Meta-Analysis
Copyright ©The Author(s) 2023. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Oct 26, 2023; 11(30): 7329-7336
Published online Oct 26, 2023. doi: 10.12998/wjcc.v11.i30.7329
Left lateral decubitus sleeping position is associated with improved gastroesophageal reflux disease symptoms: A systematic review and meta-analysis
Daniel Martin Simadibrata, Elvira Lesmana, Bagus Ramasha Amangku, Muhammad Prasetio Wardoyo, Marcellus Simadibrata
Daniel Martin Simadibrata, Elvira Lesmana, Bagus Ramasha Amangku, Muhammad Prasetio Wardoyo, Department of Internal Medicine, Faculty of Medicine Universitas Indonesia, Jakarta 10430, Indonesia
Daniel Martin Simadibrata, Nuffield Department of Population Health, University of Oxford, Oxford OX3 7LF, United Kingdom
Daniel Martin Simadibrata, Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN 55905, United States
Marcellus Simadibrata, Division of Gastroenterology, Department of Internal Medicine, Faculty of Medicine Universitas Indonesia, Jakarta 10430, Indonesia
Author contributions: Simadibrata DM contributed to study concept and design; acquisition of data; analysis and interpretation of data; drafting of the manuscript; critical revision of the manuscript; Lesmana E contributed to study concept and design; acquisition of data; drafting of the manuscript; Amangku BR contributed to acquisition of data; drafting of the manuscript; Wardoyo MP contributed to acquisition of data; drafting of the manuscript; Simadibrata M contributed to study concept and design; acquisition of data; drafting of the manuscript; critical revision of the manuscript.
Conflict-of-interest statement: All authors have no conflict of interest to declare.
PRISMA 2009 Checklist statement: The authors have read the PRISMA 2020 Checklist, and the manuscript was prepared and revised according to the PRISMA 2020 Checklist.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Marcellus Simadibrata, FACG, MD, PhD, Full Professor, Professor, Division of Gastroenterology, Department of Internal Medicine, Faculty of Medicine Universitas Indonesia, Jl Salemba IV, Jakarta 10430, Indonesia. prof.marcellus.s@gmail.com
Received: August 7, 2023
Peer-review started: August 7, 2023
First decision: September 14, 2023
Revised: September 24, 2023
Accepted: October 8, 2023
Article in press: October 8, 2023
Published online: October 26, 2023
Processing time: 78 Days and 9.2 Hours
Abstract
BACKGROUND

A limited number of studies have demonstrated that sleeping in the left lateral decubitus (LLD) decreases nocturnal reflux in patients with gastroesophageal reflux disease (GERD) compared to right lateral decubitus (RLD) and supine.

AIM

This systematic review summarizes the association between sleeping in the LLD position and nocturnal reflux in patients with GERD.

METHODS

Studies published up to July 17, 2023, in MEDLINE, EMBASE, and CENTRAL were searched. Eligible studies were randomized and nonrandomized studies assessing the effect of sleeping in LLD compared to RLD and supine in reducing nocturnal reflux in GERD patients. Outcomes include the acid exposure time (AET) (% time in pH<4), acid clearance time (ACT) (in sec/episode), number of reflux episodes, and improvement in N-GSSIQ scores.

RESULTS

Two nonrandomized studies showed decreased AET and ACT in LLD sleep position in comparison to RLD (mean difference [MD] -2.03 [95%CI: -3.62 to -0.45]; -81.84 [95%CI: -127.48 to -36.20], respectively) and supine position (MD -2.71 [95%CI: -4.34 to -1.09]; -74.47 [95%CI: -116.26 to -32.69], respectively). There was no difference in AET and ACT between RLD sleep position and supine. Furthermore, one randomized controlled trial investigating the use of electronic sleep positional therapy, which increased the duration of LLD sleep and decreased the duration of RLD sleep compared to sham, showed nocturnal symptoms improvement (improved N-GSSIQ score, increased reflux-free nights, and resolution of nocturnal reflux symptoms).

CONCLUSION

Current evidence suggests that sleeping on the left side could reduce nocturnal reflux and improve GERD-related quality of life, therefore warranting interventions that promote LLD sleep position.

Keywords: Gastroesophageal reflux disease; Left lateral decubitus; Sleep position; Systematic review

Core Tip: This systematic review summarizes the association between left lateral decubitus (LLD) sleep position and nocturnal reflux in GERD patients. Overall, sleeping in the LLD position demonstrated significantly decreased acid exposure time and acid clearance time compared to right lateral decubitus (RLD) and supine. Furthermore, increased LLD sleep was shown to improve nocturnal symptoms, as evidenced by a randomized controlled trial using sleep positional therapy to promote LLD sleep and reduce RLD sleep. The above findings suggest that LLD sleep benefits GERD patients who experience nocturnal symptoms and warrants interventions that promote LLD sleep position.