Department of Psychology, University of Mississippi, Oxford, MS, USA.
Headache. 2014 Jan;54(1):116-24. doi: 10.1111/head.12168. Epub 2013 Jun 28.
Disturbances in sleep are common among migraineurs, particularly those with frequent (ie, chronic) migraine. Examination of specific types of sleep disturbance and behaviors among episodic migraineurs, however, has not been sufficiently explored. Further, few studies have investigated whether sleep disturbance is attributable to comorbid affective symptomatology.
The present case-control study sought to (1) assess sleep quality, daytime sleepiness, and sleep hygiene among a large sample of episodic migraineurs; (2) quantify relations between sleep disturbance and headache-related variables; and (3) determine if these relations remain after accounting for comorbid depression and anxiety.
Two hundred ninety-two undergraduate students (69.9% female, mean age = 19.19, standard deviation [SD] = 3.21 years) completed measures of sleep quality, daytime sleepiness, and sleep hygiene along with well-validated measures of depression and anxiety symptomatology. Those screening positive for migraine were subsequently administered a structured diagnostic interview to verify diagnosis of migraine consistent with the International Classification of Headache Disorders, 2nd edition. Episodic migraineurs and non-migraine controls were compared on the sleep disturbance variables, and among those with migraine, relations with headache frequency, severity, and disability were quantified with linear regression analyses.
Seventy-eight (26.7%) participants met International Classification of Headache Disorders, 2nd edition criteria for episodic migraine. Compared with participants without migraine, episodic migraineurs reported poorer sleep quality (mean = 8.90 [SD = 3.39] vs 6.63 [SD = 3.02], P < .0001), with 85.9% reporting clinically significant poor sleep quality (vs 62.0% of controls). Poor sleep quality was significantly associated with headache frequency and headache-related disability, accounting for proportions of variance (14.8% in frequency and 18.2% in disability, both P ≤ .001) similar to those attributable to depression and anxiety. These relationships remained significant after controlling for these affective symptoms, in which sleep quality accounted for 5.3% and 5.8% of unique variance in frequency and disability, respectively (P < .05). By comparison, daytime sleepiness and poor sleep hygiene were not consistently associated with migraine or migraine-related variables.
Consistent with prior studies on chronic migraine, poor sleep quality is uniquely associated with episodic migraine, and this relationship is not solely attributable to comorbid psychiatric symptomatology. Sleep quality should be preferentially assessed (vs sleepiness and sleep hygiene) when subjective self-report measures of insomnia are used in clinical headache settings. Future studies should supplement these findings by evaluating the efficacy of interventions that specifically target sleep quality and insomnia (eg, stimulus control, sleep restriction) among episodic migraineurs.
睡眠障碍在偏头痛患者中很常见，尤其是那些经常（即慢性）偏头痛的患者。然而，对于偶发性偏头痛患者的特定类型的睡眠障碍和行为的研究还不够充分。此外，很少有研究调查睡眠障碍是否归因于共病的情感症状。
本病例对照研究旨在：（1）评估大量偶发性偏头痛患者的睡眠质量、白天嗜睡和睡眠卫生；（2）量化睡眠障碍与头痛相关变量之间的关系；（3）确定在考虑到共病抑郁和焦虑后，这些关系是否仍然存在。
292 名大学生（69.9%为女性，平均年龄=19.19 岁，标准差[SD]=3.21 岁）完成了睡眠质量、白天嗜睡和睡眠卫生的测量，以及经过充分验证的抑郁和焦虑症状的测量。那些对偏头痛筛查呈阳性的患者随后接受了结构化的诊断访谈，以验证符合国际头痛疾病分类第 2 版的偏头痛诊断。偶发性偏头痛患者和非偏头痛对照组在睡眠障碍变量上进行比较，对于偏头痛患者，使用线性回归分析来量化与头痛频率、严重程度和残疾的关系。
78 名（26.7%）参与者符合国际头痛疾病分类第 2 版的偶发性偏头痛标准。与没有偏头痛的参与者相比，偶发性偏头痛患者报告的睡眠质量较差（平均=8.90[SD=3.39] vs 6.63[SD=3.02]，P<0.0001），85.9%的人报告存在临床显著的睡眠质量差（而对照组为 62.0%）。睡眠质量差与头痛频率和头痛相关残疾显著相关，解释了 14.8%的频率差异和 18.2%的残疾差异（均 P≤0.001），与抑郁和焦虑的解释比例相似。在控制这些情感症状后，这些关系仍然显著，其中睡眠质量分别占频率和残疾独特变异的 5.3%和 5.8%（P<0.05）。相比之下，白天嗜睡和睡眠卫生差与偏头痛或偏头痛相关变量并不一致。
与慢性偏头痛的先前研究一致，睡眠质量差与偶发性偏头痛有独特的关联，而这种关联并非完全归因于共病的精神症状。在临床头痛环境中使用失眠的主观自我报告测量时，应优先评估睡眠质量（与嗜睡和睡眠卫生相比）。未来的研究应该通过评估专门针对偶发性偏头痛患者的睡眠质量和失眠（例如，刺激控制、睡眠限制）的干预措施的疗效来补充这些发现。
