Morning Headache in Sleep Apnoea: Clinical and Polysomnographic Evaluation and Response to Nasal Continuous Positive Airway Pressure

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 prevalence and characteristics in 101 controls with apnoea-hypnoea index (AHI) < 5 and 462 OSAS patients with AHI > or = 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 prevalence 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.

Sleep and headache: a bidirectional relationship

“…In a comparative study by Grenough et al, OSAS patients with and without headache did not differ in the percentage of sleep time (either REM or NREM) spent with oxygen saturation less than 90%, thus negating the hypothesis that the duration of nocturnal hypoxemia relates to headache [69]. These findings have been contradicted in another recent study in which it emerged that the oxygen saturation nadir during REM and NREM sleep as well as mean oxygen saturation during total sleep time are significantly lower in OSAS patients with morning headache compared with headache-free patients [70].…”

Sleep and Chronic Daily Headache

“…36 Apnoea-hypopnoea index (AHI) was significantly higher in OSA patients with morning headache compared with patients without morning headaches. Oxygen saturation nadir during rapid eye movement and nonrapid 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 [32].…”

“…Of this group, morning headache was totally resolved in 90 % of patients treated with nasal continuous positive airway pressure [32].…”

Kopfschmerzen im Alter: Was ist anders?

“…In Fallkontrollstudien klagen 11-40% dieser Patienten über meist morgendliche holozephale Kopfschmerzen, die vom Charakter am ehesten einem Spannungskopfschmerz entsprechen und möglicherweise mit der nächtlichen Sauerstoffentsättigung korrelieren [25,26]. Das mittlere Manifestationsalter liegt bei 50-70 Jahren [26,27]; Frauen scheinen relativ häufiger betroffen. Therapie der Wahl ist das Anpassen einer nächtlichen CPAP-Maskenbeatmung, die in bis zu 90% die Kopfschmerzen bessern bzw.…”