Polysomnographic and clinical characteristics of sleep apnea headache patients.

IF 2.1 4区医学 Q3 CLINICAL NEUROLOGY Sleep and Breathing Pub Date : 2024-12-01 Epub Date: 2024-10-10 DOI:10.1007/s11325-024-03117-x

Esra Aydin Sunbul, Rahşan Karacı, Elif Gözde Türedi Karabulut, Hüseyin Güleç, Füsun Mayda Domaç

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引用次数: 0

Abstract

Purpose: Sleep apnea headache can be defined as a persistent, widespread, throbbing headache that occurs recurrently, is not accompanied by any additional symptoms after waking up, and usually resolves within four hours. Diagnosis of the condition requires confirmation through polysomnography with an apnea-hypopnea index of at least 5, indicating the presence of obstructive sleep apnea syndrome (OSAS). While sleep apnea headaches are common in 10-15% of individuals with OSAS, morning headaches are experienced by 5% of this population. The aim of this study is to examine both polysomnographic and clinical features associated with sleep apnea headache in individuals confirmed to have OSAS by polysomnography.

Method: The study was conducted in the sleep center of University of Health Science, Erenköy Mental and Nervous Disease Training and Research Hospital. We have examined the clinical and polysomnographic data of the patients with sleep apnea headache (SAH) diagnosed according to IHS-3 criteria retrospectively and grouped the patients as mild, moderate and severe OSAS. Patients with morning headache except sleep apnea headache and under PAP titration treatment were excluded. The differences between the sleep macro structures of patients with (WSAH) and without sleep apnea headache (WOSAH) were examined.

Results: The WSAH group consisted of 384 participants and the control group (WOSAH) consisted of 294 participants The mean age was 46.29 ± 12.18 and 45.08 ± 12.62 years, respectively. Patients in the WSAH group had significantly higher scores on the Epworth Sleepiness Scale (ESS) (p = 0.004) and higher periodic limb movement index (PLMI) (p = 0.014) compared to the WOSAH group. WSAH patients exhibited shorter wake times after sleep onset (WASO) and lower scores on the sleep quality index, in contrast to WOSAH patients. Additionally, within the WSAH group, there was a negative correlation between age and several sleep parameters, including total sleep parameters. A positive correlation was observed between sleep duration (p = 0.009), waking up after sleep (p = 0.043), sleep efficiency (p = 0.001) and apnea-hypopnea index (AHI) (p = 0.018). Additionally, ESS scores were positively correlated with AHI and total awake time (p = 0.000 and p = 0.008, respectively), while negatively correlated with stage N3 sleep percentage and mean minimum oxygen level (p = 0.001 and p = 0.020, respectively) in the WSAH group.

Conclusion: The causes and possible mechanisms of sleep apnea headache are not fully clarified and the underlying processes are not fully understood. Sleep apnea headaches appear to be related to disturbances in nocturnal sleep. Dysregulation in regions that modulate sleep and nociception may be one possible mechanism.

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睡眠呼吸暂停头痛患者的多导睡眠图和临床特征。

目的：睡眠呼吸暂停头痛可定义为反复发作的持续性、广泛性、搏动性头痛，起床后不伴有任何其他症状，通常在四小时内缓解。要确诊这种病症，需要通过多导睡眠监测仪进行确认，呼吸暂停-低通气指数至少为 5，表明存在阻塞性睡眠呼吸暂停综合征（OSAS）。睡眠呼吸暂停头痛常见于 10-15% 的阻塞性睡眠呼吸暂停综合症患者，而晨起头痛则占这一人群的 5% 。本研究旨在对通过多导睡眠图检查确认为 OSAS 患者的睡眠呼吸暂停头痛的相关多导睡眠图和临床特征进行研究：研究在埃伦柯伊精神和神经疾病培训与研究医院健康科学大学睡眠中心进行。我们对根据 IHS-3 标准诊断出的睡眠呼吸暂停头痛（SAH）患者的临床和多导睡眠图数据进行了回顾性研究，并将患者分为轻度、中度和重度 OSAS。排除了除睡眠呼吸暂停头痛以外的晨起头痛患者和正在接受 PAP 滴定治疗的患者。研究了有睡眠呼吸暂停头痛（WSAH）和无睡眠呼吸暂停头痛（WOSAH）患者睡眠宏观结构的差异：平均年龄分别为（46.29±12.18）岁和（45.08±12.62）岁。与 WOSAH 组相比，WSAH 组患者的埃普沃思嗜睡量表（ESS）得分明显更高（p = 0.004），周期性肢体运动指数（PLMI）也更高（p = 0.014）。与 WOSAH 患者相比，WSAH 患者睡眠开始后的觉醒时间（WASO）更短，睡眠质量指数得分更低。此外，在 WSAH 组中，年龄与多项睡眠参数（包括总睡眠参数）呈负相关。睡眠持续时间（p = 0.009）、睡后觉醒（p = 0.043）、睡眠效率（p = 0.001）和呼吸暂停-低通气指数（AHI）（p = 0.018）之间呈正相关。此外，ESS评分与AHI和总清醒时间呈正相关（分别为p = 0.000和p = 0.008），而在WSAH组中，ESS评分与N3期睡眠百分比和平均最低氧气水平呈负相关（分别为p = 0.001和p = 0.020）：结论：睡眠呼吸暂停头痛的原因和可能的机制尚未完全明确，其潜在的过程也不完全清楚。睡眠呼吸暂停头痛似乎与夜间睡眠紊乱有关。调节睡眠和痛觉的区域失调可能是一种可能的机制。

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来源期刊

Sleep and Breathing 医学-呼吸系统

CiteScore

5.20

自引率

4.00%

发文量

222

审稿时长

3-8 weeks

期刊介绍： The journal Sleep and Breathing aims to reflect the state of the art in the international science and practice of sleep medicine. The journal is based on the recognition that management of sleep disorders requires a multi-disciplinary approach and diverse perspectives. The initial focus of Sleep and Breathing is on timely and original studies that collect, intervene, or otherwise inform all clinicians and scientists in medicine, dentistry and oral surgery, otolaryngology, and epidemiology on the management of the upper airway during sleep. Furthermore, Sleep and Breathing endeavors to bring readers cutting edge information about all evolving aspects of common sleep disorders or disruptions, such as insomnia and shift work. The journal includes not only patient studies, but also studies that emphasize the principles of physiology and pathophysiology or illustrate potentially novel approaches to diagnosis and treatment. In addition, the journal features articles that describe patient-oriented and cost-benefit health outcomes research. Thus, with peer review by an international Editorial Board and prompt English-language publication, Sleep and Breathing provides rapid dissemination of clinical and clinically related scientific information. But it also does more: it is dedicated to making the most important developments in sleep disordered breathing easily accessible to clinicians who are treating sleep apnea by presenting well-chosen, well-written, and highly organized information that is useful for patient care.