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Mercante JPP, Oliveira AB, Peres MFP, Wang YP, Brunoni AR, Lotufo PA, Benseñor IM, Goulart AC. Association of mental health symptoms with the migraine-tension-type headache spectrum in the Brazilian longitudinal study of adult health. J Psychosom Res 2024; 179:111624. [PMID: 38432062 DOI: 10.1016/j.jpsychores.2024.111624] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Revised: 02/21/2024] [Accepted: 02/21/2024] [Indexed: 03/05/2024]
Abstract
OBJECTIVE To investigate the relationship between mental health symptoms and the migraine-tension-type headache (TTH) spectrum in middle-aged adults from the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil study). METHODS In this cross-sectional analysis (baseline data: 2008-2010), it was evaluated the relationship between each mental health symptom assessed by the Clinical Interview Schedule-Revised (CIS-R) questionnaire and headache subtypes (migraine and TTH) according to international criteria. It was performed binary logistic regression models, with estimated odds ratios (OR) with their respective 95% confidence intervals (CI) adjusted for confounders including migraine attack frequency. RESULTS Among 13,916 participants, 70.1% reported any major primary headache subtype within the last year. The most common subtype was definite TTH (33.4%), followed by probable migraine (21.0%), definite migraine (8.5%), and probable TTH (7.2%). Our main findings indicated positive associations between anxiety-related symptoms and the migraine-tension type headache (TTH) spectrum with a clear trend toward definite migraine more than tension-type headache. The presence of somatic symptoms presented a high likelihood for the associations with headaches, mainly definite migraine (OR: 7.9, 95% CI: 6.4-9.8), probable migraine (OR: 4.5, 95% CI 3.7-5.4) and probable TTH (OR: 3.0, 95% CI: 2.3-3.8). Other symptoms associated with headache disorders included fatigue, panic, irritability, anxiety symptoms, concentration problems, forgetfulness, depressive symptoms, and worry. The effect of associations remained significant after controlling for headache attack frequency. CONCLUSION This study provides evidence of consistent associations between mental health symptoms and primary headache disorders, with a higher burden of anxiety-based symptoms observed in people with migraine than those with TTH.
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Affiliation(s)
- Juliane Prieto Peres Mercante
- Center for Clinical and Epidemiological Research, Hospital Universitário, Universidade de São Paulo, São Paulo, SP, Brazil.
| | - Arão Belitardo Oliveira
- Center for Clinical and Epidemiological Research, Hospital Universitário, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Mario Fernando Prieto Peres
- Center for Clinical and Epidemiological Research, Hospital Universitário, Universidade de São Paulo, São Paulo, SP, Brazil; Instituto de Psiquiatria, Departamento de Psiquiatria, School of Medicine, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Yuan-Pang Wang
- Instituto de Psiquiatria, Departamento de Psiquiatria, School of Medicine, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Andre Russowsky Brunoni
- Center for Clinical and Epidemiological Research, Hospital Universitário, Universidade de São Paulo, São Paulo, SP, Brazil; Instituto de Psiquiatria, Departamento de Psiquiatria, School of Medicine, Universidade de São Paulo, São Paulo, SP, Brazil; School of Medicine, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Paulo Andrade Lotufo
- Center for Clinical and Epidemiological Research, Hospital Universitário, Universidade de São Paulo, São Paulo, SP, Brazil; Instituto de Psiquiatria, Departamento de Psiquiatria, School of Medicine, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Isabela Martins Benseñor
- Center for Clinical and Epidemiological Research, Hospital Universitário, Universidade de São Paulo, São Paulo, SP, Brazil; Instituto de Psiquiatria, Departamento de Psiquiatria, School of Medicine, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Alessandra Carvalho Goulart
- Center for Clinical and Epidemiological Research, Hospital Universitário, Universidade de São Paulo, São Paulo, SP, Brazil; Departament of Epidemiology, School of Public Health, Universidade de São Paulo, São Paulo, SP, Brazil
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Huang Z, Zhou N, Chattrattrai T, van Selms MKA, de Vries R, Hilgevoord AAJ, de Vries N, Aarab G, Lobbezoo F. Associations between snoring and dental sleep conditions: A systematic review. J Oral Rehabil 2023; 50:416-428. [PMID: 36691754 DOI: 10.1111/joor.13422] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Revised: 11/06/2022] [Accepted: 01/13/2023] [Indexed: 01/25/2023]
Abstract
BACKGROUND It is important for dentists to know if the presence of snoring is associated with the presence of other dental sleep conditions (e.g. obstructive sleep apnea [OSA], sleep bruxism [SB], gastroesophageal reflux disease [GERD], xerostomia and oro-facial pain). If so, dentists could play a significant role in the early recognition and management of these conditions. OBJECTIVES This systematic review aimed to: (i) investigate the associations between the presence of snoring and the presence of other dental sleep conditions; and (ii) determine if it is clinically relevant that dentists assess snoring in their population. METHODS The literature search was performed in PubMed and Embase.com in collaboration with a medical librarian. Studies were eligible if they employed regression models to assess whether snoring was associated with other dental sleep conditions, and/or investigated the incidence of snoring in patients with other dental sleep conditions and vice versa. RESULTS Of the 5299 retrieved references, 36 eligible studies were included. The available evidence indicates that the presence of snoring is associated with higher probabilities of OSA, GERD and headache. Due to limited evidence and conflicting findings, the currently available articles are not indicative of associations between the presence of snoring and the presence of SB and oral dryness. CONCLUSION Within the limitations of this study, it can be concluded that the presence of snoring is associated with higher probabilities of OSA, GERD and headache. Therefore, it is clinically relevant that dentists assess snoring in their patient population.
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Affiliation(s)
- Zhengfei Huang
- Department of Orofacial Pain and Dysfunction, Academic Center for Dentistry Amsterdam (ACTA), University of Amsterdam and Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.,Department of Clinical Neurophysiology, OLVG, Amsterdam, The Netherlands
| | - Ning Zhou
- Department of Orofacial Pain and Dysfunction, Academic Center for Dentistry Amsterdam (ACTA), University of Amsterdam and Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.,Amsterdam UMC location University of Amsterdam, Department of Oral and Maxillofacial Surgery, University of Amsterdam, Amsterdam, The Netherlands.,Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Thiprawee Chattrattrai
- Department of Orofacial Pain and Dysfunction, Academic Center for Dentistry Amsterdam (ACTA), University of Amsterdam and Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Maurits K A van Selms
- Department of Orofacial Pain and Dysfunction, Academic Center for Dentistry Amsterdam (ACTA), University of Amsterdam and Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Ralph de Vries
- Medical Library, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | | | - Nico de Vries
- Department of Orofacial Pain and Dysfunction, Academic Center for Dentistry Amsterdam (ACTA), University of Amsterdam and Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.,Department of Otorhinolaryngology - Head and Neck Surgery, OLVG, Amsterdam, The Netherlands.,Department of Otorhinolaryngology - Head and Neck Surgery, Antwerp University Hospital (UZA), Antwerp, Belgium
| | - Ghizlane Aarab
- Department of Orofacial Pain and Dysfunction, Academic Center for Dentistry Amsterdam (ACTA), University of Amsterdam and Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Frank Lobbezoo
- Department of Orofacial Pain and Dysfunction, Academic Center for Dentistry Amsterdam (ACTA), University of Amsterdam and Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
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Marchetti M, Gualtieri P, De Lorenzo A, Trombetta D, Smeriglio A, Ingegneri M, Cianci R, Frank G, Schifano G, Bigioni G, Di Renzo L. Dietary ω-3 intake for the treatment of morning headache: A randomized controlled trial. Front Neurol 2022; 13:987958. [PMID: 36203988 PMCID: PMC9530603 DOI: 10.3389/fneur.2022.987958] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Accepted: 08/31/2022] [Indexed: 11/13/2022] Open
Abstract
Morning headache (MH) is a frequent condition with a not fully explained pathogenesis. During the past years, several studies have been performed to identify a better diet therapy to reduce the frequency and intensity of headaches. Our study aims to determine if an adequate omega-3 (ω-3) intake in a Modified Mediterranean Diet (MMD) can improve the frequency and intensity of MH and, subsequently, the quality of life. Of the 150 enrolled subjects, 95 met the inclusion criteria (63.3%). Patients were included in the study and randomized into two groups: group A following MMD A and group B following MMD B. The MMD A group was designed to arise at least a 1.5:1 ω-6/ω-3 ratio; the MMD B group was designed to derive at least a 4:1 ω-6/ω-3 ratio. Eighty-four subjects completed the 6 weeks intervention (56%). After 6 weeks (t1), group A showed a significant reduction in both Headache Impact Test-6 and Visual Analog Scale scores (p < 0.001, p < 0.001, respectively). During dietary treatment, group A progressively dismissed ketoprofen-based pharmacological treatment (p = 0.002) from baseline to t1. Furthermore, a decrease in the platelet-to-lymphocyte ratio and neutrophil-to-lymphocyte ratio at t1 in group A (p = 0.02) was observed compared to group B. Concluding, this study provides evidence of a positive impact of ω-3-enriched MMD regimen on the inflammatory status and MH. Clinical trial registration:https://clinicaltrials.gov/ct2/show/NCT01890070, identifier: NCT01890070.
