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Journal of Clinical Sleep Medicine :... Jul 2017To assess the benefit and tolerance of autotitrating positive airway pressure (APAP) versus continuous positive airway pressure (CPAP) in subjects who experience... (Comparative Study)
Comparative Study Randomized Controlled Trial
A Randomized Crossover Trial Comparing Autotitrating and Continuous Positive Airway Pressure in Subjects With Symptoms of Aerophagia: Effects on Compliance and Subjective Symptoms.
STUDY OBJECTIVES
To assess the benefit and tolerance of autotitrating positive airway pressure (APAP) versus continuous positive airway pressure (CPAP) in subjects who experience aerophagia.
METHODS
This is the report of a prospective, two-week, double-blinded, randomized crossover trial set in an Australian clinical sleep laboratory in a tertiary hospital. Fifty-six subjects who reported symptoms of aerophagia that they attributed to CPAP were recruited. Full face masks were used by 39 of the 56 subjects recruited. Subjects were randomly and blindly allocated to either CPAP at their treatment recommended pressure or APAP 6-20 cm HO, in random order. Subjects spent two weeks on each therapy mode. Therapy usage hours, 95th centile pressure, maximum pressure, 95th centile leak, and residual apnea-hypopnea index (AHI) were reported at the end of each two-week treatment period. Functional Outcome of Sleepiness Questionnaire, Epworth Sleepiness Scale, and visual analog scale to measure symptoms of aerophagia were also completed at the end of each 2-week treatment arm.
RESULTS
The median pressure ( < .001) and 95th centile pressure ( < .001) were reduced with APAP but no differences in compliance ( = .120) and residual AHI were observed. APAP reduced the symptoms of bloating ( = .011), worst episode of bloating ( = .040), flatulence ( = .010), and belching ( = .001) compared to CPAP. There were no differences in Epworth Sleepiness Scale or Functional Outcome of Sleepiness Questionnaire outcomes between CPAP and APAP.
CONCLUSIONS
APAP therapy reduces the symptoms of aerophagia while not affecting compliance when compared with CPAP therapy.
CLINICAL TRIAL REGISTRATION
Australian and New Zealand Clinical Trials Registry at https://www.anzctr.org.au, trial number ACTRN12611001250921.
COMMENTARY
A commentary on this article appears in this issue on page 859.
Topics: Aerophagy; Aged; Australia; Continuous Positive Airway Pressure; Cross-Over Studies; Double-Blind Method; Female; Humans; Male; Patient Compliance; Polysomnography; Prospective Studies; Surveys and Questionnaires; Treatment Outcome
PubMed: 28558864
DOI: 10.5664/jcsm.6658 -
Balkan Medical Journal Oct 2019
Topics: Abdomen; Aerophagy; Child, Preschool; Female; Humans; Radiography
PubMed: 31397143
DOI: 10.4274/balkanmedj.galenos.2019.2019.6.66 -
Journal of Clinical Sleep Medicine :... Oct 2008Aerophagia is a complication of continuous positive airway pressure (CPAP) therapy for sleep disordered breathing (SDB), whereupon air is forced into the stomach and...
STUDY OBJECTIVES
Aerophagia is a complication of continuous positive airway pressure (CPAP) therapy for sleep disordered breathing (SDB), whereupon air is forced into the stomach and bowel. Associated discomfort can result in CPAP discontinuation. We hypothesize that aerophagia is associated with gastroesophageal reflux disease (GERD) via mechanisms involving GERD related lower esophageal sphincter (LES) compromise.
METHODS
Twenty-two subjects with aerophagia and 22 controls, matched for age, gender, and body mass index, who were being treated with CPAP for SDB were compared in regard to clinical aspects of GERD, GERD associated habits, SDB severity as measured by polysomnography, and mean CPAP pressure.
RESULTS
More subjects with aerophagia had symptoms of GERD (77.3% vs. 36.4%; p < 0.01) and were on GERD related medications (45.5% vs. 18.2%, p < 0.05) than controls. Regarding polysomnography, mean oxygen saturation percentages were lower in the aerophagia group than controls (95.0% vs. 96.5%, p < 0.05). No other differences were observed, including mean CPAP pressures. No one in the aerophagia group (vs. 27.3% of the control group) was a current tobacco user (p < 0.01). There was no difference in caffeine or alcohol use between the 2 groups.
CONCLUSIONS
These results imply aerophagia is associated with GERD symptoms and GERD related medication use. This finding suggests a relationship between GERD related LES pathophysiology and the development of aerophagia in patients with SDB treated with CPAP.
Topics: Adult; Aerophagy; Case-Control Studies; Comorbidity; Continuous Positive Airway Pressure; Female; Gastroesophageal Reflux; Humans; Male; Middle Aged; Pilot Projects; Polysomnography; Risk Factors; Sleep Apnea, Obstructive; Smoking
PubMed: 18853700
DOI: No ID Found -
Alimentary Pharmacology & Therapeutics Nov 2005Aerophagia is a functional upper gastrointestinal disorder that has not previously been well described in a large patient group. (Comparative Study)
Comparative Study
BACKGROUND
Aerophagia is a functional upper gastrointestinal disorder that has not previously been well described in a large patient group.
