J Otolaryngol Head Neck Surg. 2026 Jan-Dec;55:19160216261464873. doi: 10.1177/19160216261464873. Epub 2026 Aug 4.

ABSTRACT

IMPORTANCE: Laryngopharyngeal reflux (LPR) is frequently encountered in patients with obstructive sleep apnea (OSA). However, its relationship with OSA severity remains uncertain. Clarifying this association may improve reflux phenotyping and guide otolaryngology-focused evaluation in OSA populations.

OBJECTIVE: To evaluate the association between LPR-related parameters and OSA severity and the relationship between velum obstruction grade and LPR-related measures.

DESIGN: Prospective observational study.

SETTING: Single tertiary academic medical center (Peking University Third Hospital), outpatient sleep clinic.

PARTICIPANTS: A total of 196 adults with polysomnography-diagnosed OSA were enrolled. All completed Reflux Symptom Index (RSI) assessment and laryngoscopic Reflux Finding Score (RFS) evaluation.Intervention or Exposures:No intervention. Exposure was OSA severity classified by the apnea-hypopnea index and velum obstruction grade assessed by the Müller maneuver. Clinically defined LPR was operationally defined as RSI > 13 and/or RFS > 7.

MAIN OUTCOME MEASURES: Associations between OSA severity, velum obstruction grade, and LPR-related measures.

RESULTS: Clinically defined LPR was present in 84 of 196 patients with OSA (42.9%). RFS increased significantly with greater OSA severity (P < .001), whereas RSI showed only a nonsignificant increasing trend (P = .070). OSA severity correlated weakly with RSI and more clearly with RFS (r = 0.16, P = .023; r = 0.33, P < .001, respectively). After adjustment for sex, body mass index, and LSO₂, moderate and severe OSA were independently associated with LPR compared with mild OSA (moderate: Odds ratio [OR] = 2.53; 95% Confidence interval [CI]: 1.08-5.95; severe: OR = 4.83; 95% CI: 1.59-14.66). Velum obstruction grade was associated with LPR prevalence and RFS.

CONCLUSIONS: Clinically defined LPR was common in adults with OSA and was independently associated with greater OSA severity. RFS appeared to reflect OSA severity more consistently than symptom-based RSI, suggesting that laryngoscopic findings may better capture reflux-related laryngeal involvement in this population.

RELEVANCE: Laryngoscopic assessment may complement symptom questionnaires and support phenotype-informed evaluation of reflux-related findings in OSA.

LEVEL OF EVIDENCE: 3.

PMID:42549535 | DOI:10.1177/19160216261464873