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Epidemiologic studies have suggested a relationship between gastroesophageal reflux disease (GERD) and daytime somnolence, perhaps due to nighttime sleep disturbances and frequent awakenings caused by nocturnal heartburn and regurgitation of gastric contents. The influence of GERD on daytime cognitive function was examined by P?l Demeter, MD, and colleagues in a study of 134 patients undergoing upper panendoscopy. The Epworth Sleepiness Scale (ESS) was used to evaluate sleepiness, and results were analyzed with respect to the severity of endoscopic findings.
The results, which were reported in the June 2004 issue of the World Journal of Gastroenterology, showed a positive relationship between reflux disease severity and ESS scores. More severe GERD groups, categorized by the Savary-Miller classification, exhibited a gradually increasing and more "somnolent" result on the ESS. Mild somnolence (8 on the ESS) occurred in only 29% of the GERD 0 group (mild GERD) but was noted in 39% of the GERD I group and in 46% of the GERD II group. Significant somnolence occurred in more than 77% of patients in the GERD III group. The authors concluded that GERD severity affects daytime somnolence and suggested that patients with extraesophageal symptoms may develop daytime somnolence even earlier (and without visible esophagitis) than those without extraesophageal symptoms.