AIMS
To describe the initial evaluation of patients who presented with symptoms of aerophagia at a tertiary medical centre.
METHODS
A computerized search was used to identify all patients who were diagnosed with aerophagia at the Mayo Clinic, Rochester between 1996 and 2003 (n = 79). Individual medical charts were abstracted for information on the demographics, clinical features, co-morbid diagnoses, diagnostic workup and treatment. Information on presenting symptoms was also collected for a group of patients who were classified as having functional dyspepsia for comparison (n = 121).
RESULTS
The median duration of symptoms in patients with aerophagia was 24 months. The most common symptoms were belching (56%), abdominal pain (19%), bloating (27%) and abdominal distension (19%). Patients with functional dyspepsia had a higher prevalence of reporting nausea, vomiting, early satiety, weight loss and abdominal pain (all P < 0.01, adjusting for age, gender and body mass index). Significantly more patients with aerophagia had anxiety (19%) than those with functional dyspepsia (6%, P < 0.01).
CONCLUSIONS
Individuals with aerophagia experience prolonged upper gastrointestinal symptoms. Initial presenting symptoms appear to be distinctly different from those who have functional dyspepsia.
Topics: Abdominal Pain; Adult; Aerophagy; Anxiety; Deglutition Disorders; Dyspepsia; Female; Heartburn; Humans; Male; Middle Aged; Nausea; Satiety Response; Vomiting; Weight Loss
PubMed: 16225495
DOI: 10.1111/j.1365-2036.2005.02651.x -
Journal of Korean Medical Science Apr 2007The treatment of pathologic aerophagia has rarely been discussed in the literature. In this retrospective study, the authors investigated the effects of clonazepam on...
The treatment of pathologic aerophagia has rarely been discussed in the literature. In this retrospective study, the authors investigated the effects of clonazepam on the management of pathologic childhood aerophagia (PCA) with psychological stresses (PS), but not with mental retardation. Data from 22 consecutive PCA patients with PS (aged 2 to 10 yr), who had been followed up for over 1 yr, were reviewed. On the basis of videolaryngoscopic views, the authors observed that the pathology of aerophagia was the result of reflex-induced swallowing with paroxysmal openings of the upper esophageal sphincter due to unknown factors and also observed that these reflex-induced openings were subsided after intravenous low dose benzodiazepine administration. Hence, clonazepam was administered to treat paroxysmal openings in these PCA patients with PS. Remission positivity was defined as symptom-free for a consecutive 1 month within 6 months of treatment. The results of treatment in 22 PCA patients with PS were analyzed. A remission positive state was documented in 14.3% of PCA patients managed by reassurance, and in 66.7% of PCA patients treated with clonazepam (p=0.032). Thus, clonazepam may produce positive results in PCA with PS. Future studies by randomized and placebo-controlled trials are needed to confirm the favorable effect of clonazepam in PCA.
Topics: Aerophagy; Anticonvulsants; Child; Child, Preschool; Clonazepam; Female; Humans; Injections, Intravenous; Male; Retrospective Studies; Stress, Psychological; Treatment Outcome
PubMed: 17449924
DOI: 10.3346/jkms.2007.22.2.205 -
Anaesthesia Feb 2011Air swallowing can occur as a psychogenic phenomenon, because of abnormal anatomy, or during non-invasive positive pressure ventilation. Gross distension of the stomach...
Air swallowing can occur as a psychogenic phenomenon, because of abnormal anatomy, or during non-invasive positive pressure ventilation. Gross distension of the stomach with air can have severe consequences for the respiratory and gastrointestinal systems. We report the case of a 62-year-old man with severe dynamic hyperinflation due to chronic obstructive pulmonary disease, who developed respiratory failure requiring intubation a few hours after radical prostatectomy. Following a percutaneous tracheostomy and weaning of sedation on day six, his abdomen began to enlarge progressively. X-rays revealed massive gastric distension due to air swallowing, which continued despite all efforts to optimise therapy. The use of an underwater seal drainage system on a nasogastric tube improved ventilation and ultimately aided weaning from mechanical support.
Topics: Aerophagy; Drainage; Humans; Intubation, Gastrointestinal; Male; Middle Aged; Nasal Cavity; Postoperative Care; Prostatectomy; Pulmonary Disease, Chronic Obstructive; Ventilator Weaning; Water
PubMed: 21128904
DOI: 10.1111/j.1365-2044.2010.06565.x -
Anaesthesia 1978A case of acute gastric dilatation due to massive aerophagy in a patient who had previously had a laryngectomy is reported. Excitement during regional analgesia was...
