GOR(D) and Apnoea

  • Silvia SalvatoreEmail author
  • Yvan Vandenplas


Several mechanisms can contribute to respiratory manifestations in patients with gastro-oesophageal reflux (GOR), but pathological and causal relationship is uncommon. In most infants apnoea of short duration is a physiologic phenomenon occurring frequently in relation to an episode of GOR and a protective mechanism to prevent aspiration. Diagnostic gold standard, cut-off values and follow-up data are currently lacking making the relation between GOR or GOR disease and respiratory system difficult to clarify. When compared with pH monitoring, oesophageal impedance with simultaneous polysomnography can better demonstrate the temporal association in selected patients but should be reserved to severe or recurrent otherwise unexplained respiratory events. Empirical treatment for GOR is not recommended due to lack of evidence of efficacy and possible pharmacologically related adverse events.


Reflux GOR GOR(D) Regurgitation Apnoea ALTE Infants Children 


  1. 1.
    Vandenplas Y, Rudolph CD, Di Lorenzo C, North American Society for Pediatric Gastroenterology Hepatology and Nutrition, European Society for Pediatric Gastroenterology Hepatology and Nutrition, et al. Pediatric gastroesophageal reflux clinical practice guidelines: joint recommendations of the North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition (NASPGHAN) and the European Society for Pediatric Gastroenterology, Hepatology, and Nutrition (ESPGHAN). J Pediatr Gastroenterol Nutr. 2009;49(4):498–597.CrossRefPubMedCentralPubMedGoogle Scholar
  2. 2.
    Zimbric G, Bonkowsky JL, Maloney CG, Srivastava R. Adverse outcomes associated with gastroesophageal reflux disease are rare following an apparent life-threatening event. J Hosp Med. 2012;7:476–81.CrossRefPubMedCentralPubMedGoogle Scholar
  3. 3.
    Sacre L, Vandenplas Y. Gastroesophageal reflux associated with respiratory abnormalities during sleep. J Pediatr Gastroenterol Nutr. 1989;9:28–33.CrossRefPubMedGoogle Scholar
  4. 4.
    Wenzl TG, Schneider S, Scheele F, et al. Effects of thickened feeding on GER in infants: a placebo-controlled crossover study using intraluminal impedance. Pediatrics. 2003;114:e355–9.CrossRefGoogle Scholar
  5. 5.
    Tolia V, Vandenplas Y. Systematic review: the extra-oesophageal symptoms of gastro-oesophageal reflux disease in children. Aliment Pharmacol Ther. 2009;29(3):258–72.CrossRefPubMedCentralPubMedGoogle Scholar
  6. 6.
    Kahn A, Rebuffat E, Sottiaux M, et al. Prevention of airway obstructions during sleep in infants with breath-holding spells by means of oral belladonna: a prospective double-blind crossover evaluation. Sleep. 1991;14(5):432–8.Google Scholar
  7. 7.
    Vandenplas Y, Hauser B. Gastro-oesophageal reflux, sleep pattern, apparent life threatening event and sudden infant death. The point of view of a gastroenterologist. Eur J Pediatr. 2000;159:726–9.CrossRefPubMedGoogle Scholar
  8. 8.
    Lang IM, Medda BK, Shaker R. Mechanisms of reflexes induced by esophageal distension. Am J Phys. 2001;281:G1246–63.Google Scholar
  9. 9.
    Cuomo R, De Giorgi F, Adinolfi L, et al. Oesophageal acid exposure and altered neurocardiac function in patients with GERD and idiopathic cardiac dysrhythmias. Aliment Pharmacol Ther. 2006;24:361–70.CrossRefPubMedGoogle Scholar
  10. 10.
    Dobrek L, Nowakowski M, Mazur M, et al. Disturbances of the parasympathetic branch of the autonomic nervous system in patients with gastroesophageal reflux disease (GERD) estimated by short-term heart rate variability recordings. J Physiol Pharmacol. 2004;55(S2):77–90.PubMedGoogle Scholar
  11. 11.
