Sleep quality, arousal and pain thresholds in migraineurs: a blinded controlled polysomnographic study

Engstrøm, Morten; Hagen, Knut; Bjørk, Marte Helene; Stovner, Lars Jacob; Gravdahl, Gøril Bruvik; Stjern, Marit; Sand, Trond

doi:10.1186/1129-2377-14-12

Cited by 68 publications

(68 citation statements)

References 43 publications

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“…In a recent PSG study of migraine sufferers, shorter sleep latency was observed in the preictal phase relative to the interictal phase. 35 Methodological differences notwithstanding, these two findings appear to suggest that an acute pain increase in a chronic pain condition may be related to shorter sleep latency. 35 While no details on medication use among migraine sufferers were reported, 35 in the present sample of women with TMD the relationship between pre-sleep pain ratings and sleep latency was apparently mediated by the use of opioid medications.…”

Section: Pain and Covariate Predictorsmentioning

confidence: 88%

Polysomnographic Investigation of Sleep and Respiratory Parameters in Women with Temporomandibular Pain Disorders

Dubrovsky

Raphael

Lavigne

et al. 2014

Journal of Clinical Sleep Medicine

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Study Objectives: Temporomandibular pain disorders (TMD) and myofascial pain were linked to increased prevalence of insomnia and obstructive sleep apnea (OSA) on clinical grounds. However, the literature lacks an accurate polysomnographic (PSG) characterization of sleep abnormalities associated with TMD, given that prior studies included small or uncontrolled samples of TMD patients. The present investigation aims to objectively evaluate measures of sleep and respiratory disturbance in a large representative sample of TMD cases in comparison with matched controls. Methods: Sleep, respiration, and limb movements were measured using a 2-night attended PSG protocol in 170 women-124 TMD cases with myofascial pain and 46 demographically matched controls. The second night data were compared between the groups using ANCOVAs. In TMD cases, the relationship between pain ratings and sleep parameters was analyzed using multiple regressions. Results: In comparison to healthy controls, TMD cased evidenced a signifi cant increase in stage N1 sleep (12.2% ± 7.6% vs. 9.2% ± 5.0%, p = 0.03), which was only mild relative to normative values. TMD cases also demonstrated mild but signifi cant elevations in arousals associated with all types of respiratory events (6.0/h ± 6.1 vs. 3.5/h ± 3. S C I E N T I F I C I N V E S T I G A T I O N ST emporomandibular disorders (TMD), most often characterized by painful musculoskeletal signs and symptoms in the masticatory region, is a pain syndrome estimated to affect approximately 5% to 15% of the population, predominantly women.1-4 Subjective sleep disturbance has been consistently reported in TMD patients. 5,6 Two earlier polysomnographic (PSG) studies failed to demonstrate objective differences in sleep or respiratory measures between TMD cases with myofascial pain and control participants free from myofascial pain and signs of TMD; however, the small sample sizes and restrictive selection criteria limit their interpretability. 7,8 A recent investigation employing PSG recordings and clinical sleep interviews in an uncontrolled sample of TMD cases showed that TMD is associated with primary sleep disorders, such as insomnia and obstructive sleep apnea (OSA): nearly 36% of TMD cases met diagnostic criteria for insomnia, and over 28% met criteria for OSA. 9 In the same sample of TMD cases, sleep effi ciency on PSG was directly related to a measure of pain threshold, suggesting an association between pain and sleep disturbance in TMD.9,10 Additionally, a high prevalence of TMD was reported in clinical patients with mild to moderate OSA referred for a clinical dental evaluation, lending further support to the association between TMD and OSA.11 It was BRIEF SUMMARYCurrent Knowledge/Study Rationale: A relationship between temporomandibular pain disorders (TMD) and sleep and respiratory disturbance has been suggested; however, large-scale controlled polysomnographic studies are lacking. The present investigation used two-night polysomnography to measure sleep architecture and respiration in a large...

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Section: Pain and Covariate Predictorsmentioning

confidence: 88%

Polysomnographic Investigation of Sleep and Respiratory Parameters in Women with Temporomandibular Pain Disorders

Dubrovsky

Raphael

Lavigne

et al. 2014

Journal of Clinical Sleep Medicine

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“…Recording details are presented elsewhere (9)(10)(11). All participants filled in sleep diaries 2 weeks before and 2 weeks after measurement of pain thresholds and subsequent polysomnography.…”

Section: Methodsmentioning

confidence: 99%

“…The method is described in detail elsewhere (9)(10)(11). One hundred and twenty-six persons, 85 women and 41 men, (age range 18-64, mean age 38.9 years), including 41 healthy controls, 24 TTH, and 61 migraine patients participated in this study (Fig.…”

Section: Participantsmentioning

confidence: 99%

Sleep quality and arousal in migraine and tension-type headache: the headache-sleep study

et al. 2014

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Objectives -The present paper summarizes and compares data from our studies on subjective and objective sleep quality and pain thresholds in tension-type headache (TTH), migraine, and controls. Material and methods -In a blinded controlled explorative study, we recorded polysomnography (PSG) and pressure, heat, and cold pain thresholds in 34 controls, 20 TTH, and 53 migraine patients. Sleep quality was assessed by questionnaires, sleep diaries, and PSG. Migraineurs who had their recordings more than 2 days from an attack were classified as interictal while the rest were classified as either preictal or postictal. Interictal migraineurs (n = 33) were also divided into two groups if their headache onsets mainly were during sleep and awakening (sleep migraine, SM), or during daytime and no regular onset pattern (non-sleep migraine, NSM). TTH patients were divided into a chronic or episodic group according to headache days per month. Results -Compared to controls, all headache groups reported more anxiety and sleep-related symptoms. TTH and NSM patients reported more daytime tiredness and tended to have lower pain thresholds. Despite normal sleep times in diary, TTH and NSM had increased slow-wave sleep as seen after sleep deprivation. Migraineurs in the preictal phase had shorter latency to sleep onset than controls. Except for a slight but significantly increased awakening index SM, patients differed little from controls in objective measurements. Conclusions -We hypothesize that TTH and NSM patients on the average need more sleep than healthy controls. SM patients seem more susceptible to sleep disturbances. Inadequate rest might be an attack-precipitating-and hyperalgesia-inducing factor.

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“…Interictal migraineurs may have lower thermal pain thresholds compared to controls (Schwedt et al , 2011, Engstrom et al , 2013. The pain thresholds may further decrease right before and during migraine attack (Burstein et al , 2000, Sand et al , 2008.…”

Section: Introductionmentioning

confidence: 99%

Non-invasive cortical modulation of experimental pain in migraine

Uglem

Omland

Engstrøm

et al. 2016

Clinical Neurophysiology

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Sleep quality, arousal and pain thresholds in migraineurs: a blinded controlled polysomnographic study

Cited by 68 publications

References 43 publications

Polysomnographic Investigation of Sleep and Respiratory Parameters in Women with Temporomandibular Pain Disorders

Polysomnographic Investigation of Sleep and Respiratory Parameters in Women with Temporomandibular Pain Disorders

Sleep quality and arousal in migraine and tension-type headache: the headache-sleep study

Non-invasive cortical modulation of experimental pain in migraine

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