Study On The Characteristics Of TCM Syndromes In Gastroesophageal Reflux Disease With Sleep Disturbance

Goal:Gastroesophageal reflux disease(Gastroesophageal Reflux disease,GERD)is a common clinical digestive system disease.In recent years,studies have shown that GERD patients often suffer from sleep disorders such as difficulty in falling asleep and awakening at night due to reflux.At the same time,sleep disorders can also cause autonomic nervous function disorders,which may aggravate or even induce GERD,and the two can easily form a vicious circle and aggravate the condition.Therefore,in recent years,clinicians have gradually realized the importance of sleep in the diagnosis and treatment of GERD,and improving the patient's sleep quality has possibly become an important means to reduce their daytime reflux symptoms and improve their quality of life.At present,Modern medicine still focuses on acid suppression in the treatment of GERD with sleep disorders,like increased use of PPI,and combined use with H2 receptor antagonists or hypnotic drugs.But some refractory patients take acid-suppressive drugs ineffectively,and hypnotic drugs are easy to cause Drug dependence and residual effects on the next day,so there is still a lack of reliable basis for efficacy evaluation and unified diagnosis and treatment standards.GERD belongs to the category of "sour acid"while the sleep disorder belongs to the category of "insomnia" in traditional Chinese medicine."Su Wen" says:"Stomach disorder causes restless sleep." It has long been revealed that stomach-qi disorder can cause restless sleep,and there are also many records of "tonic acid"and"insomnia" in historical documents.Therefore,Chinese medicine has a long history and good curative effect in treating this disease.Since the key to Chinese medicine lies in the grasp of the pathogenesis,this study explored the characteristics of the TCM syndromes of GERD with sleep disorders through questionnaire surveys,in order to deepen doctors' understanding of the pathogenesis of this type of disease,thereby improving the clinical efficacy.Method:This study collected a total of 204 patients who met the GERD diagnostic criteria of the"2014 China Gastroesophageal Reflux Disease Expert Consensus" by the Chinese Medical Association Gastroenterology Branch.The cases were from the outpatient and ward of the Gastroenterology Department of Beijing Hospital of Traditional Chinese Medicine Affiliated to Capital Medical University,Beijing University of Chinese Medicine and the Jingshan community.All cases accept surveys of general data,Pittsburgh Sleep Scale,RDQ Scale,and four-diagnosis data of traditional Chinese medicine.The data was statistically processed using SPSS 24.0:measurement data were expressed as(mean and standard error);measurement data that did not conform to the normal distribution were tested by non-parametric test,and the pairwise comparison was performed by Kruskal-Wallis single factor ANOVA test;The composition ratio analysis of the enumeration data adopts the chi-square test,and the pairwise comparison adopts the z-test.Result:1 This study included a total of 204 patients with GERD,of which 159 had sleep disorders,accounting for 77.9%of the total.The main manifestations of sleep disorders are sleep maintenance disorders(79.9%),prolonged sleep latency(73.0%),and daytime residual effects(64.2%),Among them,the course of sleep disorders occurred after reflux symptoms in 75 cases(47.2%),and the course of sleep disorders occurred before reflux symptoms in 84 cases(52.8%).2 There was no statistical difference in RDQ score between patients with sleep disorder and without sleep disorder(P>0.05),so as gastroscopic performance(P>0.05)and BMI index(P>0.05).3 The incidence of sleep disorders of GERD in the different TCM syndromes is not exactly the same(P<0.01).The incidence of sleep disorders in the liver and gallbladder-related syndromes group is higher than that in the non-hepatobiliary-related syndromes group(P<0.01);the PSQI index of each syndrome is incompletely the same(P<0.05),the PSQI index of the liver and gallbladder-related syndrome group was higher than that of the non-hepatobiliary-related syndrome group(P<0.01),even the PSQI index of patients with sleep disorders in the liver and gallbladder-related syndrome group was higher than that of the non-hepatobiliary-related syndrome group(P<0.05).The proportion of hepatobiliary-related syndromes in female patients with GERD and sleep disorders was greater than that of males(P<0.05).4 The three PSQI component indexes of sleep quality,time to fall asleep,and sleep time in the liver and gallbladder-related syndrome group were higher than those in the non-hepatobiliary-related syndrome group(P<0.01).The sleep efficiency component score of the syndrome of gallbladder-heat and stomach-injury was higher than the overall level(P<0.05).Conclusion:1 Patients with TCM syndromes belonging to the liver and gallbladder-related syndrome group have a higher incidence and severity of sleep disorders than the non-hepatobiliary-related syndrome group,and the proportion of hepatobiliary syndromes in female patients is higher than that in men.2 Compared with patients in the non-hepatobiliary-related syndrome group,patients in the GERD liver and gallbladder-related syndrome group have poorer average subjective sleep quality,long objective time to fall asleep,and short total sleep time.The sleep efficiency of patients with gallbladder heat and stomach syndrome is lower than the overall level.