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Affiliation(s)
- Marco Marchetti
- PhD School of Applied Medical-Surgical Sciences, University of Rome Tor Vergata, Rome, Italy
| | - Paola Gualtieri
- Section of Clinical Nutrition and Nutrigenomics, Department of Biomedicine and Prevention, University of Tor Vergata, Rome, Italy
| | - Antonino De Lorenzo
- Section of Clinical Nutrition and Nutrigenomics, Department of Biomedicine and Prevention, University of Tor Vergata, Rome, Italy
| | - Domenico Trombetta
- Department of Chemical, Biological, Pharmaceutical and Environmental Sciences (ChiBioFarAm), University of Messina, Messina, Italy
- *Correspondence: Domenico Trombetta
| | - Antonella Smeriglio
- Department of Chemical, Biological, Pharmaceutical and Environmental Sciences (ChiBioFarAm), University of Messina, Messina, Italy
| | - Mariarosaria Ingegneri
- Department of Chemical, Biological, Pharmaceutical and Environmental Sciences (ChiBioFarAm), University of Messina, Messina, Italy
| | - Rossella Cianci
- Dipartimento di Medicina e Chirurgia Traslazionale, Università Cattolica del Sacro Cuore, Fondazione Policlinico Universitario “Agostino Gemelli” IRCCS, Rome, Italy
| | - Giulia Frank
- School of Specialization in Food Science, University of Tor Vergata, Rome, Italy
| | - Giulia Schifano
- School of Specialization in Food Science, University of Tor Vergata, Rome, Italy
| | - Giulia Bigioni
- Department of Physics, University of Rome Sapienza, Rome, Italy
| | - Laura Di Renzo
- Section of Clinical Nutrition and Nutrigenomics, Department of Biomedicine and Prevention, University of Tor Vergata, Rome, Italy
- School of Specialization in Food Science, University of Tor Vergata, Rome, Italy
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Kim HY, Jo JH, Chung JW, Park JW. The multisystemic effects of oral appliance therapy for obstructive sleep apnea: A narrative review. Medicine (Baltimore) 2022; 101:e29400. [PMID: 35866792 PMCID: PMC9302291 DOI: 10.1097/md.0000000000029400] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
Obstructive sleep apnea (OSA) is a chronic condition accompanied by repeated obstruction of the upper airway during sleep despite respiratory efforts, resulting in intermittent hypoxemia, altered sleep structure, and sympathetic activation. Previous studies have shown a significant association between OSA and general health issues such as cardiovascular diseases, endocrine disorders, neurocognitive function decline, and poor quality of life. Continuous positive airway pressure (CPAP) has been considered as the first line treatment for OSA. However, accumulating evidence supports the role of oral appliance (OA) therapy, including mandibular advancement devices, as an alternative option for snoring and OSA patients who do not comply with or refuse CPAP usage. Despite a generally favorable outcome of OA therapy for OSA related respiratory indices, studies focusing on the impact of systemic effects of OA therapy in OSA patients are relatively scarce compared with the extensive literature focusing on the systemic effects of CPAP. Therefore, this article aimed to provide an overview of the current evidence regarding the multisystemic effects of OA therapy for OSA.
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Affiliation(s)
- Hee Young Kim
- Department of Oral Medicine, Seoul National University Dental Hospital, Seoul, Republic of Korea
- Department of Oral Medicine and Oral Diagnosis, School of Dentistry, Seoul National University, Seoul, Republic of Korea
| | - Jung Hwan Jo
- Department of Oral Medicine, Seoul National University Dental Hospital, Seoul, Republic of Korea
- Department of Oral Medicine and Oral Diagnosis, School of Dentistry, Seoul National University, Seoul, Republic of Korea
| | - Jin Woo Chung
- Department of Oral Medicine, Seoul National University Dental Hospital, Seoul, Republic of Korea
- Department of Oral Medicine and Oral Diagnosis, School of Dentistry, Seoul National University, Seoul, Republic of Korea
- Dental Research Institute, Seoul National University, Seoul, Republic of Korea
| | - Ji Woon Park
- Department of Oral Medicine, Seoul National University Dental Hospital, Seoul, Republic of Korea
- Department of Oral Medicine and Oral Diagnosis, School of Dentistry, Seoul National University, Seoul, Republic of Korea
- Dental Research Institute, Seoul National University, Seoul, Republic of Korea
- *Correspondence: Ji Woon Park, Orofacial Pain Clinic, Department of Oral Medicine and Oral Diagnosis, School of Dentistry and Dental Research Institute, Seoul National University, 101 Yunkeun-Dong, Chongro-Ku, Seoul 03080, Republic of Korea (e-mail: )
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Abstract
Obstructive sleep apnea (OSA) is a disease that results from loss of upper airway muscle tone leading to upper airway collapse during sleep in anatomically susceptible persons, leading to recurrent periods of hypoventilation, hypoxia, and arousals from sleep. Significant clinical consequences of the disorder cover a wide spectrum and include daytime hypersomnolence, neurocognitive dysfunction, cardiovascular disease, metabolic dysfunction, respiratory failure, and pulmonary hypertension. With escalating rates of obesity a major risk factor for OSA, the public health burden from OSA and its sequalae are expected to increase, as well. In this chapter, we review the mechanisms responsible for the development of OSA and associated neurocognitive and cardiometabolic comorbidities. Emphasis is placed on the neural control of the striated muscles that control the pharyngeal passages, especially regulation of hypoglossal motoneuron activity throughout the sleep/wake cycle, the neurocognitive complications of OSA, and the therapeutic options available to treat OSA including recent pharmacotherapeutic developments.
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Affiliation(s)
- Luu V Pham
- Division of Pulmonary and Critical Care Medicine, Johns Hopkins University, Baltimore, MD, United States.
| | - Jonathan Jun
- Division of Pulmonary and Critical Care Medicine, Johns Hopkins University, Baltimore, MD, United States
| | - Vsevolod Y Polotsky
- Division of Pulmonary and Critical Care Medicine, Johns Hopkins University, Baltimore, MD, United States
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Ghonim HA, Nassef EM, El Sharaby FA. Prevalence of Obstructive Sleep Apnea in Orthodontic Patients with Different Skeletal Classes Using STOP-BANG Questionnaire: An Observational Study. Open Access Maced J Med Sci 2021. [DOI: 10.3889/oamjms.2021.5892] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
AIM: The aim of the study was to determine the prevalence of obstructive sleep apnea (OSA) in orthodontic adult patients with different skeletal classes and no pathology in the airway as detected from the lateral cephalometric radiographs using the STOP-BANG questionnaire.
METHODS: The sample comprised 309 subjects (152 males and 157 females) collected from the Egyptian population presented to the orthodontic follicular unit extraction for treatment. The sample was divided into three groups based on the anteroposterior relationship between maxilla and mandible (ANB angle) as evident from pretreatment lateral cephalometric. Patients were asked to fill out general medical history, sign a consent form, and fill in the STOP-BANG questionnaire. Patient’s neck size and height were measured using tape measuring tool and weighing scale, respectively. Body mass index (BMI) was obtained. After submission of the questionnaire, scores were measured for each patient to evaluate the severity of OSA.
RESULTS: Comparison between OSA risk in the three classes showed no statistically significant difference (p = 0.791, effect size = 0.052).
CONCLUSIONS: STOP-BANG questionnaire showed that there was no statistically significant difference in the prevalence of OSA between different skeletal classes.
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Park JW, Mehta S, Fastlicht S, Lowe AA, Almeida FR. Changes in headache characteristics with oral appliance treatment for obstructive sleep apnea. Sci Rep 2021; 11:2568. [PMID: 33510288 PMCID: PMC7843638 DOI: 10.1038/s41598-021-82041-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Accepted: 12/22/2020] [Indexed: 01/03/2023] Open
Abstract
Changes in headache characteristics in obstructive sleep apnea (OSA) patients following oral appliance treatment was investigated for the first time. Thirteen OSA patients with headaches treated with a mandibular advancement device were investigated. Level I polysomnography and Migraine Disability Assessment Questionnaire were completed before and after treatment. Various headache characteristics and concomitant conditions were analyzed. The patient was considered a headache responder when ≥ 30% reduction in headache frequency following treatment. Differences in headache and polysomnographic parameters were compared between headache responder groups. Eight patients (62%) were headache responders. Eleven patients (85%) before and 7 (54%) after treatment reported morning headaches. Significantly more patients had bilateral headache in the responder group before treatment (P = 0.035). The severest headache intensity (P = 0.018) at baseline showed a significant decrease in the headache responder group after treatment. The time spent in N2 (r = - 0.663, P = 0.014), REM sleep (r = 0.704, P = 0.007) and mean oxygen saturation (r = 0.566, P = 0.044) showed a significant correlation with post-treatment average headache intensity. Pre-treatment lower PLM index (r = - 0.632, P = 0.027) and higher mean oxygen saturation levels (r = 0.592, P = 0.043) were significantly correlated with higher post-treatment severest headache intensity. Treatment with an oral appliance is beneficial for many OSA patients with headaches. It should be considered as an alternative treatment in headache patients with mild to moderate OSA.