    Milovanovic B, Filipovic B, Mutavdzin S, et al. Cardiac autonomic dysfunction in patients with gastroesophageal reflux disease. World J Gastroenterol. 2015;21:6982–9.CrossRefPubMedCentralPubMedGoogle Scholar
  12. 12.
    Huang W-J, Shu C-H, Chou K-T, et al. Evaluating the autonomic nervous system in patients with laryngopharyngeal reflux. Otolaryngol—Head Neck Surg. 2013;148:997–1002.CrossRefPubMedCentralPubMedGoogle Scholar
  13. 13.
    Djeddi D-D, Kongolo G, Stéphan-Blanchard E, et al. Involvement of autonomic nervous activity changes in gastroesophageal reflux in neonates during sleep and wakefulness. PLoS One. 2013;8:e83464.CrossRefPubMedCentralPubMedGoogle Scholar
  14. 14.
    Heatley RV, Collins RJ, James PD, Atkinson M. Vagal function in relation to gastro oesophageal reflux and associated motility changes. Br Med J. 1980;280:755–7.CrossRefPubMedCentralPubMedGoogle Scholar
  15. 15.
    Sharma A, Paine P, Rhodes S, et al. The autonomic response to human esophageal acidification and the development of hyperalgesia. Neurogastroenterol Motil. 2012;24:e285–93.CrossRefPubMedCentralPubMedGoogle Scholar
  16. 16.
    Tougas G, Spaziani R, Hollerbach S, et al. Cardiac autonomic function and oesophageal acid sensitivity in patients with non-cardiac chest pain. Gut. 2001;49:706–12.CrossRefPubMedCentralPubMedGoogle Scholar
  17. 17.
    Ariagno RL. Evaluation and management of infantile apnea. Pediatr Ann. 1984;13:210–3. 216–217PubMedPubMedCentralGoogle Scholar
  18. 18.
    Kahn A, Rebuffat E, Sottiaux M, et al. Lack of temporal relation between acid reflux in the proximal oesophagus and cardiorespiratory events in sleeping infants. Eur J Pediatr. 1992;151(3):208–12.CrossRefPubMedCentralPubMedGoogle Scholar
  19. 19.
    Newman LJ, Russe J, Glassman MS, et al. Patterns of gastroesophageal reflux (GER) in patients with apparent life-threatening events. J Pediatr Gastroenterol Nutr. 1989;8:157–60.CrossRefPubMedCentralPubMedGoogle Scholar
  20. 20.
    Paton JY, Nanayakkara CS, Simpson H. Observations on gastroesophageal reflux, central apnoea and heart rate in infants. Eur J Pediatr. 1990;149:608–12.CrossRefPubMedCentralPubMedGoogle Scholar
  21. 21.
    Paton JY, Macfadyen U, Williams A, et al. Gastro-oesophageal reflux and apnoeic pauses during sleep in infancy – no direct relation. Eur J Pediatr. 1990;149:680–6.CrossRefPubMedCentralPubMedGoogle Scholar
  22. 22.
    Veereman-Wauters G, Bochner A, Van Caillie-Bertrand M. Gastroesophageal reflux in infants with a history of near-miss sudden infant death. J Pediatr Gastroenterol Nutr. 1991;12:319–23.CrossRefPubMedCentralPubMedGoogle Scholar
  23. 23.
    Walsh JK, Farrell MK, Keenan WJ, et al. Gastroesophageal reflux in infants: relation to apnea. J Pediatr. 1981;99:197–201.CrossRefPubMedCentralPubMedGoogle Scholar
  24. 24.
    Machado R, Woodley FW, Skaggs B, et al. Gastroesophageal reflux causing sleep interruptions in infants. J Pediatr Gastroenterol Nutr. 2013;56:431–5.CrossRefPubMedGoogle Scholar
  25. 25.
