Department of Psychiatry, University of Health Sciences Erenköy Mental Health and Neurological Diseases Training and Research Hospital, Istanbul, Turkey.
Department of Neurology, University of Health Sciences Erenköy Mental Health and Neurological Diseases Training and Research Hospital, Istanbul, Turkey.
Sleep Breath. 2024 Dec;28(6):2591-2596. doi: 10.1007/s11325-024-03117-x. Epub 2024 Oct 10.
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.
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.
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.
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.
睡眠呼吸暂停相关性头痛可定义为一种持续存在、广泛分布、搏动性头痛，反复发作，醒来后无任何其他症状，通常在 4 小时内缓解。该疾病的诊断需要通过多导睡眠图（apnea-hypopnea index 至少为 5）确认，表明存在阻塞性睡眠呼吸暂停综合征（OSAS）。尽管睡眠呼吸暂停相关性头痛在 10-15%的 OSAS 患者中较为常见，但该人群中只有 5%出现晨发性头痛。本研究旨在研究通过多导睡眠图确诊为 OSAS 的患者中与睡眠呼吸暂停相关性头痛相关的多导睡眠图和临床特征。
该研究在伊斯坦布尔健康科学大学 Erenköy 精神与神经疾病培训与研究医院的睡眠中心进行。我们回顾性地检查了根据 IHS-3 标准诊断为睡眠呼吸暂停相关性头痛（SAH）的患者的临床和多导睡眠图数据，并将患者分为轻度、中度和重度 OSAS。排除了除睡眠呼吸暂停相关性头痛外还有晨发性头痛和正在接受 PAP 滴定治疗的患者。检查了有（WSAH）和无睡眠呼吸暂停相关性头痛（WOSAH）的患者的睡眠宏观结构差异。
WSAH 组有 384 名参与者，对照组（WOSAH）有 294 名参与者。平均年龄分别为 46.29±12.18 岁和 45.08±12.62 岁。与 WOSAH 组相比，WSAH 组的 Epworth 嗜睡量表（ESS）评分（p=0.004）和周期性肢体运动指数（PLMI）（p=0.014）明显更高。与 WOSAH 组相比，WSAH 患者的睡眠潜伏期后觉醒时间（WASO）较短，睡眠质量指数得分较低。此外，在 WSAH 组中，年龄与总睡眠参数等多项睡眠参数呈负相关。观察到睡眠持续时间（p=0.009）、睡眠后醒来（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（p=0.000 和 p=0.008），与 WSAH 组中 N3 睡眠百分比和平均最小氧水平呈负相关（p=0.001 和 p=0.020）。
睡眠呼吸暂停相关性头痛的病因和可能机制尚未完全阐明，其潜在过程尚不完全清楚。睡眠呼吸暂停相关性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。
