Association Between Obstructive Sleep Apnea and Barrett’s Esophagus: A Systematic Review and Meta-Analysis

Background: Obstructive sleep apnea (OSA) has gastrointestinal implications as it is associated with gastroesophageal reflux disease. Less certain is an independent association between OSA and Barrett’s esophagus. We performed a systematic review and meta-analysis to evaluate the association between OSA and Barrett’s esophagus. Methods: A systematic search of Ovid MEDLINE, Embase, Web of Science, CINAHL, and the Cochrane Central Register of Controlled Trials was performed. Inclusion criteria were observational studies (retrospective and case–control) assessing the association between OSA and Barrett’s esophagus in adult subjects. Data from the included studies were extracted and used to calculate the pooled odds ratio of OSA with 95% confidence interval (CI) between patients with Barrett’s esophagus and those without, using a random-effects model. Results: Altogether six studies involving 2333 subjects met the inclusion criteria and were included in this meta-analysis. The pooled analysis found a significantly increased risk of OSA, high risk of OSA, and patient-reported OSA symptoms among patients with Barrett’s esophagus versus those without Barrett’s esophagus, with a pooled odds ratio (OR) of 2.19 (95% CI 1.53–3.15). A subgroup analysis for cases of definite OSA (formally diagnosed via polysomnography) and Barrett’s esophagus (n = 2 studies) also demonstrated significant association (OR 2.59, 95% CI 1.39–4.84). Conclusion: A significantly increased risk of OSA among patients with Barrett’s esophagus was demonstrated in this meta-analysis. Further investigation is warranted to determine the pathophysiology and clinical implications of this association.