    Cresi F, Castagno E, Storm H, et al. Combined esophageal intraluminal impedance, pH and skin conductance monitoring to detect discomfort in GERD infants. PLoS One. 2012;7:e43476.CrossRefPubMedCentralPubMedGoogle Scholar
  26. 26.
    Abu Jawdeh EG, Martin RJ. Neonatal apnea and gastroesophageal reflux (GER): is there a problem? Early Hum Dev. 2013;89(Suppl 1):S14–6.CrossRefPubMedCentralPubMedGoogle Scholar
  27. 27.
    Shepherd K, Hillman D, Holloway R, Eastwood P. Mechanisms of nocturnal gastroesophageal reflux events in obstructive sleep apnea. Sleep Breath. 2011;15(3):561–70.CrossRefPubMedCentralPubMedGoogle Scholar
  28. 28.
    Green BT, Broughton WA, O’Connor B. Marked improvement in nocturnal gastroesophageal reflux in a large cohort of patients with obstructive sleep apnea treated with continuous positive airway pressure. Arch Intern Med. 2003;163:41–5.CrossRefPubMedCentralPubMedGoogle Scholar
  29. 29.
    Shepherd KL, Holloway RH, Hillman DR, Eastwood PR. The impact of continuous positive airway pressure on the lower esophageal sphincter. Am J Physiol Gastrointest Liver Physiol. 2007;292(5):G1200–5.CrossRefPubMedCentralPubMedGoogle Scholar
  30. 30.
    Ing AJ, Ngu MC, Breslin AB. Obstructive sleep apnea and gastroesophageal reflux. Am J Med. 2000;108(Suppl. 4A):120S–5S.CrossRefPubMedCentralPubMedGoogle Scholar
  31. 31.
    Ozturk O, Ozturk L, Ozdogan A, et al. Variables affecting the occurrence of gastroesophageal reflux in obstructive sleep apnea patients. Eur Arch Otorhinolaryngol. 2004;261(4):229–32.CrossRefPubMedGoogle Scholar
  32. 32.
    Penzel T, Becker HF, Brandenburg U, et al. Arousal in patients with gastro-oesophageal reflux and sleep apnoea. Eur Respir J. 1999;14:1266–70.CrossRefPubMedGoogle Scholar
  33. 33.
    Urata M, Fukuno H, Nomura M, et al. Gastric motility and autonomic activity during obstructive sleep apnea. Aliment Pharmacol Ther. 2006;24(S 4):132–40.Google Scholar
  34. 34.
    Jadcherla SR, Gupta A, Fernandez S, et al. Spatiotemporal characteristics of acid refluxate and relationship to symptoms in premature and term infants with chronic lung disease. Am J Gastroenterol. 2008;103:720–8.CrossRefPubMedCentralPubMedGoogle Scholar
  35. 35.
    Rosen R, Nurko S. The importance of multichannel intraluminal impedance in the evaluation of children with persistent respiratory symptoms. Am J Gastroenterol. 2004;99:2452–8.CrossRefPubMedCentralPubMedGoogle Scholar
  36. 36.
    Condino AA, Sondheimer JM, Pan Z, et al. Evaluation in infantile acid and non-acid gastroesophageal reflux utilizing combined pH monitoring and impedance measurement. J Pediatr Gastroenterol Nutr. 2006;42:16–21.CrossRefPubMedGoogle Scholar
  37. 37.
    Condino AA, Sondheimer J, Pan Z, et al. Evaluation of GER in pediatric patients with asthma using impedance-pH monitoring. J Pediatr. 2006;149:216–9.CrossRefPubMedCentralPubMedGoogle Scholar
  38. 38.
    Salvatore S, Arrigo S, Luini C, Vandenplas Y. Esophageal impedance in children: symptom-based results. J Pediatr. 2010;157:949–54.e1-2.CrossRefPubMedGoogle Scholar
  39. 39.
