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Goyal A, Meena R, Gupta S, Kar A, Ali R, Bohra A, Solanki V, Chaudhary P, Pakhare A. Sex-specific differences in presenting symptoms of obstructive sleep apnea. Lung India 2024; 41:115-120. [PMID: 38700405 PMCID: PMC10959312 DOI: 10.4103/lungindia.lungindia_235_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Revised: 04/17/2023] [Accepted: 06/07/2023] [Indexed: 05/05/2024] Open
Abstract
OBJECTIVES Scant data from India are available on the gender differences in presenting features of Obstructive Sleep Apnea (OSA) in India. This study aims to compare male and female patients with OSA for general characteristics and presenting symptoms. METHODOLOGY Retrospective study was done in OSA patients diagnosed in our sleep lab. History, biochemical reports, and polysomnography variables were retrieved from the sleep registry and were compared between males and females. RESULTS Out of 514 patients of OSA (367 males; 147 females). Females were older (55.97 ± 9.73 v/s 50.2 + 12.70 years, P<0.001) and more obese (BMI 35.26 ± 7.17 v/s 29.58 ± 5.49 Kg/m2; P<0.001). Waist and hip circumference were significantly higher in the female patients (P = 0.009 and <0.001 respectively). Morning headache, nocturia, fatigability (P < 0.001), and depression (P = 0.005) was more common in females (P = 0.036). Hypersomnia was more commonly seen in males (P < 0.001). Mean diastolic blood pressure was significantly higher in males, although no difference was seen in Systolic BP. Females had higher mean Fasting Blood glucose (FBS) (P = 0.02). Apnea hypopnea index was significantly higher in females {P = 0.01}. CONCLUSION Women with OSA are more obese, elderly, and with higher fasting blood glucose than males at the time of diagnosis. Females have a higher prevalence of symptoms like fatigability, depression, nocturia and early morning headache and had more severe AHI than males.
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Affiliation(s)
| | | | - Suruchi Gupta
- Community and Family Medicine, AIIMS Bhopal, Madhya Pradesh, India
| | - Avishek Kar
- Pulmonary Medicine, AIIMS Raipur, Chhattisgarh, India
| | - Rashida Ali
- Pulmonary Medicine, AIIMS Bhopal, Madhya Pradesh, India
| | - Arwa Bohra
- Pulmonary Medicine, AIIMS Bhopal, Madhya Pradesh, India
| | | | | | - Abhijit Pakhare
- Community and Family Medicine, AIIMS Bhopal, Madhya Pradesh, India
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Błaszczyk B, Martynowicz H, Więckiewicz M, Straburzyński M, Antolak M, Budrewicz S, Staszkiewicz M, Kopszak A, Waliszewska-Prosół M. Prevalence of headaches and their relationship with obstructive sleep apnea (OSA) - Systematic review and meta-analysis. Sleep Med Rev 2024; 73:101889. [PMID: 38056382 DOI: 10.1016/j.smrv.2023.101889] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2023] [Revised: 11/20/2023] [Accepted: 11/26/2023] [Indexed: 12/08/2023]
Abstract
Obstructive sleep apnea (OSA) is one of the most common sleep disorders; however, there are inconsistent results about the connection and occurrence of primary and secondary headaches in OSA. Therefore, the primary objectives were to estimate the prevalence and potential relationship between all types of headaches and OSA. A systematic review was conducted according to PRISMA 2020 guidelines. Studies were searched in PubMed, Embase, and Web of science up to July 2023. The Joanna Briggs Institute tool assessed the risk of bias. 1845 articles were identified, and 23 studies describing 15,402 patients were included. Pooled prevalence of all headaches in OSA was 33% (95% CI: 0.25-0.41), 33% for morning headaches (95% CI: 0.24-0.45), 25% for sleep apnea headaches (95% CI: 0.18-0.34), 19% for tension-type headache (95% CI: 0.15-0.23), and 16% for migraine (95% CI: 0.09-0.26). Relative risk for the occurrence of headache in OSA patients compared to the non-OSA people was 1.43 (95% CI: 0.92-2.25). OSA females and males had morning headaches with similar frequency. The prevalence of headaches in OSA was moderate. OSA did not increase the risk of headache. There is a need to conduct further studies focused on bidirectional connections between sleep disorders and headaches.
