***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: BACKGROUND Nocturnal gastroesophageal reflux ( nGER ) is common in patients with obstructive sleep apnea ( OSA ) . Small , short-term studies have shown that treatment with nasal continuous positive airway pressure ( CPAP ) decreases esophageal acid exposure . OBJECTIVE To examine the relationship between OSA and nGER , and the effect of CPAP on nGER , in a long-term follow-up study of a large cohort of patients with OSA and nGER . METHODS We prospect ively studied 331 patients diagnosed as having OSA between October 1 , 1993 , and November 30 , 2000 . At baseline , patients grade d their frequency of nGER symptoms on a scale of 1 ( never ) to 5 ( always ) . All patients were prescribed CPAP for their OSA . At follow-up , the frequency of nGER symptoms was obtained by telephone interview . RESULTS Of the 331 patients with OSA , nGER was present in 204 ( 62 % ) before treatment with CPAP . Follow-up was obtained in 181 patients ( 89 % ) . Of these 181 patients , 165 ( 91 % ) were still using CPAP and 16 ( 9 % ) were not , forming the treatment and control groups , respectively . The patients compliant with CPAP had a significant improvement in nGER score , from a mean of 3.38 before CPAP treatment to 1.75 after treatment ( 48 % improvement ; P<.001 ) , while patients not using CPAP ( control subjects ) showed no improvement ( mean , 3.56 to 3.44 ; P = .55 ) . There was a strong correlation between CPAP pressure and improvement in nGER score ( correlation , r = 0.70 ; P<.001 ) , with patients with higher CPAP pressures demonstrating a greater improvement in nGER score . CONCLUSIONS Nocturnal GER is common in patients with OSA . Treatment with nasal CPAP decreases the frequency of nGER symptoms by 48 % . Higher nasal CPAP pressures are associated with greater improvement in nGER OBJECTIVES : Sleep disturbances are common in patients with gastroesophageal reflux disease ( GERD ) . This study examined the effects of esomeprazole on nighttime heartburn , GERD-related sleep disturbances , sleep quality , work productivity , and regular activities . METHODS : This multicenter , r and omized , double-blind , placebo-controlled trial included adults with GERD-associated sleep disturbances and moderate-to-severe nighttime heartburn ( recorded by patient diary during screening ) . Patients received oral esomeprazole 40 mg ( n = 220 ) or 20 mg ( n = 226 ) or placebo ( n = 229 ) once daily for 4 wk . The primary outcome was relief of nighttime heartburn . Secondary outcomes included resolution of sleep disturbances , sleep quality measured by the Pittsburgh Sleep Quality Index ( PSQI ) question naire , and work productivity measured by the Work Productivity and Activity Impairment Question naire . RESULTS : Nighttime heartburn was relieved in 53.1 % ( 111/209 ) , 50.5 % ( 111/220 ) , and 12.7 % ( 28/221 ) of patients who received esomeprazole 40 mg , esomeprazole 20 mg , and placebo , respectively . Differences ( 95 % CI ) versus placebo were 40.5 % ( 32.4 % , 48.5 % ) and 37.8 % ( 29.9 % , 45.7 % ) and were highly significant ( p < 0.0001 ) . GERD-related sleep disturbances resolved in significantly more ( p < 0.0001 ) patients who received esomeprazole 40 ( 73.7 % ) or 20 mg ( 73.2 % ) than in those who received placebo ( 41.2 % ) . Both esomeprazole groups had greater PSQI global score changes from baseline ( p < 0.0001 vs placebo ) and more ( p < 0.0001 vs placebo ) work hours saved per week per patient compared with baseline ( esomeprazole 40 mg , 11.6 h ; esomeprazole 20 mg , 12.3 h ; placebo , 6.2 h ) . CONCLUSIONS : Esomeprazole reduced nighttime heartburn and GERD-related sleep disturbances and improved sleep quality and work productivity Nocturnal gastro-oesophageal reflux has been observed in patients with obstructive sleep apnoea ( OSA ) . Negative intrathoracic pressure during apnoeas and arousal have been suggested as the underlying mechanisms . In order to evaluate this hypothesis , the coincidence and sequence in time of arousal , apnoea and reflux events were analysed . Fifteen patients with OSA or heavy snoring were studied by means of st and ard polysomnograpy with parallel recording of 24-h oesophageal pH.  