Subjective Sleep Quality and Sleep Architecture in Patients With Migraine

Abstract

Objectives:Sleep disturbance is often associated with migraine. However, there is a paucity of research investigating objective and subjective measures of sleep in migraine patients. 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 architecture measured using polysomnography between adult and pediatric patients, and healthy controls.Methods:This review was pre-registered on PROSPERO (CRD42020209325). A systematic search of five databases (Embase, MEDLINE®, Global Health, APA PsycINFO, APA PsycArticles, last searched: 12/17/2020) was conducted to find case-controlled studies which measured polysomnography and/or PSQI in patients with migraine. Pregnant participants and those with other headache disorders were excluded. Effect sizes (Hedges’ g) were entered into a random effects model meta-analysis. Study quality was evaluated with the Newcastle Ottawa Scale, and publication bias with Egger’s regression test.Results:32 studies were eligible, of which 21 measured PSQI and/MIDAS in adults, 6 measured PSG in adults and 5 in children. The overall mean study quality score was 5/9, and this did not moderate any of the results, and there was no risk of publication bias. Overall, adults with migraine had higher PSQI scores than healthy controls (g=0.75, p < .001, 95% confidence interval [95%CI]: 0.54 - 0.96). This effect was larger in those with chronic rather than episodic condition (g=1.03, p < .001, 95%CI: 0.37 - 1.01, g = 0.63, p < .001, 95%CI: 0.38 - 0.88 respectively). For polysomnographic studies, adults and children with migraine displayed a lower percentage of REM sleep (g=-0.22, p = 0.017, 95%CI: -0.41 - -0.04, g = -0.71, p = 0.025, 95%CI: -1.34 - -0.10 respectively) than controls. Pediatric patients displayed less total sleep time (g=-1.37, p = 0.039, 95%CI: -2.66 - -0.10), more wake (g=0.52, p < .001, 95%CI: 0.08 – 0.79) and shorter sleep onset latency (g=-0.37, p < .001, 95%CI: -0.54 - -0.21) than controls.Discussion:People with migraine have significantly poorer subjective sleep quality and altered sleep architecture compared to healthy individuals. Further longitudinal empirical studies are required to enhance our understanding of this relationship.

Changes in brain connectivity linked to multisensory processing of pain modulation in migraine with acupuncture treatment

“…PSQI is a self-rated questionnaire that organically combines the quality and quantity of sleep to evaluate the sleep status of the subjects in the last month. PSQI scale is often used to evaluate the impact of migraine on sleep quality ( Stanyer et al, 2021 ). A total of 19 items generated seven measures, including subjective sleep quality, sleep latency, sleep duration, habitual sleep efficiency, sleep disturbances, use of sleeping medication, and daytime dysfunction ( Buysse et al, 1989 ).…”

Current Perspectives on the Impact of Chronic Migraine on Sleep Quality: A Literature Review

“…This leads researchers to conduct further studies on sleep in migraine. 79 The hypothalamic orexinergic system plays a critical role in sleep/wakefulness transitions and stabilizing REM sleep and has been linked to migraine. 80 …”

Sleep Patterns Changes Depending on Headache Subtype and Covariates of Primary Headache Disorders

“…It may be aggrevated with physical activity and nausea and/or phonophobia, and photophobia may accompany [81]. Migraneurs have higher scores of Pittsburg Sleep Quality Index (PSQI) showing a poor sleep quality [13]. Frequency of attacks were found to be related with decrease in sleep quality, and prevalance of poor sleeper is high in migraine [70].…”

“…The latency of rapid eye movement (REM) sleep may be longer. The total amount of REM sleep may decrease, and sleep efficiency may also be low [13,84]. In the microstructure of sleep in migraneous patients, rate of CAP and amount of CAP cycles and arousal index in REM and NonREM sleep stages may be low [28,40], or arousals may be frequent especially in patients with aura [38].…”

“…The severity of a sleep disorder may be in an adverse correlation with the intension of the pain [3]. Patients with headache may have poor sleep quality, reduced total sleep time, more awakenings, and alterations in architecture of sleep recorded by polysomnography (PSG) [13]. Prevalance of chronic headache was found to be higher in patients who underwent polysomnographic investigation due to sleep problems [14].…”