Results from a study published in the American Journal of Gastroenterology suggest that a left lateral sleeping position may minimize nocturnal acid reflux. In a cohort study of patients referred for reflux monitoring during the night, the left lateral position was associated with faster esophageal acid clearance and shorter acid exposure time compared with the right lateral and supine positions.

This prospective cohort study enrolled adult patients with indications for ambulatory pH-impedance reflux monitoring. Patients were fitted with a pH monitoring catheter; those with an esophageal acid exposure ≥0.5% or higher while in a supine position were included in analyses. Concurrent sleep positions were measured using a 3-axis accelerometer affixed to patients’ sternums using adhesive. The effect of sleep positions on acid exposure time, acid clearance time, and number of reflux episodes was assessed.

The study cohort consisted of 57 patients of mean age 48.9 years, among whom 26 (45.6%) were men. The most common sleep position was the left lateral decubitus position, comprising a median of 30.6% of sleep time. The next most common positions by median time were the right lateral decubitus (27. 3%) and supine (26.0%). Very little sleep time was spent in the prone (0.4%) and upright (1.0%) positions. Analyses thus only accounted for the 3 major sleep positions.


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Overall, median esophageal acid clearance rate was significantly shorter with the left lateral sleep position (median, 35 seconds; IQR, 16-115 seconds) compared with the right lateral (median, 90 seconds; IQR, 26-250 seconds; P =.002) and supine (median, 76 seconds; IQR, 22-257 seconds; P =.030) positions.

Acid exposure time was also lowest with the left lateral position, with a median of 0.0% (IQR, 0.0-3.0%) of sleep time spent with pH <4, compared with values of 1.2% (IQR, 0.0-7.5%) and 0.6% (IQR, 0.0-8.3%) for the right lateral and supine positions, respectively (both P =.022). The number of reflux episodes did not differ among sleeping positions. However, liquid reflux occurred more frequently in the supine and right decubitus positions compared with the left decubitus position (P =.018 for trend).

Investigators note that most study participants had likely already received other treatment for their reflux symptoms.

Results from this study suggest that sleeping in the left lateral decubitus position may reduce esophageal acid exposure during the night. The likely cause of this association is the positioning of the esophagus relative to the stomach while on the left side.

“These findings provide a rationale for interventions aiming to promote the left lateral decubitus sleep position to alleviate nocturnal esophageal acid exposure and reflux symptoms,” investigators wrote.

Disclosure: One study author declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of authors’ disclosures. 

Reference

Schuitenmaker JM, van Dijk M, Oude Nijhuis RAB, Smout AJPM, Bredenoord AJ. Associations between sleep position and nocturnal gastroesophageal reflux: a study using concurrent monitoring of sleep position and esophageal pH and impedance. Am J Gastroenterol. 2022;117(2):346-351. doi: 10.14309/ajg.0000000000001588