수면장애와 동반된 위식도역류질환에 관한 연구 = Sleep Disorder Associated with Gastroesophageal Reflux Disease

다국어 초록 (Multilingual Abstract)

Background/Aims:Gastroesophageal reflux disease (GERD) may contribute to the development of sleep disturbance, which may, in turn, provoke or worsen GERD. We evaluated the prevalence of GERD, non-erosive reflux disease (NERD), and extra-esophageal syndrome in subjects with self-reported sleep disturbance.
Methods:Subjects presenting for a health check-up were enrolled. Valid self-administered questionnaires provided information about reflux symptoms and sleep disturbances. We defined insomnia as self-reported sleep disturbance that occurred at least twice a week. GERD was defined as at least weekly symptoms of heartburn or acid regurgitation. Factors affecting sleep disturbance were revealed by a logistic regression analysis.
Results:We recruited 1,701 subjects (men 57.5%; mean age 45.0 ± 15.0 years). The prevalence of sleep disturbance was 16.3%. GERD was reported in 14.8% of the subjects with insomnia and 7.1% of controls (p < 0.001). The prevalence of NERD was 13.7% in subjects with insomnia and 6.2% in controls (p < 0.001). The prevalence of extra-esophageal symptoms was higher in the insomniacs than controls. There was a significant correlation between the number of extra-esophageal symptoms and the frequency of sleep disturbance. Multivariate analysis showed that having GERD, NERD, extra-esophageal symptoms, and high depression and anxiety scores were predictors of sleep disturbance.
Conclusions:The prevalence of GERD is higher in subjects with sleep disturbance. The number of extra-esophageal symptoms was correlated with the severity of poor sleep quality, regardless of the presence of erosive change. These findings have therapeutic implications for GERD, NERD, and extra-esophageal syndrome in patients with sleep disturbance, and future trials are warranted. (Korean J Med 2011;81:602-610)

국문 초록 (Abstract)

목적: 수면장애는 성인에서 매우 흔한 질환으로 전세계적으로 그 유병률이 10-35%에 달한다. 위식도역류질환은 수면장애의 원인 중 하나로 알려져 있고, 수면장애로 인해 위식도역류질환이 악화되고 삶의 질 저하와 주간의 생산성 악화가 초래된다. 본 연구는 성인에서 수면장애 여부에 따라 위식도역류질환(gastroesophageal reflux disease, GERD), 비미란성 위식도역류질환(non-erosive reflux disease, NERD), 역류성 식도염, 식도외 증상증후군의 유병률을 비교하고 위험인자를 분석하고자 하였다.
방법:2009년 3월부터 5월까지 이화여자대학교부속 목동병원 건강증진센터에서 종합검진을 받은 성인남녀 중, 수면장애와 위장증상에 대한 자가설문지를 시행하고 상부위장관 내시경을 받은 검진자를 대상으로 하였다. 수면장애는 최소 1주에 1회 이상 불면증상이 있는 경우로 정의하였고 대조군은 수면장애가 없는 검진자로 하였다.
결과:전체 대상자 1,701명 중 수면장애군은 16.3% (277명)이었고, 위식도역류질환은 수면장애군에서 대조군에 비해 유의하게 호발하였다(14.8% vs. 7.1%, p < 0.001). 수면장애군에서는 대조군에 비해 NERD (13.7% vs. 6.2%, p < 0.001)와 식도외 증상증후군(27.8% vs.15.5%, p < 0.001)도 유의하게 호발하였으나 역류성 식도염의 발생은 양 군 간에 차이가 없었다. 다변량 로지스틱 회귀 분석 결과 위식도역류질환, NERD, 식도외 증상증후군, 높은 우울과 불안 증상 점수가 수면장애 발생의 유의한 위험인자였다. 식도외 증상 개수가 증가할수록 불면증의 주간 발생 빈도도 유의하게 증가되었다.
결론:수면장애가 동반된 환자에서 위식도역류질환, NERD와 식도외 증상증후군이 호발하였고, 식도외 증상증후군의 동반 증상 개수와 불면증의 주간 빈도는 유의한 상관성을 보였다. 그러므로 수면장애가 있는 환자에서는 위식도역류질환 동반 유무를 평가하고 이에 대한 치료를 고려할 필요성이 있다.

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