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Affiliation(s)
- Ji Woon Park
- Department of Oral Health Sciences, Faculty of Dentistry, University of British Columbia, 2199 Wesbrook Mall, Vancouver, BC, V6T 1Z3, Canada.,Department of Oral Medicine and Oral Diagnosis, School of Dentistry and Dental Research Institute, Seoul National University, 101, Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea
| | - Sujay Mehta
- Vancouver Orofacial Pain, 1160 Burrard Street #701, Vancouver, BC, V6Z 2E8, Canada
| | - Sandra Fastlicht
- Department of Oral Health Sciences, Faculty of Dentistry, University of British Columbia, 2199 Wesbrook Mall, Vancouver, BC, V6T 1Z3, Canada
| | - Alan A Lowe
- Department of Oral Health Sciences, Faculty of Dentistry, University of British Columbia, 2199 Wesbrook Mall, Vancouver, BC, V6T 1Z3, Canada
| | - Fernanda R Almeida
- Department of Oral Health Sciences, Faculty of Dentistry, University of British Columbia, 2199 Wesbrook Mall, Vancouver, BC, V6T 1Z3, Canada.
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Pergolizzi JV, Magnusson P, LeQuang JA, Wollmuth C, Taylor R, Breve F. Exploring the Connection Between Sleep and Cluster Headache: A Narrative Review. Pain Ther 2020; 9:359-371. [PMID: 32382871 PMCID: PMC7648820 DOI: 10.1007/s40122-020-00172-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Indexed: 12/12/2022] Open
Abstract
Cluster headache is a rare form of headache associated with sleep and even speculated to be a manifestation of a sleep disorder rather than a primary headache. Cluster headache exhibits both circadian and circannual rhythmicity. While attacks often occur during sleep, the implication that cluster headaches might be involved with rapid eye movement (REM) sleep phases has neither been fully established nor refuted. The regulatory mechanisms governing sleep including hypothalamic activity and the autonomic nervous system response may play a role. Hypothalamic activation has been observed in cluster headache patients during positron emission tomography testing, but only during attacks. While sleep apnea is associated with morning headaches in general, the link between sleep-disordered respiration and cluster headache remains elusive. Hypoarousal during sleep and periods of hypoxia are associated with cluster headache, the latter likely involving inflammatory processes rather than apnea. Further study is needed, as cluster headaches represent a serious primary cephalgia that is incompletely understood.
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Affiliation(s)
| | - Peter Magnusson
- Cardiology Research Unit, Department of Medicine, Karolinska Institutet, Stockholm, Sweden
- Centre for Research and Development, Uppsala University/Region Gävleborg, Gävle, Sweden
| | | | | | | | - Frank Breve
- Department of Pharmacy Practice, School of Pharmacy, Temple University, Philadelphia, PA, USA
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Zhu K, Born DW, Dilli E. Secondary Headache: Current Update. Headache 2020; 60:2654-2664. [PMID: 33078413 DOI: 10.1111/head.13986] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Accepted: 09/10/2020] [Indexed: 12/13/2022]
Abstract
PURPOSE The purpose of this paper is to review some of the causes of secondary headache particularly focusing on the subcategories of secondary headache in the International Classification of Headache Disorders, 3rd edition, the clinical features of these headaches, and their associated features and management. OVERVIEW Headache attributed to trauma or injury to the head and/or neck, headache attributed to cranial or cervical vascular disorder, headache attributed to non-vascular intracranial disorder, headache attributed to a substance or its withdrawal, headache attributed to infection, headache attributed to disorder of homeostasis, and headache or facial pain attributed to disorder of the cranium, neck, eye, ears, nose, sinuses, teeth, mouth, or other facial or cervical structure are discussed in this paper. DISCUSSION Headache is a common symptom of multiple medical conditions. Although a minority of headache patients have a secondary basis for their headaches, it is important to identify clinical features of secondary headache disorders including both the headache and non-headache features of the condition, diagnose the secondary etiology correctly, and treat them appropriately.
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Affiliation(s)
- Kai Zhu
- Department of Medicine, Division of Neurology, University of British Columbia, Vancouver, BC, Canada
| | - Dawson W Born
- Department of Medicine, Division of Neurology, University of British Columbia, Vancouver, BC, Canada
| | - Esma Dilli
- Department of Medicine, Division of Neurology, University of British Columbia, Vancouver, BC, Canada
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11
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Robblee J, Singh RH. Headache in the Older Population: Causes, Diagnoses, and Treatments. Curr Pain Headache Rep 2020; 24:34. [DOI: 10.1007/s11916-020-00866-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
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12
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KoÇ G, Metİn KM, AkÇay BD, KaradaŞ Ö, Sayin R, Yetkİn S. Relationship between Apnea-Hypopnea Index and Oxygen Desaturation in REM-Sleep Period and Morning Headache in Patients with Obstructive Sleep Apnea Syndrome. ACTA ACUST UNITED AC 2019; 57:294-298. [PMID: 33354121 DOI: 10.29399/npa.23348] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2018] [Accepted: 10/24/2018] [Indexed: 11/07/2022]
Abstract
Introduction In patients with morning headache, REM sleep period decreases though little is known about its physiopathology. We evaluate the polysomnographic records of obstructive sleep apnea syndrome (OSAS) patients with the hypothesis that oxygen desaturations may be a better determinant in patients with morning headache, especially those in REM sleep periods. Methods Patient group (group 1) with a total of 361 patients with OSAS and the controls (group 2) with 107 healthy individuals were evaluated. The presence of morning headache was compared between the groups, and sleep parameters were correlated with morning headache. Results In group 1, patients with OSAS and morning headache, apnea-hypopnea index in the REM sleep period (26.7/hour, min-max: 0-108.4/hour) was higher than those in patients without morning headache (17.8/hour, min-max: 0-107.8/hour). The minimum oxygen saturation in REM sleep period and total sleep time (TST) was lower in patients with morning headache (REM sleep period: 82%, min-max: 50-94% ; TST: 79%, min-max: 50-97%) in compared to patients without morning headache (REM sleep period: 84%, min-max: 50-93% ; TST: 81%, min-max: 50-90%). Conclusion Here we demonstrated that higher apnea-hypopnea index and lower oxygen saturation in REM sleep period were associated with morning headache in patients with obstructive sleep apnea syndrome.
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Affiliation(s)
- Güray KoÇ
- Department of Neurology, Gülhane Training and Research Hospital, Ankara, Turkey
| | - Kübra Mehel Metİn
- Department of Neurology, Gülhane Training and Research Hospital, Ankara, Turkey
| | - Bülent Devrim AkÇay
- Department of Psychiatry, Gülhane Training and Research Hospital, Ankara, Turkey
| | - Ömer KaradaŞ
- Department of Neurology, Gülhane Training and Research Hospital, Ankara, Turkey
| | - Refah Sayin
- Department of Neurology, Ufuk University Faculty of Medicine, Ankara, Turkey
| | - Sinan Yetkİn
- Department of Psychiatry, Gülhane Training and Research Hospital, Ankara, Turkey
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Vgontzas A, Pavlović JM. Sleep Disorders and Migraine: Review of Literature and Potential Pathophysiology Mechanisms. Headache 2018; 58:1030-1039. [PMID: 30091160 DOI: 10.1111/head.13358] [Citation(s) in RCA: 118] [Impact Index Per Article: 19.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/31/2016] [Indexed: 12/20/2022]
Abstract
Migraine shares a complex and poorly understood relationship with sleep. Patients consistently report poor sleep prior to migraine attacks and during them, identifying poor sleep as a migraine trigger. However, anecdotally, sleep is reported to serve a therapeutic role in terminating headache. Are the associations between migraine and sleep simply the result of various bidirectional relationships? A growing body of evidence suggests there may be a common underlying etiology as well. Our objective was to review studies of sleep and migraine from the last 2 decades utilizing validated subjective and objective measures of sleep and to explore potential mechanisms underlying this complex relationship by incorporating recent advances in neuroscience. We specifically focus on insomnia, obstructive sleep apnea, parasomnias, sleep related movement disorders, and REM sleep related disorders and their relationship to migraine. Parts of brainstem-cortical networks involved in sleep physiology are unintentionally being identified as important factors in the common migraine pathway. Recent discoveries on anatomic localization (the hypothalamus as a key and early mediator in the pathophysiology of migraine), common mediating signaling molecules (such as serotonin and dopamine), and the discovery of a new CNS waste removal system, the glymphatic system, all point to a common pathophysiology manifesting in migraine and sleep problems.
