Investigation Into Sleep Disturbance of Patients Suffering from Cluster Headache

Abstract

The new discoveries relating to cluster headache (CH) encouraged the study of the relationship of the hypothalamus to respiratory physiology and its comorbidity with sleep apnoea. The question is whether the apnoeas are more frequent during REM sleep and the desaturations could be involved as triggers of the cluster attacks. Furthermore, could the connection with the hypothalamus, already proved, be responsible for an alteration in the structure of REM sleep and a chemoreceptor dysfunction. We set out to analyse when polysomnography investigation is necessary in patients with CH. We studied 37 patients suffering from episodic CH, 31 (83.8%) men and six (16.2%) women. For the control group, we selected 35 individuals, 31 (88.6%) men and four (11.4%) women. There was a greater percentage of obstructive sleep apnoea (OSA) in patients with CH (58.3%) compared with the control group (14.3%) and with the general population (2-4%). In cases of pain during sleep, the majority is deflagrated during the REM phase, following a desaturation episode. A stratified analysis of the apnoea/hypnoea index relating to body mass index (BMI) and age showed that patients with CH have 8.4 times more chance of exhibiting OSA than normal individuals (P < 0001). This risk increases to 24.38 in patients with a BMI > 25 kg/m(2) and increases to 13.5 in patients > 40 years old. Surprisingly, the risk decreases sharply in patients with a BMI < 25 kg/m(2) and who are < 40 years old. Due to the fact that polysomnography is a complex, costly and sometimes difficult examination, we suggest, in concordance with the results, that it should be carried out routinely in patients with CH that exhibit a BMI of > 25 kg/m(2) and/or in patients who are > 40 years of age.

Sleep and headaches

“…Cluster headache has been associated with REM sleep and sleep-disordered breathing. A study of 37 cluster headache patients who underwent polysomnography identified an 8.4-fold increase in the incidence of obstructive sleep apnea relative to age-and gender-matched controls (58% vs 14%, respectively), and this risk increased over 24-fold among patients with a body mass index greater than 25 kg/m 2 [24]. This marked increase in the incidence of sleep apnea among cluster headache patients had been reported in earlier research [25,26], and treatment of sleep apnea had been observed to improve cluster headache control [25].…”

Refractory cluster headache in a patient with bruxism and obstructive sleep apnea: a case report

“…When both factors are associated, the treatment of sleep apnea may result in reduction or total remission of clusters [8]. For this reason, Nobre et al have suggested that polysomnography (PSG) studies would be required to check the presence of OSA in patients with cluster headaches [9].…”

Obstructive Sleep Apnea Related Symptom Prevalence in Patients with Headache Presented to Neurology Outpatient Clinic: Results of a Preliminary Study*

“…We couldn't detect any exacerbation of cluster headaches or chronic daily headaches in our patients, but a prevalence of 53.8% was reported for cluster headaches, which were approximately 8.4 times more common in OSAS, when compared with normal individuals [17]. This rate was reported as 42.8% for chronic daily headaches in patients with OSAS, as well [18].…”