Poceta J S, Dalessio D J
Scripps Clinic and Research Foundation, La Jolla, California 92037, USA.
Headache. 1995 Nov-Dec;35(10):586-9. doi: 10.1111/j.1526-4610.1995.hed3510586.x.
This study investigates the relationship between nocturnal or morning headache and obstructive sleep apnea syndrome (sleep apnea). It is not known if headache of any type is more common in patients with sleep apnea than in other patients, but morning headache is a symptom of sleep apnea. A method is needed for identifying patients with chronic headache who might benefit from evaluation and treatment of sleep apnea. We performed a retrospective assessment of frequency of morning headache in patients grouped according to final diagnosis: sleep apnea (n = 72), periodic leg movements of sleep (n = 28), and psychophysiologic insomnia (n = 42). Prospective overnight sleep studies were obtained in a different group of 19 patients who presented for evaluation of headache. We selected certain patient characteristics as possibly indicative of sleep apnea-related headache. The retrospective study showed that 24% of patients with sleep apnea had frequent morning headache, which was not different from the other groups. In the separate group of 19 patients with chronic headache and suspected sleep disorder, 17 had sleep apnea. Nasal continuous positive airway pressure was prescribed to 14 patients. Marked improvement in headache occurred and persisted in 4 patients and moderate improvement in 3. Responders to therapy were more likely to have vascular headaches than mixed or tension headaches, more severe sleep apnea, and a nocturnal or morning timing to their headaches. However, there was large overlap in severity of sleep apnea and likelihood of response. We conclude that morning headache is not more common in sleep apnea than in other sleep disorders. However, over 30% of patients with chronic headache and other symptoms of sleep apnea have significant improvement in headache after treatment of sleep apnea.
本研究调查夜间或早晨头痛与阻塞性睡眠呼吸暂停综合征（睡眠呼吸暂停）之间的关系。目前尚不清楚任何类型的头痛在睡眠呼吸暂停患者中是否比其他患者更常见，但早晨头痛是睡眠呼吸暂停的一种症状。需要一种方法来识别可能从睡眠呼吸暂停评估和治疗中受益的慢性头痛患者。我们根据最终诊断对患者进行分组，回顾性评估了早晨头痛的频率：睡眠呼吸暂停（n = 72）、睡眠周期性腿部运动（n = 28）和心理生理性失眠（n = 42）。对另一组因头痛前来评估的19名患者进行了前瞻性夜间睡眠研究。我们选择了某些可能提示与睡眠呼吸暂停相关头痛的患者特征。回顾性研究表明，24%的睡眠呼吸暂停患者经常出现早晨头痛，这与其他组并无差异。在另一组19名患有慢性头痛且疑似睡眠障碍的患者中，17人患有睡眠呼吸暂停。对14名患者开具了鼻持续气道正压通气治疗。4名患者的头痛出现了显著改善且持续存在，3名患者有中度改善。治疗有反应者比混合性或紧张性头痛患者更易出现血管性头痛，睡眠呼吸暂停更严重，且头痛发作于夜间或早晨。然而，睡眠呼吸暂停的严重程度和反应可能性存在很大重叠性。我们得出结论，早晨头痛在睡眠呼吸暂停患者中并不比其他睡眠障碍患者更常见。然而，超过30%患有慢性头痛及其他睡眠呼吸暂停症状的患者在接受睡眠呼吸暂停治疗后头痛有显著改善。