Reflux events during the day were present in all patients , five of whom had symptoms of reflux . In three of these and in five other patients , a total of 69 nocturnal reflux events were found . In 68 events , arousal was found with the reflux event . Only one reflux without arousal was found ( sleep stage 2 ) . Seventeen events occurred during wakefulness after sleep onset . The percentage of time with a pH of < 4 during wakefulness after sleep onset was significantly higher than the percentage of time with a pH of < 4 during total sleep time ( p<0.05 ) . In 37 of the 52 reflux events which occurred during sleep , either an apnoea or a hypopnoea was found prior to the event . The investigation of sequence in time did not prove a causal relation between respiratory events and reflux events . The results indicate that gastro-oesophageal reflux and obstructive sleep apnoea are two separate disorders , which both have a high prevalence in obese patients STUDY OBJECTIVE To estimate the possible association between reported symptoms of  gastroesophageal reflux ( GER )  after bedtime , sleep-disordered breathing , respiratory symptoms , and asthma . DESIGN Cross-sectional international population survey . PARTICIPANTS Participants consisted of 2,661 subjects ( age range , 20 to 48 years ) from three countries ( Icel and , Belgium , and Sweden ) , of whom 2,202 were r and omly selected from the general population and 459 were added because of reported asthma . MEASUREMENTS The investigation included a  structured interview , spirometry , methacholine challenge , peak flow diary , skin-prick tests , and a question naire on sleep disturbances .  RESULTS In the r and om population sample , 101 subjects ( 4.6 % ) reported GER , which was defined as the occurrence of heartburn or belching after going to bed at least once per week . Subjects with nocturnal GER more often were overweight and had symptoms of sleep-disordered breathing than participants not reporting GER . Participants with GER were more likely to report wheezing ( adjusted odds ratio [ OR ] , 2.5 ) , breathlessness at rest ( adjusted OR , 2.8 ) , and nocturnal breathlessness ( adjusted OR , 2.9 ) , and they had increased peak flow variability compared to the subjects without GER . Physician-diagnosed current asthma was reported by 9 % of subjects with GER compared to 4 % of those not reporting GER ( p < 0.05 ) . Subjects with the combination of asthma and GER had a higher prevalence of nocturnal cough , morning phlegm , sleep-related symptoms , and higher peak flow variability than subjects with asthma alone . CONCLUSION The occurrence of GER after bedtime is strongly associated with both asthma and respiratory symptoms , as well as symptoms of obstructive sleep apnea syndrome . The partial narrowing or occlusion of the upper airway during sleep , followed by an increase in intrathoracic pressure , might predispose the patient to nocturnal GER and , consequently , to respiratory symptoms OBJECTIVE : To determine the efficacy of pantoprazole therapy for daytime somnolence , psychomotor vigilance , and quality of life in patients with mild-moderate obstructive sleep disordered breathing ( OSDB ) and gastroesophageal reflux disease ( GERD ) . STUDY DESIGN : R and omized , double-blind , placebo-controlled crossover trial . METHODS : Sixty patients with daytime sleepiness , mildmoderate OSDB and GERD were r and omly assigned a 2-week treatment with pantoprazole 40 mg or placebo followed by a 2-week washout period and crossover respectively to 2-week treatment with placebo or pantoprazole . Outcomes included Epworth Sleepiness Score ( ESS ) , sleep-related quality -of-life ( FOSQ ) , and reaction time . RESULTS : With pantoprazole , patients reported statistically significantly greater improvement of overall reflux symptoms ( P = 0.0003 ) and in ESS ( P = 0.04 ) . A significant improvement was noted in FOSQ for both treatments with a trend toward greater improvement with pantoprazole ( P = 0.058 ) . No improvement in reaction