    Lopez-Alonso M, Moya MJ, Cabo JA, et al. 24-hour esophageal impedance-pH monitoring in healthy preterm neonates: rate and characteristics of acid, weakly acidic, and weakly alkaline gastro-esophageal reflux. Pediatrics. 2006;118:e299–308.CrossRefPubMedCentralPubMedGoogle Scholar
  40. 40.
    Hasenstab KA, Jadcherla SR. Respiratory events in infants presenting with apparent life threatening events: is there an explanation from esophageal motility? J Pediatr. 2014;165:250–5.CrossRefPubMedCentralPubMedGoogle Scholar
  41. 41.
    Tolia V, Wuerth A, Thomas R. Gastroesophageal reflux disease: review of presenting symptoms, evaluation, management, and outcome in infants. Dig Dis Sci. 2003;48(9):1723–9.CrossRefPubMedCentralPubMedGoogle Scholar
  42. 42.
    Barrington KJ, Tan K, Rich W. Apnea at discharge and gastro-esophageal reflux in the preterm infant. J Perinatol. 2002;22(1):8–11.Google Scholar
  43. 43.
    Spitzer AR, Boyle JT, Tuchman DN, et al. Awake apnea associated with gastroesophageal reflux: a specific clinical syndrome. J Pediatr. 1984;104:200–5.CrossRefPubMedCentralPubMedGoogle Scholar
  44. 44.
    Tieder JS, Cowan CA, Garrison MM, Christakis DA. Variation in inpatient resource utilization and management of apparent life-threatening events. J Pediatr. 2008;152(5):629–35.CrossRefPubMedCentralPubMedGoogle Scholar
  45. 45.
    Okada K, Miyako M, Honma S, et al. Discharge diagnoses in infants with apparent life-threatening event. Pediatr Int. 2003;45(5):560–3.Google Scholar
  46. 46.
    Rosen CL, Frost JD Jr, Harrison GM. Infant apnea: polygraphic studies and follow-up monitoring. Pediatrics. 1983;71:731–6.PubMedPubMedCentralGoogle Scholar
  47. 47.
    Tirosh E, Kessel A, Jaffe M, et al. Outcome of idiopathic apparent life-threatening events: infant and mother perspectives. Pediatr Pulmonol. 1999;28:47–52.CrossRefPubMedGoogle Scholar
  48. 48.
    Herbst JJ, Book LS, Bray PF. Gastroesophageal reflux in the “near miss” sudden infant death syndrome. J Pediatr. 1978;92:73–5.CrossRefPubMedGoogle Scholar
  49. 49.
    Herbst JJ, Minton SD, Book LS. Gastroesophageal reflux causing respiratory distress and apnea in newborn infants. J Pediatr. 1979;95:763–8.CrossRefPubMedGoogle Scholar
  50. 50.
    Leape LL, Holder TM, Franklin JD, et al. Respiratory arrest in infants secondary to gastroesophageal reflux. Pediatrics. 1977;60:924–8.PubMedGoogle Scholar
  51. 51.
    Friesen CA, Streed CJ, Carney LA, et al. Esophagitis and modified Bernstein tests in infants with apparent life-threatening events. Pediatrics. 1994;94:541–4.PubMedGoogle Scholar
  52. 52.
    Gorrotxategi P, Eizaguirre I, Saenz de Ugarte A, et al. Characteristics of continuous esophageal pH-metering in infants with gastroesophageal reflux and apparent life-threatening events. Eur J Pediatr Surg. 1995;5(3):136–8.CrossRefPubMedGoogle Scholar
  53. 53.
    Kahn A, Rebuffat E, Sottiaux M, et al. Sleep apneas and acid esophageal reflux in control infants and in infants with an apparent life-threatening event. Biol Neonate. 1990;57(3–4):144–9.CrossRefPubMedCentralPubMedGoogle Scholar
  54. 54.
    Arad-Cohen N, Cohen A, Tirosh E. The relationship between gastroesophageal reflux and apnea in infants. J Pediatr. 2000;137:321–6.CrossRefPubMedCentralPubMedGoogle Scholar
  55. 55.
