Correlation between gastroesophageal reflux disease, obstructive sleep apnea syndrome and cognitive decline.
DOI:
https://doi.org/10.52692/1857-0011.2025.3-83.42Keywords:
GERD, OSAS, cognitive impairmentAbstract
Introduction. Gastroesophageal reflux disease (GERD) affects approximately 10–40% of adults worldwide, while obstructive sleep apnea (OSAS) has an estimated prevalence of 9–38% in the adult population. The coexistence of these two conditions occurs in approximately 40–60% of cases and is associated with subtle cognitive impairments in over 50% of affected individuals, impacting memory, attention, and executive functions.
Materials and Methods. The study included 30 GERD patients who were consulted or treated at the Clinical Hospital of Rehabilitation and Chronic Care, Chișinău. OSAS risk was assessed using the STOP-Bang questionnaire, and cognitive function was evaluated with the AD-8 questionnaire. In parallel, a literature review of publications from 2015–2025 was conducted to integrate recent data regarding the prevalence, mechanisms, and interactions between GERD, OSAS, and cognitive impairment.
Results. In our study (n=30, mean age 59.7 years, 60% women), 83% of patients with GERD had intermediate or high risk of obstructive sleep apnea (STOP-Bang ≥3), and 60% had AD-8 scores ≥2, suggestive of cognitive decline. BMI (body mass index) was strongly correlated with abdominal circumference (r=0.71), while STOP-Bang correlated with weight (r=0.59) and neck circumference (r=0.55). Age was moderately associated with AD-8 scores (r=0.32).
Conclusions. Integrated screening of GERD patients for OSAS and cognitive impairment using STOP-Bang and AD-8 enables early identification of high-risk individuals. Neurological consultation is essential to differentiate cognitive deficits secondary to fragmented sleep from neurodegenerative disorders. Multidisciplinary management can improve sleep quality, reduce digestive symptoms, and prevent cognitive decline.
References
Mo L., Liu Z., Cao W., et al. Global, regional, and national burden of gastroesophageal reflux disease (1990–2021): age-period-cohort analysis and Bayesian projections. Front Public Health., 2025;13:1576527.
Scorpan A., Bivol G., Scurtu A., Istrati V., Sârbu O., Calin Gh., Stoica M. Clasificarea clinica a bolii de reflux gastro-esofagian (BRGE). In: Congresul Medicilor de Familie din Republica Moldova, Ed. 5, 17-18 mai 2014, Chisinau. Chişinău: CEP Medicina, 2024, Ediția 5, pp. 189-201. ISBN (pdf) 978-9975-82- 377-7.
Fakhre Yaseri H. Gender is a risk factor in patients with gastroesophageal reflux disease. Med J Islam Repub Iran., 2017;31:58.
Senaratna C.V., Perret J.L., et al. Prevalence of obstructive sleep apnea in the general population: a systematic review. Sleep Med Rev., 2017;34:70–81.
Cunningham J., Hunter M., Budgeon C., et al. The prevalence and comorbidities of obstructive sleep apnea in middle-aged men and women: the Busselton Healthy Ageing Study. J Clin Sleep Med., 2021;17(10):2029–2039.
St-Onge M.P., et al. Sleep duration and quality: impact on lifestyle behaviors and cardiometabolic
health: a scientific statement from the American Heart Association. Circulation., 2016;134:e367–e386.
El Hage Chehade N., et al. Association between obstructive sleep apnea and gastroesophageal reflux disease: a systematic review and meta-analysis. J Gastroenterol Hepatol., 2023;38(8):1244–1251.
Stoica M., Caliga E., Sârbu O., Sasu D., Gavriliuc S., Scurtu A., Scorpan A., Istrati V. Sintropia - boala de reflux gastroesofagian și boala cardiacă ischemică - metodelede diagnostic și tactica de tratament. In: Sănătate Publică, Economie şi Management în Medicină , 2023, nr. 4(97_S), pp. 33- 39. ISSN 1729-8687.
Shibli F., et al. Nocturnal gastroesophageal reflux disease (GERD) and sleep: an important relationship that is commonly overlooked. J Clin Gastroenterol., 2020;54:663–674.
Orr W.C., Fass R., et al. The effect of sleep on gastrointestinal functioning in common digestive diseases. Lancet Gastroenterol Hepatol., 2020;5:616–624.
Gau S.Y., Lai J.N., et al. Higher dementia risk in people with gastroesophageal reflux disease: a real-world evidence. Front Aging Neurosci., 2022;14:830729.
Shieu M.M., Dunietz G.L., et al. The association between obstructive sleep apnea risk and cognitive disorders: a population-based study. J Clin Sleep Med., 2022;18(4):1177–1185.
Pivetta B., Chen L., Nagappa M., et al. Use and performance of the STOP-Bang questionnaire for obstructive sleep apnea screening across geographic regions: a systematic review and meta-analysis. JAMA Netw Open., 2021;4(3):e211009.
Hendry K., Green C.., McShane R, et al. AD-8 for detection of dementia across a variety of healthcare settings. Cochrane Database Syst Rev., 2019;3(3):CD011121.
Kim Y., et al. Associations between obstructive sleep apnea severity and endoscopically proven gastroesophageal reflux disease. Sleep Breath., 2018;22(1):85–90.
Chen G., et al. Causal analysis between gastro- oesophageal reflux disease and obstructive sleep apnoea. ERJ Open Res., 2023;9(4):00127-2023.
Appleton S., et al. Obstructive sleep apnea in adults: prevalence, risk factors, and comorbidities. J Clin Sleep Med., 2021;17(10):2029–2039.
Wojtowicz A., Larner A.J. Diagnostic test accuracy of cognitive screeners in older people. Progress Neurol Psychiatry., 2017;21(1):17–21.
Downloads
Published
License
Copyright (c) 2026 Bulletin of the Academy of Sciences of Moldova. Medical Sciences
This work is licensed under a Creative Commons Attribution 4.0 International License.
