Obstructive Sleep Apnea Syndrome (OSAS), Gastroesophageal Reflux Disease (GERD) and Hyperuricemia: Uneasy Bedfellows or Natural Partners?

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Abstract Introduction and Rationale: Traditionally Obstructive Sleep Apnea Syndrome (OSAS), Gastroesophageal Reflux Disease (GERD) & Hyperuricemia have been considered “uneasy bedfellows” having an indispensable, but uncomfortable relationship. There are large gaps in our understanding of this interlinkage in patients presenting with OSA in Developing countries. Within this background, we conducted this study to explore whether a relationship exists between Obstructive Sleep Apnea (OSA) and Gastroesophageal Reflux Disease (GERD) and Hyperuricemia and to determine if such relationship is interdependent contributor to the clinical corelates of severity of OSA. Methods: We conducted this Hospital Based Cross Sectional Study at Department of Pulmonary, Critical Care & Sleep Medicine at B. P. Koirala Institute of Health Science (BPKIHS), a university teaching hospital in Nepal. All Patients presenting with the diagnosis of Obstructive Sleep Apnea during 1 year (from July 2021 to June 2022) were enrolled. A structured proforma detailed the socio-demographic information, clinical data and Polysomnography score. GERD was diagnosed Clinically. Hyperuricemia was diagnosed as presence of Serum Uric Acid (SUA) level ≥ 7.0 mg/dl in males or ≥ 6.0 mg/dl in females. Descriptive and Inferential Statistics were used to analyze the clinical variables that most strongly reflected the presences of relationship between OSAS and GERD and Hyperuricemia as well as their interdependency in contributing to the clinical corelates of severity of OSAS. Results: During 1 yr, 40 Patients of polysomnography (PSG)confirmed Obstructive Sleep Apnea (OSA) were enrolled. Among them (55 %) were male. Mean Age of Patients was 48 years. 60 % reported Gastroesophageal Reflux Disease (GERD) and Hyperuricemia. 45% of patients with OSA having hyperuricemia and GERD had raised CRP and ferritin and moderate to severe OSA. 72% Male had higher Apnea/ Hypopnea Index (AHI), respiratory distress Index, oxygen desaturation Index, compared to female. They were 2 times more likely to report restless leg syndrome. Hyperuricemia and GERD in patients with severe OSA positively corelated to male gender, presence of hypertension, hyperlipidemia, increase CRP and alcohol consumption. Conclusions: Obstructive Sleep Apnea Syndrome (OSAS), Gastroesophageal Reflux Disease (GERD) and Hyperuricemia are “Natural Partners” having interdependent and mutually reinforcing partnership because of their shared pathophysiological pathways and biologically plausible mechanism rather than “uneasy bedfellows” (unusual heterogeneous alliances). Severe OSA seems to be causally associated with GERD and that GERD and Hyperuricemia were causally associated with severe OSA; this effect is especially profound and synergistic in Current smoker, with history of frequent alcohol consumption and male gender.

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