    Doshi A, Bernard-Stover L, Kuelbs C, et al. Apparent life-threatening event admissions and gastroesophageal reflux disease: the value of hospitalization. Pediatr Emerg Care. 2012;28(1):17–21.CrossRefPubMedCentralPubMedGoogle Scholar
  56. 56.
    Mousa H, Woodley FW, Metheney M, Hayes J. Testing the association between gastroesophageal reflux and apnea in infants. J Pediatr Gastroenterol Nutr. 2005;41:169–77.CrossRefPubMedCentralPubMedGoogle Scholar
  57. 57.
    Blasco-Alonso J, Yun-Castilla C, Girón-Fernández-Crehuet F, et al. Esophageal multichannel intraluminal impedance and pH testing in the study of apparent life threatening episode incidents in infants. Rev Esp Enferm Dig. 2014;106:159–64.PubMedPubMedCentralGoogle Scholar
  58. 58.
    Jolley SG, Halpern LM, Tunell WP, et al. The risk of sudden infant death from gastroesophageal reflux. J Pediatr Surg. 1991;26(6):691.CrossRefPubMedCentralPubMedGoogle Scholar
  59. 59.
    Tieder JS, Altman RL, Bonkowsky JL, et al. Management of apparent life-threatening events in infants: a systematic review. J Pediatr. 2013;163(1):94–9.CrossRefPubMedCentralPubMedGoogle Scholar
  60. 60.
    Tieder JS, Bonkowsky JL, Etzel RA, Subcommittee on apparent life threatening events, et al. Brief resolved unexplained events (formerly apparent life-threatening events) and evaluation of lower-risk infants. Pediatrics. 2016;137(5):e20160590.CrossRefPubMedCentralPubMedGoogle Scholar
  61. 61.
    Menon AP, Schefft GL, Thach BT. Apnea associated with regurgitation in infants. J Pediatr. 1985;106:625–9.CrossRefPubMedCentralPubMedGoogle Scholar
  62. 62.
    de Ajuriaguerra M, Radvanyi-Bouvet MF, Huon C, Moriette G. Gastroesophageal reflux and apnea in prematurely born infants during wakefulness and sleep. Am J Dis Child. 1991;145:1132–6.PubMedPubMedCentralGoogle Scholar
  63. 63.
    Di Fiore JM, Arko M, Hitehouse M, et al. Apnea is not prolonged by acid gastroesophageal reflux in preterm infants. Pediatrics. 2005;116:1059–63.CrossRefPubMedCentralPubMedGoogle Scholar
  64. 64.
    Misra S, Macwan K, Albert V. Transpyloric feeding in gastroesophageal-reflux-associated apnea in premature infants. Acta Paediatr. 2007;96:1426–9.CrossRefPubMedCentralPubMedGoogle Scholar
  65. 65.
    Wenzl TG, Silny J, Schenke S, et al. Gastro-esophageal reflux and respiratory phenomena in children: status of the intraluminal impedance technique. J Pediatr Gastroenterol Nutr. 1999;28:423–8.CrossRefPubMedGoogle Scholar
  66. 66.
    Corvaglia L, Zama D, Gualdi S, et al. Gastro-oesophageal reflux increases the number of apnoeas in very preterm infants. Arch Dis Child Fetal Neonatal Ed. 2009;94:F188–92.CrossRefPubMedCentralPubMedGoogle Scholar
  67. 67.
    Magistà A, Indio F, Baldassarre M, et al. Multichannel intraluminal impedance to detect relationship between gastroesophageal reflux and apnoea of prematurity. Dig Liver Dis. 2007;39:216–21.CrossRefPubMedCentralPubMedGoogle Scholar
  68. 68.
    Peter CS, Sprodowski N, Bohnhorst B, et al. Gastroesophageal reflux and apnea of prematurity: no temporal relationship. Pediatrics. 2002;109:8–11.CrossRefPubMedCentralPubMedGoogle Scholar
  69. 69.
