Results

Among the enrolled subjects, 198 did not suffer from headache (mean age 60.3 ± 12.7 years, 159 men and 39 women) and 104 had history of headache (mean age 51.4 ± 12.3 years, 66 men and 38 women) of which 67 migraineurs (Mig - mean age 50.8 ± 14.9 years, 37 men and 30 women) and 37 with tension type headache (TTH - mean age 51.4 ± 13.3 years, 29 men and 8 women).

Out of 104 subjects with headache, 50 were allodynic. Allodynia was found in 41 out of 67 migraineurs and in 9 out of 37 patients with tension type headache.

Headache and allodynia distribution in the sample

In our population, headache was present in 34.4% of the studied subjects (104 out of 302 individuals, of which 67 with migraine and 37 with tension type headache ) and allodynia during pain attacks was present in 48% of headache patients (50 out of 104 subjects). Allodynia was more frequent among migraineurs (41 out of 67) than in tension type patients (9 out of 37).

After grouping by gender, headache was present in 29,3% of men and in 49,3% of women. Migraine was found in 30 out of 39 female headache patients (30 out of 116 enrolled women, 25% of the female cohort) and in 37 out of 159 male patients with headache (37 out of 225 observed men, 16% of the male population studied). Headache distributions in the different groups are shown in Table 1.

M/F

M (%)

(years)

Total sample

302

225/77

75

25

57,0

Without headache

198

159/39

80

20

60,3

104 with headache

migraine

67

37/30

55

45

50,8

tension type headache

37

29/8

78

22

51,4

Table 1. Presence of headache in subjects who underwent a full cardiopulmonary monitoring for presumed respiratory problems during sleep.

Table 1. Presence of headache in subjects who underwent a full cardiopulmonary monitoring for presumed respiratory problems during sleep.

Respiratory sleep parameters in different diagnostic groups

As summarized in Table 2, respiratory parameters among subjects with headache were always better than in subjects without headache.

The Apnea Hypopnea Index, that expresses the number of episodes of apnoea per hour, was 23.3 among subjects without headache and 13.8 in the headache group (p<0.01), without significant differences between different kinds of headache (14.2 in migraineurs and 13.1 in the tension type group).

Blood oxygenation during sleep was significantly better among headache patients (mean SpO2 94.4% and T90 6.3%) with respect to controls (mean SpO2 92.9% and T90 14.7%). No differences were found between allodynic and non allodynic headache patients also with regard to specific diagnostic groups.

(mean oxygen saturation) (%)

% of time with SpO2 < 90% (%)

Subjects without headache,

198

23.3

92.9

14.7

Headache subjects (Mig+TTH)

104

13.8

94.4

6.3

Allodynic headache subjects

50

15.6

94.5

6.2

Non-allodynic headache subjects

54

12.1

94.3

6.4

Subjects with TTH

37

13.1

93.9

8.9

Allodynic TTH subjects

9

15.9

93.5

10.5

Non-allodynic TTH subjects

28

12.1

94.0

8.5

Subjects with Mig

67

14.2

94.7

4.8

Allodynic migraineurs

41

15.6

94.7

5.3

Non-allodynic migraineurs

26

12.0

94.7

4.0

Table 2. Distribution of respiratory parameters among the different groups

Table 2. Distribution of respiratory parameters among the different groups

Fig. 1. Blood oxygenation was better among migraineurs. In this diagnostic group, the time period with SpO2 < 90% was globally significantly shorter than in the other groups.

Sleep behavior in different forms of headache

As previously observed, allodynic subjects with headache, especially if migraineurs, complain of difficulties in falling asleep and of frequent awakenings that disrupt their nocturnal sleep. Tabs 3a, 3b and 3c summarize sleep characteristics in different groups of patients.

subjective satisfaction

no headache n° (%)

headache n° (%)

mig n° (%)

n° (%)

allodynic subjects n° (%)

not allodynic subjects n° (%)

mig with allodynia n° (%)

mig without allodynia n° (%)

TTH with allodynia n° (%)

TTH without allodynia n° (%)

Satisfied

111 (56)

37 (36)

17 (25)

20 (54)

11 (22)

26 (48)

6 (15)

11 (42)

5 (56)

15 (54)

not satisfied

87 (44)

67 (64)

50 (75)

17 (46)

39 (78)

28 (52)

35 (85)

15 (58)

4 (44)

13 (46)

tot.