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Affiliation(s)
- Angeliki Vgontzas
- John R. Graham Headache Center, Department of Neurology, Brigham and Women's Faulkner Hospital, Harvard Medical School, Boston, MA, USA
| | - Jelena M Pavlović
- Montefiore Headache Center, Department of Neurology, Albert Einstein College of Medicine, Bronx, NY, USA
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Lovati C, Giani L, D'Amico D, Mariani C. Sleep, headaches and cerebral energy control: a synoptic view. Expert Rev Neurother 2016; 17:239-250. [PMID: 27547918 DOI: 10.1080/14737175.2016.1226133] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
INTRODUCTION The amount of cerebral functions is particularly elevated. This intense activity requires a great expenditure of energy: the restoration of energy is the fundamental function of sleep whilst the slowdown in energy consumption may be considered the physiological effect of primary headaches. The continuous interaction of sleep and primary headaches is possible as they share many anatomical and functional cerebral systems. Areas covered: This review describes how sleep and headaches are reciprocally involved in preservation and restoration of brain energy. Data were obtained from the most relevant and recent works available in PubMed about this topic. Expert commentary: The energetic view of sleep, primary headaches and their relationship may have relevant clinical consequences: the investigation and the modification of the multiple aspects, primarily environmental, that may influence sleep and headache, become mandatory to facilitate the cerebral energy preservation by reducing its consumption and by ensuring its recovery.
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Affiliation(s)
| | - Luca Giani
- b Neurology Unit , Luigi Sacco Hospital, Milan Study University , Milan , Italy
| | - Domenico D'Amico
- c Headache Center , C. Besta Neurological Institute and Foundation , Milan , Italy
| | - Claudio Mariani
- b Neurology Unit , Luigi Sacco Hospital, Milan Study University , Milan , Italy
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15
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Dolso P, Merlino G, Fratticci L, Canesin R, Valiante G, Coccolo D, Gigli GL. Non-REM Hypnic Headache: A Circadian Disorder? A Clinical And Polysomnographic Study. Cephalalgia 2016; 27:83-6. [PMID: 17212689 DOI: 10.1111/j.1468-2982.2006.01227.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- P Dolso
- Sleep Disorder Centre, Neurology and Clinical Neurophysiology, S. Maria della Misericordia Hospital, Udine, Italy
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16
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Arnardottir ES, Isleifsson B, Agustsson JS, Sigurdsson GA, Sigurgunnarsdottir MO, Sigurđarson GT, Saevarsson G, Sveinbjarnarson AT, Hoskuldsson S, Gislason T. How to measure snoring? A comparison of the microphone, cannula and piezoelectric sensor. J Sleep Res 2015; 25:158-68. [PMID: 26553758 DOI: 10.1111/jsr.12356] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2015] [Accepted: 09/08/2015] [Indexed: 11/28/2022]
Abstract
The objective of this study was to compare to each other the methods currently recommended by the American Academy of Sleep Medicine (AASM) to measure snoring: an acoustic sensor, a piezoelectric sensor and a nasal pressure transducer (cannula). Ten subjects reporting habitual snoring were included in the study, performed at Landspitali-University Hospital, Iceland. Snoring was assessed by listening to the air medium microphone located on a patient's chest, compared to listening to two overhead air medium microphones (stereo) and manual scoring of a piezoelectric sensor and nasal cannula vibrations. The chest audio picked up the highest number of snore events of the different snore sensors. The sensitivity and positive predictive value of scoring snore events from the different sensors was compared to the chest audio: overhead audio (0.78, 0.98), cannula (0.55, 0.67) and piezoelectric sensor (0.78, 0.92), respectively. The chest audio was capable of detecting snore events with lower volume and higher fundamental frequency than the other sensors. The 200 Hz sampling rate of the cannula and piezoelectric sensor was one of their limitations for detecting snore events. The different snore sensors do not measure snore events in the same manner. This lack of consistency will affect future research on the clinical significance of snoring. Standardization of objective snore measurements is therefore needed. Based on this paper, snore measurements should be audio-based and the use of the cannula as a snore sensor be discontinued, but the piezoelectric sensor could possibly be modified for improvement.
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Affiliation(s)
- Erna S Arnardottir
- Department of Respiratory Medicine and Sleep, Landspitali-The National University Hospital of Iceland, Reykjavik, Iceland.,Faculty of Medicine, University of Iceland, Reykjavik, Iceland
| | | | | | - Gunnar A Sigurdsson
- Nox Medical, Reykjavik, Iceland.,School of Computer Science, Carnegie Mellon University, Pittsburgh, PA, USA
| | - Magdalena O Sigurgunnarsdottir
- Department of Respiratory Medicine and Sleep, Landspitali-The National University Hospital of Iceland, Reykjavik, Iceland
| | - Gudjon T Sigurđarson
- Nox Medical, Reykjavik, Iceland.,Department of Electrical Engineering and Information Technology, Karlsruhe Institute of Technology, Karlsruhe, Germany
| | | | | | | | - Thorarinn Gislason
- Department of Respiratory Medicine and Sleep, Landspitali-The National University Hospital of Iceland, Reykjavik, Iceland.,Faculty of Medicine, University of Iceland, Reykjavik, Iceland
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17
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Uhlig BL, Engstrøm M, Ødegård SS, Hagen KK, Sand T. Headache and insomnia in population-based epidemiological studies. Cephalalgia 2014; 34:745-51. [PMID: 24973418 DOI: 10.1177/0333102414540058] [Citation(s) in RCA: 54] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Several epidemiological studies on the association between primary headaches and insomnia have been published in recent years. Both disorders are frequent, and our purpose was to review results from population-based studies exploring this association. METHODS We performed a literature search in PubMed for "insomnia" (or sleep disturbance) and "headache" (or migraine) linked with "epidemiology." Two hundred and eight records were identified. Three longitudinal and 10 cross-sectional studies met our inclusion criteria: population-based design with at least 200 participants including a numerical estimate of the association between headache and insomnia. RESULTS AND CONCLUSIONS In nearly all studies, primary headaches, including migraine and tension-type headache, were significantly related to insomnia symptoms with OR estimates ranging from 1.4 to 1.7. The odds were even greater, from 2.0 to 2.6, for frequent, comorbid or severe headache. Recent large longitudinal studies from Norway found a bidirectional, possibly causal, association between headache and insomnia. However, not all studies used standardized diagnostic criteria for either headache or insomnia. Further research should use well defined and validated diagnostic criteria both for insomnia and headache types in order to improve the comparability between studies, investigate causality and clarify the relevance of the findings for clinical practice.
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Affiliation(s)
- B L Uhlig
- Department of Neuroscience, Norwegian University of Science and Technology, Norway
| | - M Engstrøm
- Department of Neuroscience, Norwegian University of Science and Technology, Norway Department of Neurology and Clinical Neurophysiology, St. Olavs Hospital, Norway
| | - S S Ødegård
- Department of Neuroscience, Norwegian University of Science and Technology, Norway
| | - K K Hagen
- Department of Neuroscience, Norwegian University of Science and Technology, Norway Department of Neurology and Clinical Neurophysiology, St. Olavs Hospital, Norway Norwegian National Headache Centre, St. Olavs Hospital, Norway
| | - T Sand
- Department of Neuroscience, Norwegian University of Science and Technology, Norway Department of Neurology and Clinical Neurophysiology, St. Olavs Hospital, Norway
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18
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Russell MB, Kristiansen HA, Kværner KJ. Headache in sleep apnea syndrome: Epidemiology and pathophysiology. Cephalalgia 2014; 34:752-5. [DOI: 10.1177/0333102414538551] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
This review investigates the relation between obstructive sleep apnea and sleep apnea headache, migraine and tension-type headache. Focus is made on studies from the general population with interviews conducted by a physician and obstructive sleep apnea confirmed by polysomnography. Obstructive sleep apnea syndrome is observed in 3% of the middle-aged population. The prevalence of sleep apnea headache in this population is 12%–18%, while morning headache with similar symptomatology as sleep apnea headache occur in 5%–8% of the general population. People with sleep apnea headache did have significantly more minutes below 90% oxygen saturation (23.1 min vs. 1.9 min, p = 0.002), higher level of average oxygen desaturation (5.9% vs. 4.5%, p < 0.001) and lower average of the lowest oxygen saturation (80.9% vs. 88.5%, p < 0.001) than people with morning headache. A comparison of those with obstructive sleep apnea with or without sleep apnea headache showed no significant differences. Thus, oxygen desaturation alone cannot explain the pathophysiology of sleep apnea headache. Obstructive sleep apnea and migraine, and obstructive sleep apnea and tension-type headache are not related in the general population. The cause of sleep apnea headache remains to be elucidated.