    Poets CF. Gastroesophageal reflux: a critical review of its role in preterm infants. Pediatrics. 2004;113:e128–32.CrossRefPubMedCentralPubMedGoogle Scholar
  70. 70.
    Corvaglia L, Zama D, Spizzichino M, et al. The frequency of apneas in very preterm infants is increased after non-acid gastro-esophageal reflux. Neurogastroenterol Motil. 2011;23:303–7.CrossRefPubMedGoogle Scholar
  71. 71.
    van Wijk MP, Benninga MA, Dent J, et al. Effect of body position changes on postprandial gastroesophageal reflux and gastric emptying in the healthy premature neonate. J Pediatr. 2007;151:585–90.CrossRefPubMedCentralPubMedGoogle Scholar
  72. 72.
    Corvaglia L, Rotatori R, Ferlini M, et al. The effect of body positioning on gastroesophageal reflux in premature infants: evaluation by combined impedance and pH monitoring. J Pediatr. 2007;151:591–6.CrossRefPubMedGoogle Scholar
  73. 73.
    van Wijk MP, Benninga MA, Davidson GP, et al. Small volumes of feed can trigger transient lower esophageal sphincter relaxation and gastroesophageal reflux in the right lateral position in infants. J Pediatr. 2010;156:744–8.CrossRefPubMedCentralPubMedGoogle Scholar
  74. 74.
    Cresi F, Marinaccio C, Russo MC, et al. Short-term effect of domperidone on gastroesophageal reflux in newborns assessed by combined intraluminal impedance and pH monitoring. J Perinatol. 2008;28:766–70.CrossRefPubMedGoogle Scholar
  75. 75.
    National Institute of Health and Care Excellence (NICE) Clinical Knowledge Summaries on Gastroesophageal reflux disease in children available on
  76. 76.
    Smits MJ, Van Wijk MP, Langendam MW, et al. Association between gastroesophageal reflux and pathologic apneas in infants: a systematic review. Neurogastroenterol Motil. 2014;26:1527–38.CrossRefPubMedGoogle Scholar
  77. 77.
    Di Fiore J, Arko M, Herynk B, et al. Characterization of cardiorespiratory events following gastroesophageal reflux in preterm infants. J Perinatol. 2010;30:683–7.CrossRefPubMedCentralPubMedGoogle Scholar
  78. 78.
    Rosen CL, Storfer-Isser A, Taylor HG, et al. Increased behavioral morbidity in school-aged children with sleep-disordered breathing. Pediatrics. 2004;114:1640–8.CrossRefPubMedGoogle Scholar
  79. 79.
    Sifrim D, Dupont I, Blondeau K, et al. Weakly acidic reflux in patients with chronic unexplained cough during 24 hour pressure, pH, and impedance monitoring. Gut. 2005;54:449–54.CrossRefPubMedCentralPubMedGoogle Scholar
  80. 80.
    Blondeau K, Mertens V, Dupont L, et al. The relationship between gastroesophageal reflux and cough in children with chronic unexplained cough using combined impedance-pH-manometry recordings. Pediatr Pulmonol. 2011;46(3):286–94.CrossRefPubMedCentralPubMedGoogle Scholar
  81. 81.
    Greenstone M, Hack M. Ostructive sleep apnoea. BMJ. 2014;348:g3745.CrossRefPubMedGoogle Scholar
  82. 82.
    Ali NJ, Pitson D, Stradling JR. Natural history of snoring and related behaviour problems between the ages of 4 and 7 years. Arch Dis Child. 1994;71(1):74–6.CrossRefPubMedCentralPubMedGoogle Scholar
  83. 83.
    Section on Pediatric Pulmonology, Subcommittee on Obstructive Sleep Apnea Syndrome. American Academy of Pediatrics. Clinical practice guideline: diagnosis and management of childhood obstructive sleep apnea syndrome. Pediatrics. 2002;109:704–12.CrossRefGoogle Scholar
  84. 84.
