Is there a vicious cycle between obstructive sleep apnea and laryngopharyngeal reflux disease?

Obstructive sleep apnea (OSA) is a common sleep-related breathing disorder which is mainly characterized by the repetitive episodes of obstructive apneas and/or hypopneas. It is associated with daytime sleepiness, decrements in quality of life, cardiovascular and cerebrovascular diseases and endocrine disturbances. In addition, there is a high prevalence of gastric reflux (including both gastroesophageal reflux and laryngopharyngeal reflux diseases) in patients with OSA. However, the mechanism underlying this association has not been completely established. Herein, we hypothesize that there is a vicious cycle between OSA and laryngopharyngeal reflux disease. Increased respiratory efforts in OSA generate more-negative intrathoracic pressure, contributing to reflux of gastric contents, which in turn creates inflammation and sensory deficits in the laryngeal and pharyngeal tissues that contributes to progression of OSA through both inflammatory and neuromuscular pathways.