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Affiliation(s)
- Michael B Russell
- Head and Neck Research Group, Research Centre, Akershus University Hospital, Norway
- Institute of Clinical Medicine, Campus Akershus University Hospital, University of Oslo, Norway
| | - Håvard A Kristiansen
- Head and Neck Research Group, Research Centre, Akershus University Hospital, Norway
- Institute of Clinical Medicine, Campus Akershus University Hospital, University of Oslo, Norway
| | - Kari J Kværner
- Head and Neck Research Group, Research Centre, Akershus University Hospital, Norway
- Department of Research and Education, Oslo University Hospital, Norway
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19
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Lovati C, D’Amico D, Raimondi E, Mariani C, Bertora P. Sleep and headache: a bidirectional relationship. Expert Rev Neurother 2014; 10:105-17. [DOI: 10.1586/ern.09.135] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
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20
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Beiske KK, Russell MB, Stavem K. Prevalence and predictors of headache in patients referred to polysomnography. J Headache Pain 2013; 14:90. [PMID: 24246019 PMCID: PMC3835865 DOI: 10.1186/1129-2377-14-90] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2013] [Accepted: 11/11/2013] [Indexed: 11/21/2022] Open
Abstract
Background The objectives of this study were; (1) to assess the prevalence and frequency of headache in patients referred to polysomnography (PSG) due to a clinical suspicion of obstructive sleep apnea (OSA) or another sleep disturbance and compare with a reference population, and (2) to assess the association of OSA severity with headache and headache frequency. Methods A total of 784 participants filled in a headache questionnaire between 2003 and 2009 at the Department of Clinical Neurophysiology, Akershus University Hospital. Of these patients 477 were suspected to have OSA, and 307 had other sleep complaints. We assessed the prevalence of headache and monthly headache frequencies, as well as sleep apnea severity using an apnea-hypopnea index (AHI). The association of headache and monthly headache frequencies with PSG subgroups was assessed using multivariate logistic and ordered logistic regression analysis. Results The frequency of headache was not associated with the severity of OSA. Patients referred to a sleep study for any reason had higher odds ratio (OR) for having experienced headache during the past year than population controls after adjustment for age, gender and education, i.e. patients with normal AHI had OR of 3.56, patients with OSA had OR of 3.51, and patients with other sleep disturbances had OR of 3.33. Similarly, the adjusted OR of being in a higher category of monthly headache frequency compared to controls was higher in those with normal AHI (OR 3.42), OSA (OR 3.29), and other sleep disturbances (OR 3.00). Conclusions The odds of headache and headache frequency were higher in subjects referred to a PSG for any sleep disturbance independently of OSA, compared to general population controls. However, there was no association between experiencing headache during the past year or headache frequency with OSA severity.
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21
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Russell MB. Sleep apnea headache: a growing concern in an increasingly obese population? Expert Rev Neurother 2013; 13:1129-33. [PMID: 24117275 DOI: 10.1586/14737175.2013.840422] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Sleep apnea headache is a recurrent universal pressing headache without accompanying symptoms at awakening that resolves within 4 h. The diagnosis requires polysomnography-verified apnea hypopnea index≥5, that is, obstructive sleep apnea (OSA). Morning headache has similar symptomatology without OSA. The prevalence of sleep apnea headache is 10-15% in people with OSA, whereas morning headache occurs in 5%. The severity of OSA only slightly affects the prevalence of sleep apnea headache. The pathophysiology of sleep apnea headache remains an enigma, since average oxygen desaturation and lowest oxygen saturation are similar in OSA people without sleep apnea headache. Migraine and tension-type headache are unrelated to OSA. Thus, growing concern of sleep apnea headache in an increasingly obese population is unfounded with our current knowledge.
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Affiliation(s)
- Michael B Russell
- Head and Neck Research Group,Research Centre, Akershus University Hospital, Norway and
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22
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Engstrøm M, Hagen K, Bjørk M, Gravdahl GB, Sand T. Sleep-related and non-sleep-related migraine: interictal sleep quality, arousals and pain thresholds. J Headache Pain 2013; 14:68. [PMID: 23919583 PMCID: PMC3750452 DOI: 10.1186/1129-2377-14-68] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2013] [Accepted: 07/31/2013] [Indexed: 01/07/2023] Open
Abstract
Background The mechanisms associating sleep and migraine are unknown. No previous polysomnographic (PSG) or pain-threshold (PT) study has compared patients with sleep-related migraine attacks (SM), non-sleep related migraine attacks (NSM) and healthy controls. Methods We have performed a blinded, prospective exploratory study with case–control design. Thirty-four healthy controls, 15 patients with SM and 18 patients with NSM had interictal PSG heat-, cold- and pressure PT (HPT, CPT, PPT) recordings and completed diary- and questionnaire on sleep and headache related aspects. Results NSM patients had more slow-wave sleep (SWS) and more K-bursts than SM patients (K-bursts: p = 0.023 and SWS: p = 0.030) and controls (K-bursts: p = 0.009 and SWS: 0.041). NSM patients also had lower HPT and CPT than controls (p = 0.026 and p = 0.021). In addition, SM patients had more awakenings and less D-bursts than controls (p = 0.025 and p = 0.041). Conclusion SM- and NSM patients differed in objective-, but not subjective sleep quality. NSM patients had PSG findings indicating foregoing sleep deprivation. As foregoing sleep times were normal, a relative sleep deficit might explain reduced PT among NSM patients. The SM patients had signs of slightly disturbed sleep.
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Affiliation(s)
- Morten Engstrøm
- Department of Clinical Neurosciences, PB 8905, MTFS, Norwegian University of Science and Technology, Trondheim N-7489, Norway.
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23
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Johnson KG, Ziemba AM, Garb JL. Improvement in headaches with continuous positive airway pressure for obstructive sleep apnea: a retrospective analysis. Headache 2012; 53:333-43. [PMID: 22963547 DOI: 10.1111/j.1526-4610.2012.02251.x] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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.
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24
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Seidel S, Frantal S, Oberhofer P, Bauer T, Scheibel N, Albert F, Pacher J, Casjens T, Klösch G, Zeitlhofer J, Wöber C. Morning headaches in snorers and their bed partners: a prospective diary study. Cephalalgia 2012; 32:888-95. [PMID: 22781106 DOI: 10.1177/0333102412453950] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND The prevalence and characteristics of morning headaches (MH) in habitual snorers are not well known, with only one retrospective study reporting MH in 23.5% of snorers. The role of MH in bed partners of snorers has not yet been examined. Therefore, the objective of this study was to assess MH prospectively in habitual snorers and their bed partners. METHODS We recruited habitual snorers and their bed partners via newspaper articles. The participants completed a semistructured interview, filled in questionnaires about sleep quality, daytime sleepiness, depression and anxiety and kept a 90-day headache and sleep diary. RESULTS We included a total of 102 snorers and 63 bed partners. Seventy-six snorers (25 female) and 41 bed partners (31 female) completed the study, recording a total of 6690 and 3497 diary days, respectively. MH was present on at least 1 day in 57% of the snorers and in 61% of the bed partners and recorded on 7.2% and 3.6% of the diary days, respectively. Independent predictors of MH in snorers were pre-study headache frequency (p < 0.001), anxiety disorder (p < 0.001), waking up because of pain (p = 0.002) and waking up too early (p < 0.001); and independent predictors in bed partners were migraine (p = 0.02), difficulties breathing during sleep (p < 0.001), waking up because of pain (p = 0.01) and waking up too early (p < 0.001). The analysis of couples only (n = 41) revealed pre-study headache frequency (p < 0.001), waking up too early (p < 0.001) and nocturnal confusion (p < 0.001) as independent predictors of MH in snorers, and migraine (p = 0.02), difficulties breathing during sleep (p < 0.001), waking up because of pain (p = 0.01) and waking up too early (p < 0.001) as independent predictors in bed partners. DISCUSSION MH shows a 90-day prevalence of around 60% in habitual snorers as well as in their bed partners. Predictors of MH are related to sleep, headache and psychiatric comorbidity.
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25
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Roizenblatt M, Rosa Neto NS, Tufik S, Roizenblatt S. Pain-related diseases and sleep disorders. Braz J Med Biol Res 2012; 45:792-8. [PMID: 22760852 PMCID: PMC3854323 DOI: 10.1590/s0100-879x2012007500110] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2012] [Accepted: 06/25/2012] [Indexed: 08/30/2023] Open
Abstract
Pain and sleep share mutual relations under the influence of cognitive and neuroendocrine changes. Sleep is an important homeostatic feature and, when impaired, contributes to the development or worsening of pain-related diseases. The aim of the present review is to provide a panoramic view for the generalist physician on sleep disorders that occur in pain-related diseases within the field of Internal Medicine, such as rheumatic diseases, acute coronary syndrome, digestive diseases, cancer, and headache.
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Affiliation(s)
- M Roizenblatt
- Departamento de Psicobiologia, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, SP, Brasil
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26
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Rangel ÂJDAE, Barros VDM, Seraidarian PI. Snoring and obstructive sleep apnea syndrome: a reflection on the role of dentistry in the current scientific scenario. Dental Press J Orthod 2012. [DOI: 10.1590/s2176-94512012000300014] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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27
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Kristiansen HA, Kværner KJ, Akre H, Øverland B, Sandvik L, Russell MB. Sleep apnoea headache in the general population. Cephalalgia 2011; 32:451-8. [DOI: 10.1177/0333102411431900] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background: The objective was to investigate the prevalence and clinical characteristics of sleep apnoea headache. Methods: A postal questionnaire was received by 40,000 Norwegians from the general population. A total of 376 and 157 persons with high and low risk of sleep apnoea according to the Berlin Questionnaire had a polysomnography, and a clinical interview and examination by physicians. Results: Sleep apnoea headache was diagnosed in 11.8% of the participants with obstructive sleep apnoea (OSA), while morning headache with similar symptomatology was diagnosed in 4.6% of the participants without OSA ( p = 0.002). After adjusting for potential confounders the odds ratio for OSA remained significantly increased among participants with morning headache with an adjusted odds ratio of 2.92 (1.31–6.51). When using a cut-off of moderate (apnoea hypopnea index, AHI ≥ 15) and severe (AHI ≥ 30) OSA, the prevalence of sleep apnoea headache was 11.6% and 13.3%, respectively. Average oxygen desaturation and lowest oxygen saturation was not significantly different in participants with OSA with and without morning headache. Conclusion: Morning headaches were significantly more frequent among participants with OSA than those without OSA. Sleep apnoea headache is less common in the general population than has previously been reported in clinic populations. The relation of hypoxia and morning headache is questioned.
