Sinus Arrest during Rem Sleep

To the Editor: The recent report by Guilleminault et al. (Oct. 18 issue) 1 underscores how limited is our understanding of sleep-related disorders. They describe four "apparently healthy" young adults, with sinus arrests during rapid-eye-movement (REM) sleep, usually occurring in the early morning hours. Further investigation revealed similar periods of asystole coinciding with "vague" chest pains during exercise, sexual intercourse, urination, and defecation. Although the authors suggest an abnormal vagal tone as the underlying pathologic condition, they do not attempt to study the role of gastroesophageal acid reflux. Acid-sensitive vagal stimuli originating in the distal esophagus have been described in laboratory . . . No extract is available for articles shorter than 400 words.