times was observed . CONCLUSION : Patients with coexistent GERD and OSDB noted significant improvement in daytime sleepiness after treatment with pantoprazole over placebo likely related to a reduction in nocturnal reflux-related arousals OBJECTIVES To study the geographical variation in daytime sleepiness , snoring and disrupted breathing during sleep and to identify and compare risk factors using the same method in four European cities . DESIGN A cross-sectional , multicentre epidemiological survey . SETTING Reykjavik in Icel and , Uppsala and Göteborg in Sweden and Antwerp in Belgium . PARTICIPANTS A r and om population sample of 2202 subjects who participated in the European Community Respiratory Health Survey . MAIN OUTCOME MEASURES Sleep disturbances and daytime symptoms . RESULTS At all the centres , 5 % of the men and 2 - 3 % of the women reported snoring every night . Daytime sleepiness ( DS ) was more often reported in Uppsala [ odds ratio ( OR ) and 95 % confidence interval : 1.6 ( 1.2 - 2.1 ) ] than in the other centres , whilst daytime tiredness ( DT ) was most common in Reykjavik [ OR 1.8 ( 1.4 - 2.1 ) ] . Snoring was positively correlated with age , male gender and body-mass index in all areas . Symptoms of gastro-oesophageal reflux were associated with DS : OR 2.6 ( 1.5 4.4 ) and DT : OR 4.5 ( 2.7 - 7.6 ) and disrupted breathing : OR 3.8 ( 1.4 - 10 ) . DS and DT were reported more often by women than by men . CONCLUSION The prevalence of snoring was about the same in all four areas , whilst there was a geographical variation in daytime sleepiness and tiredness . As complaints of DS and DT and disrupted breathing were more common in subjects who reported symptoms of gastro-oesophageal reflux , we suggest that polysomnographic studies comparing sleep patterns in adult patients with and without reflux should be conducted OBJECTIVES : Nocturnal heartburn and related sleep disturbances are common among patients with gastroesophageal reflux disease ( GERD ) . This study evaluated the efficacy of dexlansoprazole MR 30 mg in relieving nocturnal heartburn and GERD-related sleep disturbances , improving work productivity , and decreasing nocturnal symptom severity in patients with symptomatic GERD . METHODS : Patients ( N=305 ) with frequent , moderate-to-very severe nocturnal heartburn and associated sleep disturbances were r and omized 1:1 in a double-blind fashion to receive dexlansoprazole MR or placebo once daily for 4 weeks . The primary end point was the percentage of nights without heartburn . Secondary end points were the percentage of patients with relief of nocturnal heartburn and of GERD-related sleep disturbances over the last 7 days of treatment . At baseline and week 4/final visit , patients completed question naires that assessed sleep quality , work productivity , and the severity and impact of nocturnal GERD symptoms . RESULTS : Dexlansoprazole MR 30 mg ( n=152 ) was superior to placebo ( n=153 ) in median percentage of nights without heartburn ( 73.1 vs. 35.7 % , respectively ; P<0.001 ) . Dexlansoprazole MR was significantly better than placebo in percentage of patients with relief of nocturnal heartburn and GERD-related sleep disturbances ( 47.5 vs. 19.6 % , 69.7 vs. 47.9 % , respectively ; P<0.001 ) , and led to significantly greater improvements in sleep quality and work productivity and decreased nocturnal symptom severity . Adverse events were similar across treatment groups . CONCLUSIONS : In patients with symptomatic GERD , dexlansoprazole MR 30 mg is significantly more efficacious than placebo in providing relief from nocturnal heartburn , in reducing GERD-related sleep disturbances and the consequent impairments in work productivity , and in improving sleep quality / quality of life BACKGROUND During sleep , individuals are uniquely vulnerable to acid reflux . Acid reflux during sleep has been studied by a number of investigators , but non-acid refl 
    Output:
    
The existing evidence supports the use of proton pump inhibitors as a treatment for esophageal reflux disease to improve quality -of-life sleep disturbance – related outcomes .