Sleep Apnea in Cluster Headache

Abstract

The impetus to study sleep changes in a cluster population arose from a recent hypothesis that predicted the finding of sleep apnea in this disorder. It holds that cluster attacks may occur in response to oxygen desaturation. Proposed mechanisms involve impairment of carotid body activity secondary to hypothalamic-vasomotor regulatory dysfunction. Five chronic and five episodic cluster patients underwent nocturnal polysomnography, utilizing standard equipment for monitoring sleep status, cardiac activity, nasal and buccal air flow change, chest and abdominal breathing, muscle activity and oxygen saturation. All episodic patients and one of five chronic patients were found to have sleep apnea (60%). Mean apneas per hour during NREM sleep were similar to that of REM sleep; 26.7 and 28.2, respectively. Six patients with sleep apnea experienced 14 cluster headache attacks during the study period. Eight attacks (57%) followed episodes of oxygen desaturation ranging from 65% to 85%. In the sleep apnea group, 8 out of 14 attacks (57%) were associated with REM; three without, and five following oxygen desaturation. Of the non-apnea group, all of whom had chronic cluster headache, none of 5 attacks were associated with oxygen desaturation, and only 2/5 attacks occurred in relation to REM. Thus, our study showed that sleep apnea was a common finding in a randomly selected group of episodic cluster patients; and most nocturnal attacks were preceded by oxyhemoglobin desaturation and REM-related. These findings were uncommon in the chronic cluster group.

Cluster headache and obstructive sleep apnea: Are they related disorders?

“…The fi rst study was done by Kudrow et al [2] in 1984. In their study, six of 10 patients with CH who were studied presented with sleep apnea.…”

“…Moreover, CH is also characterized by its nocturnal periodicity. The nocturnal attacks may make up 50% to 60% of the attacks [2]. Characteristically, CH is associated with the rapid eye movement (REM) period of sleep and may sometimes occur during or at the end of this period [3,4].…”

Sleep apnea in childhood migraine

“…In Paiva et al's [10] study, 3 patients had obstructive sleep apnea syndrome among 13 migrainous patients. Kudrow et al showed evidence of sleep apnea in 6 of 10 cluster headache patients: 4 of these patients had central apnea, and 2 obstructive apnea [9].…”

“…Dexter [8] showed that 36%-58% of patients with sleep apnea complaint of morning headache and that headache may be the presenting complaint of sleep apnea syndrome. Kudrow et al [9] found a 60% prevalence of sleep apnea among ten patients with cluster headache. Paiva et al [10] demonstrated that in several cases of adult migraine, after a polysomnographic (PSG) study, diagnosis has been changed in half of the patients and the treatment of the underlying clinical condition greatly improved the headache.…”

Schlafverhalten und Kopfschmerzattacken bei prim�ren Kopfschmerzen

“…Weekend-Migräne; [6,11]). Umgekehrt können Migräneatta-cken auch direkt aus dem Schlaf heraus auftreten, wobei dabei wahrscheinlich der REM-Schlaf-Phase besondere Bedeutung zukommt (Übersicht in: [11] Möglicherweise gibt es jedoch Unterschiede zwischen der chronischen und der episodischen Form [26,42]. 3.…”