Sleep, headache and sleep breathing disturbances: a polisomnographic study
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Sleep, headache and sleep breathing disturbances: a polisomnographic study Carlo Lovati 1 & Stefania Peruzzo 1 & Marica Pecis 2 & Pierachille Santus 2,3 & Leonardo Pantoni 3
# Fondazione Società Italiana di Neurologia 2020
Migraine is a primary disabling headache which impact on daily life is particularly relevant in case of a high frequency of attacks. Sleep and its disorders are known elements able to influence migraine frequency. Among sleep disorders breathing disturbances such as obstructive sleep apnea syndrome seems to the most relevant in modifying migraine course. Obstructive sleep apnea syndrome (OSAS) is characterized by recurrent episodes of apnea during sleep that may induce a reduction in oxygen saturation possibly dangerous for the brain particularly when apneas are frequent and prolonged. The diagnosis of OSAS is based on clinical elements and instrumental evaluation. Nocturnal respiratory polygraphy (PoliSomnoGram PSG) is the diagnostic tool used to confirm OSAS diagnosis by the assessment of the apnea-hypopnea index (AHI) and oxygen desaturation index (ODI). In fact OSAS is diagnosed in the case of AHI > 5 in the presence of OSAS symptoms or when AHI > 15. Sleep breathing disorders may worsen a preexisting primary headache but it is also able to induce a specific secondary headache namely “OSAS headache,” characterized by morning diffuse and not a pulsating headache which generally does not require analgesic intake present more than 15 days per month not associated with nausea vomit phonophobia and photophobia. The presence of headache in a patient with OSAS does not mandatorily coincide with a diagnosis of OSAS headache: as said also primary headaches may be influenced and modified by OSAS. The differential diagnosis between OSAS headache
* Carlo Lovati [email protected] 1
Headache Center, Neurology Unit, Luigi Sacco University Hospital, Milan, Italy
2
Division of Respiratory Diseases, Luigi Sacco University Hospital, Milan, Italy
3
“Luigi Sacco” Department of Biomedical and Clinical Sciences, University of Milan, Milan, Italy
and another form of head pain in a patient with OSAS is not always easy and the way to differentiate among subjects with OSAS and recurrent headache which ones had a preexisting primary headache and which ones developed a secondary headache induced by sleep apneas is frequently misunderstood. In order to make the diagnostic process easier and to clarify the reciprocal interference of sleep breathe and headache we studied polisomnographic parameters sleep behavior and headache characteristics in outpatients of the Headache Center and Sleep Disorders Center of the L. Sacco Hospital in Milan. Using an ad hoc questionnaire we investigated characteristics of sleep—defined as sleep onset latency sleep fragmentation and snoring—and of headache if present. Headache diagnosis was done according to the ICHD-III criteria. OSAS diagnosis was posed according to the International Classification of Sleep Disorders 2005. Using PSG we measured the
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