Left lateral decubitus sleeping position is associated with improved gastroesophageal reflux disease symptoms: A systematic review and meta-analysis.
Level 3 - non-randomized controlled study
Systematic review synthesizing mostly nonrandomized studies alongside one RCT
PubMed 37969463 · doi:10.12998/wjcc.v11.i30.7329
What was done
A systematic review and meta-analysis searched MEDLINE, EMBASE, and CENTRAL through July 17, 2023, for randomized and nonrandomized studies evaluating left lateral decubitus (LLD) sleeping position versus right lateral decubitus (RLD) and supine positions in patients with gastroesophageal reflux disease (GERD). Outcomes analyzed included acid exposure time (AET; % time pH < 4), acid clearance time (ACT; sec/episode), number of reflux episodes, and Nocturnal Gastroesophageal Reflux Disease Symptom Severity and Impact Questionnaire (N-GSSIQ) scores.
What was found
Two nonrandomized studies showed that LLD significantly reduced AET compared to RLD (mean difference [MD] -2.03, 95% CI: -3.62 to -0.45) and supine position (MD -2.71, 95% CI: -4.34 to -1.09). LLD also reduced ACT compared to RLD (MD -81.84 sec, 95% CI: -127.48 to -36.20) and supine position (MD -74.47 sec, 95% CI: -116.26 to -32.69). No significant difference in AET or ACT was observed between RLD and supine. One randomized controlled trial using electronic sleep positional therapy to promote LLD showed symptom improvement, including improved N-GSSIQ scores and increased reflux-free nights, though exact numeric values for this trial were not reported in the abstract.
Why it matters
Left-sided sleeping appears to physiologically reduce esophageal acid exposure and shorten acid clearance time, supporting positional therapy as a non-pharmacologic option for nocturnal GERD.
Limits
The review included only three studies in total (two nonrandomized studies and one RCT), and the abstract does not report the total sample size (n) of participants, detailed risk of bias assessments, or numerical outcomes for the RCT.
Cited by
- supports Sleeping on the right side causes gastric juices to leak and triggers gastroesophageal reflux disease, whereas sleeping on the left side avoids this.