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Affiliation(s)
- Håvard Anton Kristiansen
- Head and Neck Research Group, Akershus University Hospital, Norway
- Campus Akershus University Hospital, University of Oslo, Norway
| | - Kari Jorunn Kværner
- Head and Neck Research Group, Akershus University Hospital, Norway
- Oslo University Hospital, Norway
| | - Harriet Akre
- Head and Neck Research Group, Akershus University Hospital, Norway
- Lovisenberg Diakonale Hospital, Norway
| | - Britt Øverland
- Head and Neck Research Group, Akershus University Hospital, Norway
- Lovisenberg Diakonale Hospital, Norway
| | | | - Michael Bjørn Russell
- Head and Neck Research Group, Akershus University Hospital, Norway
- Campus Akershus University Hospital, University of Oslo, Norway
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28
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Chen PK, Fuh JL, Lane HY, Chiu PY, Tien HC, Wang SJ. Morning headache in habitual snorers: frequency, characteristics, predictors and impacts. Cephalalgia 2011; 31:829-36. [PMID: 21602422 DOI: 10.1177/0333102411403635] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVES Morning headache has been considered as an accompanying symptom of obstructive sleep apnoea syndrome (OSAS). However the frequency, characteristics, predictors and impacts of morning headache in habitual snorers are not well defined. METHODS We studied consecutive patients with habitual snoring in a sleep laboratory using polysomnography. All patients were interviewed by a physician regarding the presence or absence of morning headache, migraine and insomnia. Each patient completed the Short Form-36 health survey (SF-36) and the Hospital Anxiety and Depression Scale (HADS). Morning headache was defined as headache on awakening ≥1 day/week for ≥6 months. RESULTS Of the 268 participants with habitual snoring, 63 (23.5%) had morning headache and 184 (69%) had OSAS. Patients with morning headache reported lower scores in all eight domains of the SF-36 than those without (difference: 10.6 to 29.7 points, all p ≤ 0.005). The independent predictors of morning headache were migraine (adjusted odds ratio (AOR) 6.3), insomnia (AOR 4.2), psychological distress (HADS ≥ 8) (AOR 3.9) and OSAS (AOR 2.6). Morning headache in 12 patients (19%) fulfilled the criteria for migraine attacks. CONCLUSIONS Morning headache was common in habitual snorers and associated with a pervasive impairment of health-related quality of life. Migrainous features were not uncommon. Not only OSAS, but migraine, insomnia and psychological distress were also important predictors for morning headache, even in snoring patients.
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Cruz IAC, Drummond M, Winck JC. Obstructive sleep apnea symptoms beyond sleepiness and snoring: effects of nasal APAP therapy. Sleep Breath 2011; 16:361-6. [PMID: 21365185 DOI: 10.1007/s11325-011-0502-4] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2010] [Revised: 01/08/2011] [Accepted: 02/21/2011] [Indexed: 12/11/2022]
Abstract
OBJECTIVE The purpose of this study was to evaluate the prevalence and assess the response to nasal automatic positive airway pressure (APAP) therapy of less typical symptoms in patients diagnosed with obstructive sleep apnea (OSA), like fatigue, gasping, nocturia, nocturnal sweating, morning headaches, heartburn, and erectile dysfunction. METHODS Ninety-eight male patients with moderate to severe OSA were included in the study (n = 98). In the beginning of the study, an overnight sleep study was performed to all subjects using a five-channel recording device. Patients started APAP therapy with pre-determined minimum and maximum pressures of 4 and 15 cmH(2)0, respectively. The total Sleep Disorders Questionnaire was answered by all subjects before and 6 months after APAP therapy. Questions 4, 18, 23, 25, 58, 88, and 148 were used in this study. Statistical analysis was performed using Statistical Package for the Social Sciences (SPSS) 17.0 software. RESULTS Subjects had a mean (SD) age of 55.1 (10.8) years and an average of 52.2 (21.4) apnea-hypopnea events per hour of sleep. At baseline, nocturia was the most prevalent symptom (38%), followed by nocturnal sweating (34%), gasping (30%), erectile dysfunction (25%), fatigue (23%), heartburn (15%), and morning headaches (10%). After 6 months of APAP therapy, a statistically significant reduction on the prevalence of all symptoms was observed, except for erectile dysfunction and morning headaches. CONCLUSION The findings suggest that APAP therapy is effective in controlling the majority of OSA symptoms beyond sleepiness and snoring.
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Affiliation(s)
- Ivo A C Cruz
- Department of Pulmonology, São João Hospital, Faculty of Medicine, University of Porto, Alameda Professor Doutor Hernâni Monteiro, 4200-319, Porto, Portugal
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Kristiansen HA, Kværner KJ, Akre H, Overland B, Russell MB. Migraine and sleep apnea in the general population. J Headache Pain 2011; 12:55-61. [PMID: 21165665 PMCID: PMC3056010 DOI: 10.1007/s10194-010-0268-2] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2010] [Accepted: 11/12/2010] [Indexed: 01/05/2023] Open
Abstract
Objective is to investigate the relationship between migraine and obstructive sleep apnea in the general population. A cross-sectional population-based study. A random age and gender stratified sample of 40,000 persons aged 20-80 years residing in Akershus, Hedmark or Oppland County, Norway, were drawn by the National Population Register. A postal questionnaire containing the Berlin Questionnaire was used to classify respondents to be of either high or low risk of obstructive sleep apnea. 376 persons with high risk and 157 persons with low risk of sleep apnea aged 30-65 years were included for further investigations. They underwent an extensive clinical interview, a physical and a neurological examination by physicians, and in-hospital polysomnography. Those with apnea hypopnoea index (AHI) ≥5 were classified with obstructive sleep apnea. Migraine without aura (MO) and migraine with aura (MA) was diagnosed according to the International Classification of Headache Disorders. MO and MA occurred in 12.5 and 6.8% of the participants with obstructive sleep apnea. The logistic regression analyses showed no relationship between the two types of migraine and obstructive sleep apnea, with adjusted odds ratios for MO 1.15 (0.65-2.06) and MA 1.15 (0.95-2.39). Further, estimates using cutoff of moderate (AHI ≥ 15) and severe (AHI ≥ 30) obstructive sleep apnea, did not reveal any significant relationship between migraine and the AHI. Migraine and obstructive sleep apnea are unrelated in the general population.
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Affiliation(s)
- Håvard Anton Kristiansen
- Head and Neck Research Group, Research Centre, Akershus University Hospital, Postbox 65, 1478 Lørenskog, Norway.
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31
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Kristiansen HA, Kværner KJ, Akre H, Overland B, Russell MB. Tension-type headache and sleep apnea in the general population. J Headache Pain 2011; 12:63-9. [PMID: 21161317 PMCID: PMC3055994 DOI: 10.1007/s10194-010-0265-5] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2010] [Accepted: 10/25/2010] [Indexed: 11/29/2022] Open
Abstract
The main objective of this study is to investigate the relationship between tension-type headache and obstructive sleep apnea in the general population. The method involves a cross-sectional population-based study. A random age and gender stratified sample of 40,000 persons aged 20-80 years residing in Akershus, Hedmark or Oppland County, Norway were drawn by the National Population Register. A postal questionnaire containing the Berlin Questionnaire was used to classify respondents to be of either high or low risk of obstructive sleep apnea. Included in this study were 297 persons with high risk and 134 persons with low risk of sleep apnea, aged 30-65 years. They underwent an extensive clinical interview, a physical and a neurological examination by physicians, and in-hospital polysomnography. Those with apnea hypopnoea index (AHI) ≥5 were classified with obstructive sleep apnea. Tension-type headache was diagnosed according to the International Classification of Headache Disorders. Results showed the prevalence of frequent and chronic tension-type headache was 18.7 and 2.1% in the participants with obstructive sleep apnea. The logistic regression analyses showed no significant relationship between tension-type headache and obstructive sleep apnea, with adjusted odds ratios for frequent tension-type headache of 0.95 (0.55-1.62) and chronic tension-type headache of 1.91 (0.37-9.85). The results did not change when using cut-off of moderate (AHI ≥15) and severe (AHI ≥30) obstructive sleep apnea. Thus, we did not find any significant relationship between tension-type headache and the AHI. The presence and severity of sleep apneas seem not to influence presence and attack-frequency of tension-type headache in the general population.
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Affiliation(s)
- Håvard Anton Kristiansen
- Head and neck research group, Research Centre, Akershus University Hospital, Postbox 65, 1478 Lørenskog, Norway.