198

104

67

37

50

54

41

26

9

28

Table 3a. Sleep behavior: subjective perception of sleep quality (satisfied/not-satisfied). Migraineurs - particularly allodynic ones - have a worse perception of their sleep quality with respect to subjects without headache (chi2 test - p< 0.01 in both cases).

Sleep latency

no headache n° (%)

Headache n° (%)

rng n° (%)

n° (%)

allodynic subjects n° (%)

not allodynic subjects n° (%)

mig with allodynia n° (%)

rng without allodynia n° (%)

TTH with allodynia n° (%)

TTH without allodynia n° (%)

<30 minutes

159 (80)

72 (69)

42 (63)

30 (81)

30 (60)

42 (78)

22 (54)

20 (77)

8 (89)

22 (79)

>30 minutes

39 (20)

32 (31)

25 (37)

7 (19)

20 (40)

12 (22)

19 (46)

6 (23)

1 (11)

6 (21)

tot.

198

104

67

37

50

54

41

26

9

28

Table 3b. Sleep behavior: sleep onset latency. Migraineurs - particularly allodynic ones -take more time to fall asleep with respect to subjects without headache (chi2 test - p< 0.01 in both cases).

Nocturnal awakenings

no headache n° (%)

headache n° (%)

mig (%)

n° (%)

allodynic patients n° (%)

not allodynic patients n° (%)

mig with allodynia n° (%)

mig without allodynia n° (%)

TTH with allodynia n° (%)

TTH without allodynia n° (%)

<2 nights/month

70 (39)

26 (25)

16 (24)

10 (27)

7 (14)

19 (35)

4 (10)

12 (46)

3 (33)

7 (25)

>3 nights/month

120 (61)

78 (75)

51 (76)

27 (73)

43 (86)

35 (65)

37 (90)

14 (54)

6 (67)

21 (75)

tot.

198

104

67

37

50

54

41

26

9

28

Table 3c. Sleep behavior: nocturnal awakenings. Migraineurs - particularly allodynic ones -wake more frequently during night with respect to subjects without headache (chi2 test - p< 0.01 in both cases).

Fig. 2. Migraineurs, particularly if allodynic, are less satisfied about their subjective sleep quality.

Respiratory sleep parameters in different sleep behavior groups

As showed in tables 4a, 4b and 4c, both subjects with and without headache were grouped by sleep behaviour characteristics (satisfaction, sleep latency and presence of nocturnal awakenings). No differences in terms of respiratory parameters were found comparing, in both headache and headache-free groups, subjects satisfied vs not satisfied, subjects with short vs long sleep latency and patients with frequent vs sporadic awakenings.

AHI

SaO2 media

T<90%

Headache subjects - satisfied by their sleep

11,4

94,6

5,4

Headache subjects - not satisfied by their sleep

15,1

94,2

6,8

Controls - satisfied by their sleep

23,3

93,1

12,8

Controls - not satisfied by their sleep

23,4

92,6

16,5

Table 4a. Sleep behavior: subjects grouped by subjective perception of sleep quality. Respiratory parameters among different groups. No significant differences between satisfied and not-satisfied in both headache and non-headache group with regard to respiratory parameters during sleep.

AHI

SaO2 media

T<90%

Headache subjects with short sleep latency

15,6

94,3

6,8

Headache subjects with long sleep latency

9,6

94,5

4,2

Controls with short sleep latency

26,0

92,8

14,3

Controls with long sleep latency

14,8

93,7

17,7

Table 4b. Sleep behavior: subjects grouped by sleep onset latency. Apnea episodes (AHI) are meanly more frequent among subjects with rapid sleep onset in both headache and non-headache subjects (no difference after Bonferroni correction). No differences in term of blood oxygenation.

AHI

SaO2 media

T<90%

headache subjects with sporadic nocturnal awakenings

10,6

94,8

5,1

headache subjects with frequent nocturnal awakenings

15,0

94,2

6,8

controls with sporadic nocturnal awakenings

20,6

93,0

13,2

controls with frequent nocturnal awakenings

25,3

92,8

15,1

Table 4c. Sleep behavior: subjects grouped by presence of nocturnal awakenings. Respiratory parameters do not significantly differ among groups.

Table 4c. Sleep behavior: subjects grouped by presence of nocturnal awakenings. Respiratory parameters do not significantly differ among groups.

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