A case of acute gastric dilatation due to massive aerophagy in a patient who had previously had a laryngectomy is reported. Excitement during regional analgesia was responsible. The pathophysiology of this mechanism is discussed and suggestions are made about its prevention.
Topics: Acute Disease; Aerophagy; Aged; Gastric Dilatation; Humans; Laryngectomy; Male; Postoperative Complications; Time Factors
PubMed: 686332
DOI: 10.1111/j.1365-2044.1978.tb08421.x -
Minerva Anestesiologica Apr 2014Gastric residual volume in ventilated critically ill may complicate gut function. Over the years studies suggested to tolerate progressively higher residuals. The... (Observational Study)
Observational Study
BACKGROUND
Gastric residual volume in ventilated critically ill may complicate gut function. Over the years studies suggested to tolerate progressively higher residuals. The relationship between such volumes and the development of ventilator-associated pneumonia (VAP) is still under debate. No reports deal with the relevant anecdotal finding of air in the stomach. Aim of the present study is to test the role of air in the development of VAPs.
METHODS
Prospective observational trial in consecutive patients with a predicted length of ICU stay >3 days. The first 8 days of stay were studied. Sedation was targeted to have awake/cooperative patients. Early enteral nutrition was attempted. Gastric content was measured every 4 hours by 60 mL-syringe suction. Upper digestive intolerance (UDI) was defined as >2 consecutive findings of liquid >200 mL, aerophagia was defined as >2 consecutive findings of air >150 mL.
RESULTS
Three hundred sixty-four patients enrolled, 43 developed VAP (11.8%). Patients were sedated with enteral (76% total time), intravenous (6%) or both (28%) drugs. Conscious sedation was achieved in 54% of the observations. 326 patients began enteral nutrition during the first 24 hours (1000 kcal median calorie intake). 10% developed UDI, 15% had aerophagia. No association was found between VAP and UDI (P=0.78), while significant association was found between VAP and aerophagia (OR=2.88, P<0.01). A sensitivity analysis, excluding patients admitted with respiratory infection, confirmed the results.
CONCLUSION
High volumes of air in the stomach significantly increased the risk of developing VAP, while gastric residual volumes were not associated with the incidence of pneumonia.
Topics: Aerophagy; Aged; Critical Illness; Enteral Nutrition; Female; Humans; Male; Middle Aged; Pneumonia, Ventilator-Associated; Prospective Studies; Risk; Stomach
PubMed: 24280810
DOI: No ID Found -
Journal of Clinical Sleep Medicine :... Jan 2013Continuous positive airway pressure (CPAP), the mainstay treatment for obstructive sleep apnea (OSA), involves administration of air under pressure to the upper airway....
STUDY OBJECTIVES
Continuous positive airway pressure (CPAP), the mainstay treatment for obstructive sleep apnea (OSA), involves administration of air under pressure to the upper airway. A well-known but poorly understood side effect of positive airway pressure therapies is aerophagia, air entering the esophagus and stomach rather than the lungs. Gastric distension, a consequence of aerophagia, can increase gastroesophageal reflux (GER) by increasing transient lower esophageal sphincter relaxations, the most common cause of reflux. This study aimed to determine: (i) the prevalence of aerophagia symptoms in a group of OSA patients on CPAP therapy, and (ii) whether aerophagia symptoms are related to an increase in prevalence of GER symptoms.
METHODS
Consecutive OSA patients undergoing polysomnography for the purpose of optimizing their CPAP therapy completed a validated questionnaire regarding GER symptoms and aerophagia symptoms. Complete datasets were collected for 259 individuals (203 males).
RESULTS
The group with aerophagia symptoms (n = 130) had a greater prevalence of frequent (≥ once a week) GER symptoms (29% vs. 10%, p < 0.05) and nighttime GER symptoms (9 vs. 2%, p < 0.05) than those without aerophagia (n = 129). The group with nighttime GER symptoms (n = 27) had a greater prevalence of aerophagia symptoms (63% vs. 23%, p < 0.05) than those without nighttime GER symptoms (n = 232).
CONCLUSIONS
In patients with OSA being treated with CPAP, the prevalence of GER and nighttime GER symptoms is greater in those with symptoms of aerophagia than those without. CPAP-induced aerophagia might precipitate GER, particularly nighttime GER, by exacerbating transient lower esophageal relaxations through gastric distension.
Topics: Aerophagy; Continuous Positive Airway Pressure; Female; Gastroesophageal Reflux; Humans; Male; Middle Aged; Polysomnography; Prevalence; Sleep Apnea, Obstructive; Surveys and Questionnaires
PubMed: 23319899
DOI: 10.5664/jcsm.2328 -
Canadian Journal of Surgery. Journal... Aug 2002
Topics: Aerophagy; Comorbidity; Fundoplication; Gastroesophageal Reflux; Humans; Postprandial Period
PubMed: 12174991
DOI: No ID Found