Conscious Awakenings Are Commonly Associated With Acid Reflux Events in Patients With Gastroesophageal Reflux Disease  Choo Hean Poh, Larissa Allen, Anita Gasiorowska, Tomás Navarro–Rodriguez, Stuart F. Quan, Isaac Malagon, Jeannette Powers, Marcia R. Willis, Nicole Ashpole, Ronnie Fass  Clinical Gastroenterology and Hepatology  Volume 8, Issue 10, Pages 851-857 (October 2010) DOI: 10.1016/j.cgh.2010.05.022 Copyright © 2010 AGA Institute Terms and Conditions

Figure 1 (A) Currently available analysis demonstrates the currently available analysis of pH testing, limited only to recumbent (green shade) and upright (white shade) periods. (B) After applying a novel integrative analysis (FRIM), the new pH strip provides information about recumbent-asleep (blue shade), recumbent-awake (green shade), and 2 short conscious awakenings (black arrows). The blue bar was achieved through analysis of actigraphy recordings. The green bar was achieved from the patient's own documentation regarding recumbency time in the pH diary. Note the legend of the pH strip already incorporates sleep and awake in addition to traditional recumbent and upright periods. Clinical Gastroenterology and Hepatology 2010 8, 851-857DOI: (10.1016/j.cgh.2010.05.022) Copyright © 2010 AGA Institute Terms and Conditions

Figure 2 Integrated actigraphy and pH data from a GERD patient with acid reflux events associated with conscious awakenings. The conventional pH data output, before integration with actigraphy data, revealed no fragmentation of sleep, despite the patient's report of multiple heartburn episodes throughout most of the recumbent period (red bar on top). Blue shades indicate sleeping periods interspersed with 6 conscious awakenings that are associated with acid reflux events and heartburn symptoms (black arrows). The green arrow points to a short recumbent-awake period (green shade) that was also associated with acid reflux events. (a) 38 minutes; (b) 21 minutes; (c) 4 minutes; (d) 12 minutes; (e) 20 minutes; (f) 25 minutes. All conscious awakenings were associated with heartburn, resulting in a long, solid red line. Clinical Gastroenterology and Hepatology 2010 8, 851-857DOI: (10.1016/j.cgh.2010.05.022) Copyright © 2010 AGA Institute Terms and Conditions

Figure 3 The relationship between conscious awakenings and acid reflux events as well as symptoms in the GERD group (N = 39). (A) The left pie demonstrates the percentage of conscious awakenings with (black) and without (white) acid reflux. The right pie depicts the percentage of symptomatic (black) and asymptomatic (white) conscious awakenings associated with acid reflux events. (B) The overall percentage of conscious awakenings associated with (black) or without (white) acid reflux events and GERD-related symptoms. Clinical Gastroenterology and Hepatology 2010 8, 851-857DOI: (10.1016/j.cgh.2010.05.022) Copyright © 2010 AGA Institute Terms and Conditions

Figure 4 The recumbent period, after integrating actigraphy with recorded pH data, revealed long recumbent-awake period (green shade) associated with multiple asymptomatic reflux events and a prolonged conscious awakening associated with a reflux event that was also asymptomatic. Clinical Gastroenterology and Hepatology 2010 8, 851-857DOI: (10.1016/j.cgh.2010.05.022) Copyright © 2010 AGA Institute Terms and Conditions