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Resolving Nighttime Heartburn Improves Sleep Quality and Boosts Daytime
Productivity According to New Study Published in American Journal of Gastroenterology
Bethesda, MD, August 31, 2005 – The first major multi-center, randomized,
double-blind, placebo-controlled trial addressing therapy for gastroesophageal
reflux disease (GERD) related sleep disorders was published today in the
September issue of the American Journal of Gastroenterology. An estimate
based on findings from this study reveals that U.S. workers who frequently
suffer from moderate-to-severe nighttime heartburn symptoms cost the U.S.
economy $1,920,528,315 per week in paid hours of lost productivity.
This study demonstrated that effective acid suppression therapy with a
proton pump inhibitor (PPI), either 20 mgs or 40 mgs of esomeprazole, relieved
nighttime heartburn symptoms and GERD-related sleep disturbances and significantly
improved sleep quality and thereby improved work productivity.
“Sleep problems are extremely common in patients with GERD and are
often unrecognized,” said lead author David A. Johnson, M.D., FACG,
Professor of Medicine and Chief of Gastroenterology at Eastern Virginia
Medical School who serves as the Vice President of the American College
of Gastroenterology. For those with frequent and moderate-to-severe symptoms,
GERD has a significant negative impact on sleep. “Anyone who’s
had a poor night’s rest knows how much that impacts their performance
the next day. We found that nighttime heartburn is a treatable condition,
that responds to effective, acid-suppressive medical therapy such as esomeprazole.”
Dr. Johnson and his colleagues designed the first large-scale study to
look at relief of nighttime heartburn, as well as resolution of sleep disturbances
and improvements in sleep quality. Using validated questionnaires, they
also measured work productivity. The researchers found that nighttime heartburn
was relieved in 53.1 percent, 50.5 percent and 12.7 percent of patients
who received esomeprazole 40 mg, esomeprazole 20 mg and placebo, respectively.
Additionally, GERD-related sleep disturbances resolved in significantly
more patients who received therapy than those who received placebo. The
high percentage of patients with resolutions of sleep disturbances in the
current trial was both statistically and clinical significant.
“Many people mistakenly believe that heartburn is a trivial condition,
but this study reveals that nighttime heartburn has a dramatic impact on
daytime productivity,” explained Dr. Johnson. “Our study found
that improvements in sleep were associated with improvements in patients’ daily
activities including work productivity, which could have profound economic
benefits.”
Patients in the study lost 16 work hours of workplace productivity per
week due to GERD related sleep disturbances when measured at the beginning
of the study. After treatment, significantly more productive work hours
were saved in the patients who received acid suppression/PPI therapy compared
with those who got a placebo (11.6 to 12.3 hours saved per week for treatment
group compared to 6.2 hours saved per week for placebo.) Dr. Johnson explained
the implications of this finding: “GERD has a more significant impact
on work productivity than it does on absenteeism. Those who suffer from
GERD-related sleep disorders may not stay home from work, but our findings
reveal they are less productive, and that has cost implications for employers.”
The study authors used an average hourly total employee compensation cost
of $24.59 from the U.S. Bureau of Labor Statistics (BLS) for the fourth
quarter of 2003, the cost of productive hours saved per patient per week
by employers was in the range of $286 to $301 for the treatment arms of
the study.
According to the American College of Gastroenterology, approximately 20
percent of U.S. adults suffer from weekly heartburn symptoms. The ACG,
using data from a Gallup poll, estimates that 79 percent of heartburn sufferers
have nighttime symptoms, of whom 50 percent have symptoms that are moderate
to severe. Narrowing this population to reflect the study population of
frequent nighttime heartburn sufferers with moderate to severe symptoms,
the College included in its calculation that 62.8 percent of the U.S. population
is in the workforce (according to the U.S. BLS.) With the average savings
of 5 hours per week of workplace productivity found by Dr. Johnson and
his colleagues among the treatment groups, this translates into a potential
overall economic impact of over $1.9 billion per week compared to untreated
patients.
According to Dr. Johnson, “Physicians treating patients with acid
reflux therefore need to ask about sleep problems and furthermore to ask
how patients feel when they wake up the next day. Daytime fatigue, irritability,
concentration problems may all suggest a problem with restful sleep. Appropriate
recognition of this will lead to appropriate therapy.” He continued, “Sleep
quality should be included as an important goal for optimal disease management
of GERD. Even more so in a time of emphasis on quality management and achieving
the best outcomes in medical care, this study demonstrates that appropriate
treatment for GERD is an investment which has profound quality benefits
for patients and economic benefits for employers.”
More About Nighttime Heartburn
Heartburn affects as many as 40 percent of adults in economically developed
countries.
Heartburn and other gastroesophageal reflux disease (GERD) symptoms experienced
during the night commonly cause sleep disturbances, including arousal from
sleep, increased wakefulness, and overall poor sleep quality.
In a U.S. study of patients with GERD, 69 percent responded that they “experienced
GERD symptoms when laid down to sleep at night;” 54 percent responded
that they were “awakened at night by GERD symptoms;” and 29
percent responded that they were “awakened at night by coughing or
choking because of fluid or an acid or bitter taste, or food in the throat.” (Farup
C, et al., “The impact of nocturnal symptoms associated with gastroesophageal
reflux disease on health-related quality of life.” Arch Int Med 2001;
161:45-52.)
A survey of patients with heartburn found that 79 percent reported nighttime
heartburn, and of those, 75 percent had symptoms that affected their sleep,
and 40 percent believed that nighttime heartburn impaired their ability
to function the next day. (Shaker R, et al., “Nighttime heartburn
is an under-appreciated clinical problem that impacts sleep and daytime
functions: the results of a Gallup survey conducted on behalf of the AGA.
AmJGastroenterol 2003; 98:1487-1493.)
Full-text of the Johnson study can be accessed through the American Journal
of Gastroenterology at
http://www.blackwell-synergy.com/doi/full/10.1111/j.1572-0241.2005.00285.x
Visit the American Journal of Gastroenterology Web site at www.blackwellpublishing.com/ajg
For more information and to order free pamphlets and a free video about
heartburn and GERD visit the ACG web site http://www.acg.gi.org/patients/gerd/ or call 1-800-HRT-BURN.
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