Non-invasive Positive Pressure Ventilation In The Treatment Of Sleep Apnea Hypopnea Syndrome With Gastroesophageal Reflux Cough

BackgroundAccording to the guidelines for the diagnosis and treatment of cough in China in 2015,cough is the main or only symptom,which lasts for more than 8 weeks and is called chronic cough.The chronic cough that has not healed for a long time brings inconvenience to patients’ lives,seriously affects the quality of life of patients,and also increases the economic burden.Gastroesophageal reflux cough(gastroesophageal reflux-induced Chronic cough,GERC)is a special type of gastroesophageal reflux disease with cough as the only or prominent symptom.It is one of the common causes of chronic cough.The treatment is mainly based on acid-suppressing drugs combined with gastric motility drugs.Obstructive sleep apnea-hypopnea syndrome(OSAHS)refers to apnea and hypoventilation caused by repeated collapse of the upper airway during sleep,resulting in intermittent hypoxia,sleep structure disorder,and daytime sleepiness.OSAHS can induce and aggravate diseases associated with chronic cough,such as gastroesophageal reflux disease and nocturnal asthma.In addition,upper airway inflammation,which is closely related to OSAHS,can also cause cough.Therefore,we hypothesized that there is a correlation between OSAHS and GERC,and what effect does noninvasive positive pressure ventilation have on GERC?Objective To explore the effect of noninvasive ventilation on cough symptoms in OSAHS patients with GERC and the correlation between sleep monitoring indicators and cough in patients with GERC.MethodsA total of 79 OSAHS patients with GERC were enrolled in this study from patients who were diagnosed with OSAHS and GERC in First Affiliated Hospital of Zhengzhou University from June 2015 to June 2018.According to the different treatment methods of previous patients,they were divided into drug treatment group(proton pump inhibitor + gastric motility drug),combined treatment group(drug combined with noninvasive positive pressure ventilation),in which the drug treatment group was used as the control group.To investigate the effects of pre-treatment,1 week of treatment,and 3 months of treatment on OSAHS with GERC and the association of OSAHS with GERC:1.To assess the degree of sleep,nighttime apnea,gastroesophageal reflux,and cough in OSAHS patients with GERC before treatment;2.To investigate the effects of different treatments on PSQI score,ESS score,VAS score,daytime cough symptom score and nocturnal cough symptom score in OSAHS patients with GERC after 1 week and 3 months of treatment;and OSAHS merger after 3 months of treatment,the effects of total sleep time,sleep efficiency,nighttime sleep structure,AHI,longest apnea time,and minimum oxygen saturation on GERC patients;3.To explore the correlation between the severity of OSAHS,the severity of gastroesophageal reflux and chronic cough.Results1.OSAHS patients with GERC had more severe daytime sleepiness,sleep structure disorder,decreased sleep efficiency,moderate sleep apnea,more obvious weak acid reflux and moderate coughing events before treatment.2.Compared with the drug treatment group and before treatment,the PSQI score and ESS score of the combined treatment group decreased with the prolongation of treatment time,and the PSQI sleep quality score and ESS sleepiness score returned to normal level after 3 months of treatment.The difference was statistically significant(P<0.05).Compared with the drug-treated group and before treatment,the total sleep time and sleep efficiency of the combined treatment group increased after 3 months of treatment,but the difference was not statistically significant.After 3 months of treatment,the sleep structure of the combined treatment group improved and became normal;the sleep structure remained disordered in the drug treatment group for 3 months.Compared with before treatment,after 3 months of treatment,the severity of AHI and the longest apnea time were lower than before,and the minimum oxygen saturation during sleep was better than before(P<0.05).3.Compared with the drug treatment group and before treatment,the VAS score,daytime and nighttime cough scores of the combination treatment group and the drug treatment group were improved after treatment for 3 months,but the improvement of the combination treatment group was more obvious(P < 0.05).4.The VAS scores of OSAHS patients with GERC were positively correlated with BMI,ESS and AHI.The nighttime cough scores were positively correlated with BMI and AHI.VAS score,daytime cough score and nighttime cough score were positively correlated with Demeester score and weak acid reflux.Conclusion1.Non-invasive ventilation can improve the symptoms of cough in patients with OSCAS with GERC.2.The severity of OSAHS has a certain impact on the severity of GERC.