阻塞性睡眠呼吸暂停患者持续气道正压通气治疗后头痛改善：一项回顾性分析。

Improvement in headaches with continuous positive airway pressure for obstructive sleep apnea: a retrospective analysis.

机构信息

Baystate Medical Center, Springfield, MA 01199, USA.

出版信息

Headache. 2013 Feb;53(2):333-43. doi: 10.1111/j.1526-4610.2012.02251.x. Epub 2012 Sep 10.

DOI:10.1111/j.1526-4610.2012.02251.x

PMID:22963547

Abstract

OBJECTIVE

We aimed to identify clinical features in patients with severe headaches that predicted obstructive sleep apnea (OSA) and determine clinical and sleep study characteristics that predicted headache improvement with continuous positive airway pressure (CPAP).

BACKGROUND

Many patients with headaches complain of sleep symptoms and have OSA. There is often improvement of headaches with CPAP treatment.

METHODS

We conducted a retrospective chart review of all patients referred to adult neurology clinic for headaches and sent for polysomnography between January 2008 and December 2009. Follow-up ranged from 18 to 42 months.

RESULTS

Eighty-two headache patients (70 females, 12 males) were studied. Mean age was 45±13 years (females 45±13, males 43±11) and mean body mass index was 32±9. Headache types included 17% chronic migraine without aura, 22% episodic migraine without aura, 32% migraine with aura, 21% tension-type headache, 6% chronic post-traumatic headache, 11% medication overuse headache, and 7% other types. All patients were receiving standard treatment for their headaches by their neurologist. Fifty-two patients (63%) had OSA. Increasing age, female gender, and chronic migraine without aura were predictive of OSA. Of the patients with OSA, 33 (63%) used CPAP and 27 (82%) were adherent to CPAP. Headache improvement was reported by 40 patients (49%) due to either standard medical therapy or CPAP. Patients with OSA who were CPAP adherent (21/27) were more likely to have improvement in headaches than patients intolerant of CPAP (2/6), those that did not try CPAP (8/19), and those who did not have OSA (16/30) (P=.045). Of the 33 patients who used CPAP, 13 reported improvement in headaches specifically due to CPAP therapy and 10 additional patients noted benefit in sleep symptoms. The presence of witnessed apneas (P=.045) and male gender (P=.021) predicted improvement in headaches due to CPAP.

CONCLUSIONS

Headache patients should be evaluated for the presence of OSA. Treating OSA improves headaches in some patients.

摘要

目的

我们旨在确定严重头痛患者的临床特征，以预测阻塞性睡眠呼吸暂停（OSA），并确定临床和睡眠研究特征，以预测持续气道正压通气（CPAP）治疗头痛的改善。

背景

许多头痛患者抱怨睡眠症状，并患有 OSA。CPAP 治疗通常会改善头痛。

方法

我们对 2008 年 1 月至 2009 年 12 月期间因头痛就诊于成人神经病学诊所并进行多导睡眠图检查的所有患者进行了回顾性图表审查。随访时间为 18 至 42 个月。

结果

共研究了 82 例头痛患者（70 名女性，12 名男性）。平均年龄为 45±13 岁（女性 45±13，男性 43±11），平均体重指数为 32±9。头痛类型包括 17%的慢性无先兆偏头痛、22%的发作性无先兆偏头痛、32%的有先兆偏头痛、21%的紧张型头痛、6%的慢性创伤后头痛、11%的药物过度使用性头痛和 7%的其他类型。所有患者均由其神经病学家接受标准的头痛治疗。52 例（63%）患者患有 OSA。年龄增长、女性性别和慢性无先兆偏头痛是 OSA 的预测因素。在患有 OSA 的患者中，33 例（63%）使用 CPAP，27 例（82%）对 CPAP 有依从性。由于标准医学治疗或 CPAP，40 例（49%）患者报告头痛改善。对 CPAP 依从性较好的 OSA 患者（21/27）比不耐受 CPAP 的患者（2/6）、未尝试 CPAP 的患者（8/19）和无 OSA 的患者（16/30）更有可能改善头痛（P=.045）。在使用 CPAP 的 33 例患者中，13 例报告头痛改善是由于 CPAP 治疗，另外 10 例患者则注意到睡眠症状的改善。目击到的呼吸暂停（P=.045）和男性性别（P=.021）预测 CPAP 治疗头痛改善。