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Lateef T, Swanson S, Cui L, Nelson K, Nakamura E, Merikangas K. Headaches and sleep problems among adults in the United States: findings from the National Comorbidity Survey-Replication study. Cephalalgia 2011; 31:648-53. [PMID: 21220375 DOI: 10.1177/0333102410390395] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Several studies have demonstrated an association between headache and disturbed sleep. None have examined this association across the headache spectrum. Our goal was to determine whether migraine and migraine with aura differ from nonmigraine headache in terms of associated insomnia complaints or severity of sleep problems. METHODS A probability sample of US adults was used. A structured interview administered by trained interviewers was used. Diagnostic criteria for migraine and migraine with aura were based on the International Headache Society classification. The presence or absence of four forms of sleep disturbance associated with an insomnia diagnosis was ascertained. RESULTS There was a significant association between frequent severe headache, including migraine with and without aura, and disordered sleep. Adults with headache reported more frequently difficulty initiating sleep (odds ratio [confidence interval] = 2.0 [1.6-2.5]), difficulty staying asleep (2.5 [2.1-3]), early morning awakening (2.0 [1.7-2.5]) and daytime fatigue (2.6 [2.2-3.2]) and also were more than twice as likely to report three or more of these symptoms(2.5 [2-3.1]) compared to the individuals without headache. DISCUSSION Adults with severe headache are at significantly higher risk of also suffering from sleep problems, when compared with the general population, regardless of specific headache type. Optimal treatment of headache must include investigation for sleep disorders and vice versa.
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Affiliation(s)
- Teresa Paiva
- Institute of Molecular Medicine, Medical Faculty of Lisbon, Lisbon, Portugal.
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Socio-demographic characteristics, health behaviour, co-morbidity and accidents in snorers: a population survey. Sleep Breath 2010; 15:809-18. [DOI: 10.1007/s11325-010-0442-4] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2010] [Accepted: 10/27/2010] [Indexed: 11/26/2022]
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Morning headaches, daytime functioning and sleep problems – a population-based controlled study. Wien Klin Wochenschr 2010; 122:579-83. [DOI: 10.1007/s00508-010-1464-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2010] [Accepted: 09/07/2010] [Indexed: 11/25/2022]
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Oliveira BHD, Yassuda MS, Cupertino APFB, Neri AL. [Relations between sleep patterns, perceived health and socioeconomic variables in a sample of community resident elders: PENSA Study]. CIENCIA & SAUDE COLETIVA 2010; 15:851-60. [PMID: 20464198 DOI: 10.1590/s1413-81232010000300028] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2007] [Accepted: 03/19/2007] [Indexed: 11/21/2022] Open
Abstract
Changes in sleep pattern constitute a common complaint among elders. Age-related changes can be observed in different levels of the architecture and quality of sleep. The objective of the present study was to observe the relation between age-related sleep changes, insomnia symptoms, apnea symptoms, parasomnia symptoms with socio-economic variables and perceived health status. Sleep pattern was evaluated using the Mini-Sleep Questionnaire. Results indicated that women and individuals with lower education reported higher frequency of insomnia symptoms, the elder-elder group. On the other hand, individuals with higher perceived health status presented lower frequency of apnea symptoms, and higher perceived health status was associated to better sleep pattern overall. It can be concluded that sleep pattern is associated to socio-economic variables such as age, gender, education and perceived health.
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Affiliation(s)
- Beatriz Helena Domingos Oliveira
- Programa de Pós-Graduação em Gerontologia, Faculdade de Ciências Médicas, Universidade Estadual de Campinas, Campinas, SP, 13083-887.
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Lucchesi LM, Speciali JG, Santos-Silva R, Taddei JA, Tufik S, Bittencourt LRA. Nocturnal awakening with headache and its relationship with sleep disorders in a population-based sample of adult inhabitants of Sao Paulo City, Brazil. Cephalalgia 2010; 30:1477-85. [PMID: 20974608 DOI: 10.1177/0333102410368440] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Our aim was to estimate the prevalence of nocturnal awakening with headache (NAH) in the population of São Paulo City according to gender, age (20-80 years old) and socioeconomic classes and its relationship to sleep disorders, sleep parameters, anxiety, depression, fatigue, life quality and obesity. We used a population-based survey with a representative three-stage cluster sample. Questionnaires and scales were applied face-to-face, and polysomnography was performed in 1101 volunteers, aged 42 ± 14 years, 55% women. The complaint of NAH occurring at least once a week had a prevalence of 8.4%, mostly in women, obese subjects and those aged 50-59 years-old. We observed associations of NAH with insomnia, restless leg syndrome (RLS), nightmares and bruxism, but not obstructive sleep apnea syndrome. In a logistics regression model, risk factors for NAH were female gender, odds ratio (OR) (95% confidence interval [CI]) 4.5 (2.8-7.3); obesity, OR 1.9 (1.1-3.3); age between 50 and 59 years, OR 2.4 (1.2-4.7); severe anxiety, OR 8.1 (3.6-18.1); RLS, 2.7 (1.2-5.6); and nightmares, 2.2 (1.3-3.7). Our study shows that NAH was highly prevalent in the population of São Paulo and suggests that this phenomenon has specific characteristics with specific risk factors: obesity, RLS and nightmares.
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KIM SJ, BAIK I, KIM J, JUNG K, LEE SH, KIM SJ, SHIN C. Joint effects of body mass index, exercise, and alcohol drinking on the development of snoring. Sleep Biol Rhythms 2010. [DOI: 10.1111/j.1479-8425.2010.00441.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Introduction to a Postural Education and Exercise Program in Sleep Medicine. Sleep Med Clin 2010. [DOI: 10.1016/j.jsmc.2009.11.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Dodick DW, Bordini CA. Headache attributed to disorders of homeostasis. HANDBOOK OF CLINICAL NEUROLOGY 2010; 97:627-642. [PMID: 20816459 DOI: 10.1016/s0072-9752(10)97053-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Affiliation(s)
- David W Dodick
- Department of Neurology, Mayo Clinic Arizona, Phoenix, AZ 85054, USA.
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Goksan B, Gunduz A, Karadeniz D, Ağan K, Tascilar FN, Tan F, Purisa S, Kaynak H. Morning Headache in Sleep Apnoea: Clinical and Polysomnographic Evaluation and Response to Nasal Continuous Positive Airway Pressure. Cephalalgia 2009; 29:635-41. [DOI: 10.1111/j.1468-2982.2008.01781.x] [Citation(s) in RCA: 61] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Morning headache is accepted as part of clinical findings of obstructive sleep apnoea syndrome (OSAS). The prevalence of morning headache is at variable levels from 18% to 74% in patients with OSAS. However, there is controversy over the association of morning headache and OSAS. We studied morning headache prevalance and characteristics in 101 controls with apnoea-hypnoea index (AHI) < 5 and 462 OSAS patients with AHI ≥ 5. Morning headache was reported by only nine (8.9%) subjects in a control group compared with 156 (33.6%) of OSAS patients ( P < 0.01). Morning headache prevalance was significantly higher in severe and moderate OSAS groups. AHI was significantly higher in OSAS patients with morning headache compared with patients without morning headaches. Oxygen saturation nadir during rapid eye movement and non-rapid eye movement sleep as well as mean oxygen saturation value during total sleep time were also found to be significantly lower in morning headache group. However, none of the sleep parameters was found to be determinants of morning headache. Morning headache was more frequently reported by patients of female gender and with primary headache history. Morning headache was totally resolved in 90% of patients treated with nasal continuous positive airway pressure. The history of OSAS should be considered in the differential diagnosis of morning headache.
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Affiliation(s)
- B Goksan
- Department of Neurology, I.U. Cerrahpasa School of Medicine, Marmara University, Istanbul
| | - A Gunduz
- Department of Neurology, I.U. Cerrahpasa School of Medicine, Marmara University, Istanbul
| | - D Karadeniz
- Department of Neurology, I.U. Cerrahpasa School of Medicine, Marmara University, Istanbul
| | - K Ağan
- School of Medicine, Marmara University, Istanbul
| | - FN Tascilar
- School of Medicine, Zonguldak Kraelmas University, Zonguldak, Turkey
| | - F Tan
- Department of Neurology, I.U. Cerrahpasa School of Medicine, Marmara University, Istanbul
| | - S Purisa
- Department of Biostatistics, I.U. Cerrahpasa School of Medicine, Marmara University, Istanbul
| | - H Kaynak
- Department of Neurology, I.U. Cerrahpasa School of Medicine, Marmara University, Istanbul
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Ohayon MM. Nocturnal awakenings and comorbid disorders in the American general population. J Psychiatr Res 2008; 43:48-54. [PMID: 18374943 DOI: 10.1016/j.jpsychires.2008.02.001] [Citation(s) in RCA: 96] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2007] [Revised: 02/05/2008] [Accepted: 02/05/2008] [Indexed: 10/22/2022]
Abstract
OBJECTIVE Nocturnal awakenings are one of the most prevalent sleep disturbances in the general population. However, little is know about how its severity affects co-morbidity with mental disorders and organic diseases. METHODS A representative sample consisting of 8937 non-institutionalized individuals aged 18 or over living in Texas, New York and California states were interviewed by telephone. The interviews included sleeping habits, health, sleep and mental disorders. Nocturnal awakenings were evaluated according to their frequency per week and per night, their duration and the motive(s) for the awakenings. RESULTS A total of 35.5% of the sample reported awakening at least 3 nights per week: 23% of reported awakening at least one time every night; 4.5% 5 or 6 nights per week and 7.9% 3 or 4 nights per week. Nocturnal awakenings increased with age only among people with nightly awakenings and were more frequent among women than men only among those awakening every night. More than 90% of subjects reported this problem lasted for more than 6 months. About 40% of subjects with nocturnal awakenings also reported other insomnia symptoms. Generally speaking, organic diseases and psychiatric disorders were more frequent among subjects waking up at least 3 nights per week regardless the frequency of nocturnal awakenings. However, nightly nocturnal awakenings were associated with more frequent organic diseases, obesity and psychiatric disorders. CONCLUSIONS Nocturnal awakenings disrupt the sleep of about one third of the general population. Nocturnal awakenings are associated with a wide variety of organic diseases and psychiatric disorders that warrant appropriate treatment.
