Cluster Headache Associated with Sleep Apnoea

Abstract

This study of sleep changes in patients with cluster headache (CH) was conducted in view of the nocturnal predominance of this condition, the efficacy of oxygen and the fact that the attacks follow oxygen desaturation. Proposed mechanisms include impairment of carotid body activity secondary to hypothalamic vasomotor regulatory dysfunction. Sixteen patients with episodic CH and 29 healthy volunteers underwent nocturnal polysomnography. Five (31.3%) patients with episodic CH were found to have sleep apnoea (SA). Two patients with SA experienced two attacks during the study period. The attacks followed episodes of oxygen desaturation and were associated with REM sleep. In two patients with SA and CH, treatment with continuous positive airway pressure abolished their oxygen desaturation, sleep apnoeas and headaches. Our study confirmed the high percentage of CH associated with SA. We suggest that oxygen desaturation may be a trigger factor in some patients and play a role in the pathogenesis of CH.

Sleep and Chronic Daily Headache

“…CH patients have been reported to have an eightfold increased risk of OSA when compared with the general population. This risk increases with increasing BMI and age over 40 years [22].…”

“…OSA has been reported in 31-80 % of cluster headache patients [21][22][23]. CH patients have been reported to have an eightfold increased risk of OSA when compared with the general population.…”

Sleep and headache: a bidirectional relationship

“…The nocturnal predominance of CH in REM sleep, its association with sleep apnea in approximately a third of patients and the efficacy of oxygen therapy are features that underline the association between CH and sleep problems [98]. The hourly rate of sleep apneas and hypopneas in CH patients exceeds 80%, and minimum oxygen saturation is frequently reduced.…”

“…An association has been hypothesized with dysregulation of the 'biological clock' and the arousal mechanisms, particularly in relationship with REM sleep [101]. In patients with sleep apneas and CH, C-PAP treatment is able to prevent headaches as well as nocturnal oxygen desaturation [98].…”

Headaches and sleep disorders

“…A higher prevalence of obstructive sleep apnea has been noted in cluster headache in a number of case reports. [39][40][41][42] Increase in central apnea was demonstrated by Evers et al 43 in patients with active cluster headaches. Treatment with positive airway pressure was associated with improvement in cluster headache in most [44][45][46] but not all 43 studies.…”