Recently I wrote about a new patient who had multiple complaints about her sinuses only to be dismissed by other clinicians suggesting that her problems were related to anxiety and nothing organic. I do have an update on the case which I would like to share with you.
One of the risk factors that I was concerned about in this particular patient was that she had obstructive sleep apnea (OSA), and I had ordered an at-home sleep study to be performed. The results are in and the patient does have moderate to severe OSA. The patient did have an underlying history of GERD which was not well managed with medications. Based on the patient’s physical exam, she did have risk factors that made me suspicious that the patient may indeed have OSA.
How Obstructive Sleep Apnea (OSA) Triggers GERD and Worsens Chronic Sinusitis
Unfortunately many clinicians do not realize that OSA can contribute to chronic rhinosinusitis (CRS). Recent literature shows that there is a correlation among OSA, GERD and CRS.
It is well known that GERD is a risk factor for CRS. What isn’t well known is that OSA is a risk factor for GERD. The way that OSA exacerbates GERD is as follows. One; during apenic events the chest cavity creates negative pressure in relation to the stomach and literally acts as a siphon and sucks the gastric contents into the esophagus and the upper airways and the sinus cavities. Two; the diaphragmatic strain caused by the apenic event can force the lower esophageal sphincter open allowing the gastric contents such acid, digestive enzymes and bile into the upper airways and sinus cavities. Third; frequent arousals can contribute to behaviors such as air swallowing which are involuntary and which in itself contributes to GERD.
Why the GERD and OSA Connection Is a Two-Way Street
In addition, the association between OSA and GERD is a two-way street. As OSA can worsen GERD, so can GERD worsen OSA. GERD can cause inflammation of the vocal cords which in turn can worsen OSA.
In conclusion, there are many patients out there that suffer with CRS that believe that their case is hopeless, not realizing that they may have GERD which is not well controlled because of undiagnosed OSA.