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Affiliation(s)
- Maurice M Ohayon
- Stanford Sleep Epidemiology Research Center, Stanford University School of Medicine, 3430 West Bayshore Road, Stanford, Palo Alto, CA 94303, USA.
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Vgontzas A, Cui L, Merikangas KR. Are sleep difficulties associated with migraine attributable to anxiety and depression? Headache 2008; 48:1451-9. [PMID: 18624714 PMCID: PMC2692650 DOI: 10.1111/j.1526-4610.2008.01175.x] [Citation(s) in RCA: 63] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To examine whether sleep complaints reported by migraineurs can be attributed to comorbid anxiety and/or depression. BACKGROUND A consistent association between migraine and sleep complaints has been reported in community and clinical studies. However, anxiety and depression are often comorbid with migraine. Thus, it may be possible that the increased prevalence of sleep problems in migraineurs is attributable to comorbid anxiety and depression. To our knowledge, no previous studies have demonstrated that the associations are not solely attributed to comorbid anxiety and depression. DESIGN AND METHODS Controlled family study of anxiety disorders and substance use disorders in a community in New Haven County, CT. The sample included 221 probands (41 migraineurs) and their 261 directly interviewed first-degree relatives (39 migrainuers), including parents, siblings, and offspring over age 18. A lifetime history of migraine was obtained using the Diagnostic Interview for Headache Syndromes. A lifetime history of psychiatric disorders was obtained using the semi-structured Schedule for Affective Disorders and Schizophrenia which was modified to incorporate Diagnostic and Statistical Manual diagnostic criteria. Several sleep items on current and lifetime sleep complaints were included as a subset of the interview. RESULTS There was a significant association between migraine and the number of sleep problems as well as several specific sleep symptoms among probands and their adult relatives. Adults with migraine reported having significantly more lifetime sleep problems (OR [CI] = 2.3 [1.1-4.6]), and more current sleep difficulties, specifically, inadequate sleep (2.5 [1.2-5.0]), difficulty falling asleep (3.0 [1.5-6.3]), and persistent nightmares of childhood onset (4.3 [1.8-9.9]) than those without migraine. The associations between sleep problems and migraine persisted after controlling for both lifetime and current anxiety and mood disorders. CONCLUSIONS The association between sleep problems and migraine that is not solely explained by comorbid anxiety disorders or depression suggests that sleep problems should be evaluated among people with migraine.
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Affiliation(s)
- Angeliki Vgontzas
- National Institute of Mental Health - Section on Developmental Genetic Epidemiology, Bethesda, MD, USA
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Svensson M, Franklin KA, Theorell-Haglöw J, Lindberg E. Daytime sleepiness relates to snoring independent of the apnea-hypopnea index in women from the general population. Chest 2008; 134:919-924. [PMID: 18753465 DOI: 10.1378/chest.08-0847] [Citation(s) in RCA: 65] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
OBJECTIVES The aim was to investigate the significance of snoring and sleep apnea on daytime symptoms in a population-based sample of women. METHOD From the general population, 400 women aged 20 to 70 years were randomly selected, with oversampling of habitually snoring women. The women were investigated using full-night polysomnography and a questionnaire. The apnea-hypopnea index (AHI) was calculated, and women who acknowledged snoring loudly and disturbingly often or very often were considered habitual snorers. RESULTS Habitual snoring was independently related to excessive daytime sleepiness (odds ratio [OR], 2.28; 95% confidence interval [CI], 1.31 to 3.99), to falling asleep involuntarily during the day (OR, 2.11; 95% CI, 1.06 to 4.21), to waking up unrefreshed (OR, 2.14; 95% CI, 1.30 to 3.52), to daytime fatigue (OR, 2.77; 95% CI, 1.54 to 4.99), and to a dry mouth on awakening (OR, 2.00; 95% CI, 1.22 to 3.27) after adjustment for AHI, age, body mass index (BMI), smoking, total sleep time, percentage of slow-wave sleep, and percentage of rapid eye movement (REM) sleep. An AHI > or = 15/h was only related to a dry mouth on awakening after adjustment for snoring, age, BMI, smoking, total sleep time, percentage of slow-wave sleep, and percentage of REM sleep (OR, 2.24; 95% CI, 1.14 to 4.40). An AHI of 5 to 15/h was not related to any daytime symptom. CONCLUSIONS Excessive daytime sleepiness and daytime fatigue are related to habitual snoring independent of the apnea-hypopnea frequency, age, obesity, smoking, and sleep parameters in a population-based sample of women, but not to the AHI. This indicates that snoring is an independent cause of excess daytime sleepiness and not merely a proxy for sleep apnea.
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Affiliation(s)
- Malin Svensson
- Department of Surgical Sciences, Otorhinolaryngology, Head and Neck Surgery, Uppsala University, Uppsala.
| | - Karl A Franklin
- Department of Respiratory Medicine, University Hospital, Umeå, Sweden
| | - Jenny Theorell-Haglöw
- Department of Medical Sciences, Respiratory Medicine and Allergology, Uppsala University, Uppsala
| | - Eva Lindberg
- Department of Medical Sciences, Respiratory Medicine and Allergology, Uppsala University, Uppsala
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Ford ES, Li C, Pearson WS, Zhao G, Strine TW, Mokdad AH. Body mass index and headaches: findings from a national sample of US adults. Cephalalgia 2008; 28:1270-6. [PMID: 18727641 DOI: 10.1111/j.1468-2982.2008.01671.x] [Citation(s) in RCA: 72] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The objective was to study the cross-sectional association between body mass index (BMI) and the prevalence of severe headaches or migraines in a national sample of US adults. We used data from 7601 men and women aged > or = 20 years who participated in the National Health and Nutrition Examination Survey 1999-2002. The age-adjusted prevalence of severe headaches or migraines during the previous 3 months was 34.0, 18.9, 20.7 and 25.9% among participants with a BMI < 18.5, 18.5 to < 25, 25 to < 30 and > or = 30 kg/m(2), respectively. After adjusting for a variety of covariates in a logistic regression model, those with a BMI < 18.5 kg/m(2)[odds ratio (OR) 2.01; 95% confidence interval (CI) 1.34, 3.02] or > or = 30 kg/m(2 )(OR 1.37; 95% CI 1.09, 1.72) had a significantly elevated OR for having a headache compared with participants with a BMI of 18.5-< 25 kg/m(2). BMI is associated with the prevalence of severe headaches or migraines in a non-linear manner.
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Affiliation(s)
- E S Ford
- Division of Adult and Community Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA 30341, USA.
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Rains JC. Chronic headache and potentially modifiable risk factors: screening and behavioral management of sleep disorders. Headache 2008; 48:32-9. [PMID: 18184283 DOI: 10.1111/j.1526-4610.2007.00972.x] [Citation(s) in RCA: 54] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Sleep-related variables have been identified among risk factors for frequent and severe headache conditions. It has been postulated that migraine, chronic daily headache, and perhaps other forms of chronic headache are progressive disorders. Thus, sleep and other modifiable risk factors may be clinical targets for prevention of headache progression or chronification. The present paper is part of the special series of papers entitled "Chronification of Headache" describing the empirical evidence, future research directions, proposed mechanisms, and risk factors implicated in headache chronification as well as several papers addressing individual risk factors (ie, sleep disorders, medication overuse, psychiatric disorders, stress, obesity). Understanding the link between risk factors and headache may yield novel preventative and therapeutic approaches in the management of headache. The present paper in the special series reviews epidemiological research as a means of quantifying the relationship between chronic headache and sleep disorders (sleep-disordered breathing, insomnia, circadian rhythm disorders, parasomnias) discusses screening for early detection and treatment of more severe and prevalent sleep disorders, and discusses fundamental sleep regulation strategies aimed at headache prevention for at-risk individuals.
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Affiliation(s)
- Jeanetta C Rains
- Center for Sleep Evaluation at Elliot Hospital, Manchester, NH 03103-3599, USA
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Ashina S, Lipton RB, Bigal ME. Treatment of comorbidities of chronic daily headache. Curr Treat Options Neurol 2008; 10:36-43. [DOI: 10.1007/s11940-008-0005-1] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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