Pellitteri Gaia, Pez Sara, Nilo Annacarmen, Surcinelli Andrea, Gigli Gian Luigi, Lettieri Christian, Valente Mariarosaria
Clinical Neurology Unit, Santa Maria della Misericordia University Hospital, Udine, Italy.
Department of Medical Area (DAME), University of Udine, Udine, Italy.
Front Neurol. 2022 May 13;13:869677. doi: 10.3389/fneur.2022.869677. eCollection 2022.
Migraine and sleep share a complex and unclear relationship. Poor sleep may trigger migraine attacks; migraine, in turn, is frequently associated with sleep disorders. Few previous studies used questionnaires to assess sleep changes in patients who were treated with migraine-preventive medications (MPMs). More extensive polysomnography (PSG)-based studies for this purpose were not available.
To investigate possible sleep changes in patients with migraine treated with erenumab, using validated sleep questionnaires and home-PSG.
This observational, prospective, open-label pilot study was conducted at the Clinical Neurology Unit Headache Center of Udine University Hospital from 2020 to 2021. Patients were treated with erenumab as monotherapy or add-on treatment for migraine prevention. Sleep changes were evaluated with questionnaires and polysomnographic recordings at baseline, after 3 and 12 months of treatment. Erenumab efficacy and safety in migraine prophylaxis were also investigated.
Twenty-nine patients completed 3 months of follow-up, whereas 15 patients completed 12 months. We found a weak trend of improvement in daytime somnolence after 3 months of treatment, with stronger results after 12 months (median Epworth Sleepiness Scale (ESS) score from 6.0 to 4.0, = 0.015); a significant improvement in subjective sleep quality (median Pittsburgh Sleep Quality Index (PSQI) total score from 7 to 5; = 0.001) was also observed. Home-PSG showed a significant increase in objective sleep efficiency (SE), both after 3 (from 88.1 to 91.0, = 0.006) and 12 months (from 87.1 to 91.0, = 0.006) of treatment. In addition, our data confirmed erenumab effectiveness and safety in migraine prevention.
Our study demonstrated an improvement in both subjective and objective sleep quality in patients treated with a migraine-preventive therapy. Erenumab, in particular, does not cross the blood-brain barrier (BBB), thus a direct effect on sleep is unlikely. Future studies are needed to better understand the mutual influence between migraine and sleep disorders.
偏头痛与睡眠之间存在复杂且尚不明确的关系。睡眠不佳可能引发偏头痛发作；反过来，偏头痛又常与睡眠障碍相关。此前很少有研究使用问卷来评估接受偏头痛预防性药物（MPM）治疗的患者的睡眠变化。尚无针对此目的的更广泛的基于多导睡眠图（PSG）的研究。
使用经过验证的睡眠问卷和家庭PSG，研究接受erenumab治疗的偏头痛患者可能出现的睡眠变化。
这项观察性、前瞻性、开放标签的试点研究于2020年至2021年在乌迪内大学医院临床神经科头痛中心进行。患者接受erenumab作为偏头痛预防的单一疗法或附加疗法。在基线、治疗3个月和12个月后，通过问卷和多导睡眠图记录评估睡眠变化。还研究了erenumab在偏头痛预防中的疗效和安全性。
29名患者完成了3个月的随访，15名患者完成了12个月的随访。我们发现治疗3个月后白天嗜睡有微弱的改善趋势，12个月后效果更明显（爱泼沃斯思睡量表（ESS）中位数评分从6.0降至4.0，P = 0.015）；主观睡眠质量也有显著改善（匹兹堡睡眠质量指数（PSQI）总分中位数从7降至5；P = 0.001）。家庭PSG显示，治疗3个月（从88.1升至91.0，P = 0.006）和12个月（从87.1升至91.0，P = 0.006）后客观睡眠效率（SE）均显著提高。此外，我们的数据证实了erenumab在偏头痛预防中的有效性和安全性。
我们的研究表明，接受偏头痛预防性治疗的患者主观和客观睡眠质量均有所改善。特别是erenumab不会穿过血脑屏障（BBB），因此对睡眠不太可能有直接影响。需要进一步的研究来更好地理解偏头痛与睡眠障碍之间的相互影响。
