Gastroesophageal Reflux During Sleep

Asthma and Sleep

Asthma significantly affects quality of sleep. Asthma physiology follows a diurnal pattern with peak flow at its lowest during early morning hours. The type and timing of release of inflammatory mediators also varies during the day and nighttime. Nocturnal symptoms are common in poorly controlled asthma. Hence, these nighttime symptoms play a significant role in the assessment of asthmatic patients as demonstrated in validated asthma control and quality of life questionnaires. Comorbid conditions may include allergic rhinitis, obesity, obstructive sleep apnea, and gastroesophageal reflux, all of which may worsen asthma symptoms, especially during sleep. In addition, exposure to greater loads of allergens in susceptible individuals during sleep is a significant problem and must be addressed to break the cycle of poor asthma control. Thus, asthma education for better symptom control should address these particular issues surrounding sleep.

Sleep in hospitalized medical patients, part 1: factors affecting sleep

BACKGROUND

Multiple factors lead to sleep disturbances in hospitalized medical patients. Inadequate sleep can lead to both psychological and physiological consequences.

METHODS

A PubMed search was conducted using the terms: ("sleep deprivation," "sleep," or "insomnia") and ("hospitalized," "inpatient," "critical illness," or "acute illness") to review the published data on the topic of sleep in hospitalized medical patients. The search was limited to English-language articles published between 1997 and 2008. Subsequent PubMed searches were performed to clarify the data described in the initial search, including the terms "hospital noise," "hospital environment," "obstructive sleep apnea," and "heart failure."

RESULTS

Few articles specifically addressed the topic of sleep in hospitalized medical patients. Data were limited to observational studies that included outcomes such as sleep complaints and staff logs of wakefulness and sleep. In Part 1, we review normal sleep architecture, and discuss how major medical disorders, the hospital environment, and medications can disrupt sleep during hospitalization. In Part 2, we will propose an evaluation and treatment algorithm to optimize sleep in hospitalized medical patients.

CONCLUSIONS

Hospitalization may severely disrupt sleep, which can worsen pain, cardiorespiratory status, and the psychiatric health of acutely ill patients. Like vital signs, the patient sleep quality reveals much about patients' overall well-being, and should be a routine part of medical evaluation.