of China

Correspondence: Xiangxia Zeng, School of Public Health/The First Affiliated Hospital, Guangzhou Medical University No.1, Xinzhao Road, Guangzhou, 510000, People’s Republic of China, Tel +86-15920552245, Email zengxiangxia2020@163.com

Aim: Obstructive sleep apnea (OSA) and gastroesophageal reflux disease (RD) are two common yet frequently co-occurring conditions that significantly impact sleep quality and overall health. While a growing body of evidence suggests a potential link between these disorders, the nature and strength of their relationship remain unclear. This systematic review and meta-analysis aims to comprehensively evaluate the association between OSA and RD, focusing on the incidence of RD in OSA patients and the potential impact of RD on sleep parameters, including sleep stages and apnea severity.
Methods: We systematically searched PubMed, Embase, the Cochrane Library, and Scopus databases to identify relevant studies for this review. Eligible studies had to investigate the association between obstructive sleep apnea (OSA) and gastroesophageal reflux disease (RD) in adult populations. The primary outcomes assessed were the incidence of RD in OSA patients, as well as the impact of RD on sleep parameters, including sleep stages, apnea severity, and the Epworth Sleepiness Scale (ESS).
Results: Totally 49 studies were included in this analysis. A modest association between obstructive sleep apnea (OSA) and the increased incidence of gastroesophageal reflux disease (RD), with a pooled relative risk of 1.23 (95% CI: 1.00, 1.52), although this did not reach statistical significance (p = 0.056). A trend towards increased reflux symptoms in severe OSA patients compared to mild OSA was noted (p=0.036). Patients with RD exhibited significantly lower sleep efficiency (p=0.003) and reduced oxygen saturation (p< 0.001). Heterogeneity analysis indicated moderate variability across studies, primarily due to differences in patient characteristics and OSA severity.
Conclusion: A certain association between obstructive sleep apnea (OSA) and gastroesophageal reflux disease (RD) was observed, but this association did not reach statistical significance. RD was significantly associated with reduced sleep efficiency, but no significant relationship was found between RD and OSA severity levels. While RD may influence early sleep stages (eg, N1), this effect remains inconclusive due to limited and variable supporting data. These findings highlight the need for further research to clarify the nature and direction of the OSA-RD relationship.

Keywords: obstructive sleep apnea, reflux disease, meta-analysis, systematic review