Yi-Chu Liao^a, Ji-Hsiung Chen^b

^a Department of Molecular and Genomic Medicine, National Health Research Institutes, Miaoli, Taiwan
^b Department of Molecular Biology and Human Genetics, Tzu Chi University, Hualien, Taiwan

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Jih-Chang Chen^a, Ming-Hwang Shyr^b

^a Department of Emergency Medicine, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan
^b Department of Anesthesiology, Buddhist Tzu Chi General Hospital and Tzu Chi University, Hualien, Taiwan

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Chien-Lin Chen^a, William C. Orr^b

^a Department of Medicine, Buddhist Tzu Chi General Hospital and Tzu Chi University, Hualien, Taiwan
^b Lynn Institute for Healthcare Research, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA

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Abstract
This review addresses current advances in gastroesophageal reflux disease (GERD) and its influence on sleep and health-related quality of life (QOL). Sleep difficulties are highly prevalent among adults with GERD, especially those who experience nighttime symptoms. These sleep difficulties result in substantial costs to the health care system by increasing provider visits. Because continued sleep disruption leads to increased daytime sleepiness and fatigue, nocturnal heartburn can reduce work productivity, as well as reduce function when performing normal daily activities. The continued presence of nocturnal symptoms in routine medical treatment is strongly associated with decreases in health-related quality of life. There is a greater loss of productivity to the employer and poorer health-related QOL (HRQOL) for the patient. Obstructive sleep apnea syndrome and obesity seem to predispose some patients to nocturnal GERD, and the presence of either of these conditions may help to identify patients with symptoms consistent with GERD. Appropriate management of GERD must include treatment of nighttime reflux symptoms that affect difficulty in both initiating and maintaining sleep.

Keywords
Gastroesophageal reflux disease; Health related quality of life; Sleep

Ru-Ping Lee^a, Chung-Jen Lee^b, Yi-Maun Subeq^a, Bang-Gee Hsu^{c, d}

^a Department of Nursing, Tzu Chi University, Hualien, Taiwan
^b Department of Nursing, Tzu Chi College of Technology, Hualien, Taiwan
^c School of Medicine, Tzu Chi University, Hualien, Taiwan
^d Department of Nephrology, Buddhist Tzu Chi General Hospital, Hualien, Taiwan

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Pei-Fang Lai^{a, b}, Tzu-Ling Tseng^{c, d}, Sung-Ho Chen^a, Ching-Feng Cheng^{e, f, g}

^a Institute of Pharmacology and Toxicology, College of Medicine, Tzu Chi University, Hualien, Taiwan
^b Department of Emergency Medicine, Buddhist Tzu Chi General Hospital, Hualien, Taiwan
^c Institute of Medical Sciences, College of Medicine, Tzu Chi University, Hualien, Taiwan
^d Center of Vascular Medicine, College of Life Sciences, Tzu Chi University, Hualien, Taiwan
^e Department of Medical Research, Buddhist Tzu Chi General Hospital, Hualien, Taiwan
^f Department of Pediatrics, Tzu Chi University, Hualien, Taiwan
^g Institute of Biomedical Sciences, Academia Sinica, Taipei, Taiwan

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Qian-Shen Ke^a, Yih-Chou Chen^b, Hann-Chorng Kuo^a

^a Department of Urology, Buddhist Tzu Chi General Hospital and Tzu Chi University, Hualien, Taiwan
^b Department of Urology, Hualien General Hospital, Hualien, Taiwan

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Yin-Ming Li^{a, b}, Hui-Ling Lai^b

^a Department of Family Medicine, Buddhist Tzu Chi General Hospital, Hualien, Taiwan
^b Department of Nursing, Tzu Chi University, Hualien, Taiwan

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Cheng-Huan Peng^a, Wen-Tien Wu^{a, b}, Tzai-Chiu Yu^{a, b}, Li-Chun Chen^c, Shih-Hsiang Hsu^{a, b}, Sai-Tung Kwong^a, Ting-Kuo Yao^a, Kun-Chi Wu^{a, b}, Po-Chou Shao^a, Jen-Hung Wang^d, Ing-Ho Chen^{a, b}

^a Department of Orthopedics, Buddhist Tzu Chi General Hospital, Hualien, Taiwan
^b School of Medicine, Tzu Chi University, Hualien, Taiwan
^c Department of Physical Medicine and Rehabilitation, Buddhist Tzu Chi General Hospital, Hualien, Taiwan
^d Department of Medical Research, Buddhist Tzu Chi General Hospital, Hualien, Taiwan

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Dah-Ching Ding^{a, b}, Tang-Yuan Chu^{a, b}, Yu-Hsun Chang^{b, c}

^a Department of Obstetrics and Gynecology, Buddhist Tzu Chi General Hospital and Tzu Chi University, Hualien, Taiwan
^b Institute of Medical Sciences, Tzu Chi University, Hualien, Taiwan
^c Department of Pediatrics, Buddhist Tzu Chi General Hospital and Tzu Chi University, Hualien, Taiwan

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Sheng-Wen Wu, Tsung-Lang Chiu, Shin-Yuan Chen, Chain-Fa Su, Sheng-Tzung Tsai

Department of Neurosurgery, Institute of Neuro-Medical Science Center, Buddhist Tzu Chi General Hospital, Hualien, Taiwan

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Chiu-Fen Yang^{a, d}, Shu-Hsin Liu^{b, d}, Jing-Ren Jeng^{c, d}, Michael Yu-Chih Chen^{c, d}

^a Department of Internal Medicine, Buddhist Tzu Chi General Hospital, Hualien, Taiwan
^b Department of Nuclear Medicine, Buddhist Tzu Chi General Hospital, Hualien, Taiwan
^c Department of Cardiology, Buddhist Tzu Chi General Hospital, Hualien, Taiwan
^d Department of Cardiology, Tzu Chi University, Hualien, Taiwan

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Yung-Hsiang Hsu

Department of Pathology, Buddhist Tzu Chi General Hospital and Tzu Chi University, Hualien, Taiwan

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Chuang-Wei Chen^{a, b}, Koung-Hong Hsiao^{a, b}

^a Division of Colon and Rectal Surgery, Department of Surgery, Buddhist Tzu Chi General Hospital, Taipei Branch, New Taipei City, Taiwan
^b School of Medicine, Tzu Chi University, Hualien, Taiwan

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Chun-Ying Weng^a, Shao-Yin Chu^{a, b, c}, Pei-Chun Lai^{a, b}, Lang-Yao Chen^d, Anyi Chen^d, Yi-Ning Su^d, Pen-Jung Wang^{a, b}

^a Department of Pediatrics, Buddhist Tzu Chi General Hospital, Hualien, Taiwan
^b Department of Medicine, Tzu Chi University, Hualien, Taiwan
^c Department of Medical Education, Buddhist Tzu Chi General Hospital, Hualien, Taiwan
^d Department of Medical Genetics, National Taiwan University Hospital, Taipei, Taiwan

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Michael Cheng-Tek Tai

School of Medical Sociology and Social Work, Chungshan Medical University, Taichung, Taiwan

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Shao-Yin Chu^{a, b}, Yu-Ling Lan^c, Sheng-Po Kao^{a, b}, Tsung-Ying Chen^{a, b}, Ming-Chen Hsieh^{a, b}

^a Department of Medical Education, Buddhist Tzu Chi General Hospital, Hualien, Taiwan
^b Department of Medicine, College of Medicine, Tzu Chi University, Hualien, Taiwan
^c Department of Counseling and Clinical Psychology, National Dong Hwa University, Hualien, Taiwan

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