    Bhattacharjee R, Kheirandish-Gozal L, Spruyt K, et al. Adenotonsillectomy outcomes in treatment of obstructive sleep apnea in children: a multicenter retrospective study. Am J Respir Crit Care Med. 2010;182:676–83.CrossRefPubMedCentralPubMedGoogle Scholar
  85. 85.
    Katz ES, D’Ambrosio CM. Pathophysiology of pediatric obstructive sleep apnea. Proc Am Thorac Soc. 2008;5:253–62.CrossRefPubMedCentralPubMedGoogle Scholar
  86. 86.
    Larkin EK, Patel SR, Goodloe RJ, et al. A candidate gene study of obstructive sleep apnea in European Americans and African Americans. Am J Respir Crit Care Med. 2010;182:947–53.CrossRefPubMedCentralPubMedGoogle Scholar
  87. 87.
    Marcus CL. Pathophysiology of childhood obstructive sleep apnea: current concepts. Respir Physiol. 2000;119:2–3.CrossRefGoogle Scholar
  88. 88.
    Berg S, Hoffstein V, Gislason T. Acidification of distal esophagus and sleep related breathing disturbances. Chest. 2004;125:2101–6.CrossRefPubMedCentralPubMedGoogle Scholar
  89. 89.
    Carr MM, Poje CP, Ehrig D, Brodsky LS. Incidence of reflux in young children undergoing adenoidectomy. Laryngoscope. 2001;111:2170–2.CrossRefPubMedCentralPubMedGoogle Scholar
  90. 90.
    Friedman M, Gurpinar B, Lin HC, et al. Impact of treatment of gastroesophageal reflux on obstructive sleep apnea–hypopnea syndrome. Ann Otol Rhinol Laryngol. 2007;116:805–11.CrossRefPubMedCentralPubMedGoogle Scholar
  91. 91.
    Noronha AC, de Bruin AC, Nobre e Souza VM, et al. Gastroesophageal reflux and obstructive sleep apnea in childhood. Int J Pediatr Otorhinolaryngol. 2009;73(3):383–9.CrossRefPubMedGoogle Scholar
  92. 92.
    Stapleton A, Brodsky L. Extra-esophageal acid reflux induced adenotonsillar hyperplasia: case report and literature review. Int J Pediatr Otorhinolaryngol. 2008;72:409–13.CrossRefPubMedGoogle Scholar
  93. 93.
    Bortolotti M, Gentilini L, Morselli C, Giovannini M. Obstructive sleep apnoea is improved by a prolonged treatment of gastroesophageal reflux with omeprazole. Dig Liver Dis. 2006;38(2):78–81.PubMedPubMedCentralGoogle Scholar
  94. 94.
    Tawk M, Goodrich S, Kinasewitz G, Orr W. The effect of 1 week of continuous positive airway pressure treatment in obstructive sleep apnea patients with concomitant gastroesophageal reflux. Chest. 2006;130(4):1003–8.CrossRefPubMedCentralPubMedGoogle Scholar
  95. 95.
    Djeddi D, Cantin D, Samson N, Praud JP. Nasal continuous positive airway pressure inhibits gastroesophageal reflux in newborn lambs. PLoS One. 2014;9(9):e107736.CrossRefPubMedCentralPubMedGoogle Scholar
  96. 96.
    Praud JP. Upper airway reflexes in response to gastric reflux. Paediatr Respir Rev. 2010;11:208–12.CrossRefPubMedCentralPubMedGoogle Scholar

Copyright information

© Springer International Publishing AG 2017

Authors and Affiliations

  1. 1.Department of PaediatricsOspedale “F. Del Ponte”, Università dell’InsubriaVareseItaly
  2. 2.Department of PaediatricsUZ Brussel, Vrije Universiteit BrusselsBrusselsBelgium

Personalised recommendations