Subjective sleep quality and objective sleep physiology in migraineurs: a meta-analysis

Abstract

Objectives: Sleep disturbance is often associated with migraine. However, there is a paucity of research investigating objective and subjective measures of sleep in migraineurs. This meta-analysis aims to determine whether there are differences in subjective sleep quality measured using the Pittsburgh Sleep Quality Index (PSQI) and objective sleep physiology measured using polysomnography between adult and pediatric migraineurs, and healthy controls. Methods: A systematic search of five databases was conducted to find case-controlled studies which measured polysomnography and/or PSQI in migraineurs. Effect sizes (Hedges' g) were entered into a random effects model meta-analysis. Results: 32 separate studies were eligible. Overall, adult migraineurs had higher PSQI scores than healthy controls (g = 0.75, p < .001). This effect was larger in chronic than episodic migraineurs (g = 1.03, p < .001, g = 0.63, p < .001 respectively). For polysomnographic studies, adult and pediatric migraineurs displayed a lower percentage of REM sleep (g = -0.22, p = 0.017, g = -0.71, p = 0.025 respectively) than healthy controls. Pediatric migraineurs also displayed less total sleep time (g = -1.37, p = 0.039), more wake (g = 0.52, p < .001) and shorter sleep onset latency (g = -0.37, p < .001) than healthy controls. Conclusion: Migraineurs have significantly poorer subjective sleep quality, and altered sleep compared to healthy individuals - a finding which is particularly evident in children. This has implications for developing appropriate treatments. Further longitudinal empirical studies are required to enhance our understanding of this relationship.