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Affiliation(s)
- Bartłomiej Błaszczyk
- Department of Internal Medicine, Occupational Diseases, Hypertension and Clinical Oncology, Wroclaw Medical University, Wroclaw, Poland
| | - Helena Martynowicz
- Department of Internal Medicine, Occupational Diseases, Hypertension and Clinical Oncology, Wroclaw Medical University, Wroclaw, Poland
| | - Mieszko Więckiewicz
- Department of Experimental Dentistry, Wroclaw Medical University, Wroclaw, Poland
| | - Marcin Straburzyński
- Department of Family Medicine and Infectious Diseases, University of Warmia and Mazury, Olsztyn, Poland
| | - Mariola Antolak
- Department of Neurology, Wroclaw Medical University, Wroclaw, Poland
| | | | - Martyna Staszkiewicz
- Department of Internal Medicine, Occupational Diseases, Hypertension and Clinical Oncology, Wroclaw Medical University, Wroclaw, Poland
| | - Anna Kopszak
- Statistical Analysis Center, Wroclaw Medical University, Wroclaw, Poland
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Barone DA, Segal AZ. Obstructive Sleep Apnea and Positive Airway Pressure Usage in Populations with Neurological Disease. Sleep Med Clin 2022; 17:619-627. [DOI: 10.1016/j.jsmc.2022.07.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Fortes HMS, Severiano RSD, Barros PP, Silva BMDC, Freitas LL, Sena ADS, Roberto RP. Obstructive sleep apnea and headache: an integrative review of the last 18 years. HEADACHE MEDICINE 2022. [DOI: 10.48208/headachemed.2022.17] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Introduction
Obstructive sleep apnea (OSA) is a prevalent and underdiagnosed clinical condition, characterized by the presence of repetitive airway collapse during sleep, resulting in oxyhemoglobin desaturation and sleep fragmentation. Among the most frequent reports of patients with OSA, is morning headache or chronic daily headache, which in 2004 received its own classification in the International Classification of Headache Disorders (ICHD-2) as sleep apnea headache.
Objective
The present review aims to evaluate the available scientific literature on the association between OSA and headache after classification, totaling a period of 18 years.
Results
In 8 included studies, 1,637 patients were analyzed, observing a bilateral and frequent association between the two pathologies.
Conclusion
However, there is still no consensus on the mechanism behind this relationship, and the results of studies are divergent.
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Tran-Minh D, Phi-Thi-Quynh A, Nguyen-Dinh P, Duong-Quy S. Efficacy of obstructive sleep apnea treatment by antileukotriene receptor and surgery therapy in children with adenotonsillar hypertrophy: A descriptive and cohort study. Front Neurol 2022; 13:1008310. [PMID: 36237622 PMCID: PMC9552176 DOI: 10.3389/fneur.2022.1008310] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2022] [Accepted: 09/12/2022] [Indexed: 11/13/2022] Open
Abstract
BackgroundPrevalence of obstructive sleep apnea (OSA) in children with adenotonsillar hypertrophy is high and related to the occlusion of the upper airway. The main treatments of OSA in these children is adenotonsillectomy. However, this intervention is an invasive method with a various success rate. Thus, the indications of tonsillectomy remain debatable and non-invasive treatment is still a potential choice in these patients.MethodsIt was a cross-sectional and interventional study. This study included children aged from 2 to 12 years-old who were diagnosed with OSA by respiratory polygraphy and had tonsillar hypertrophy with/without adenoid hypertrophy. All main data including age, gender, height, weight, body mass index (BMI), clinical symptoms, and medical history were recorded for analysis. Physical examination and endoscopy were done to evaluate the size of tonsillar and adenoid hypertrophy by using Brodsky and Likert classifications, respectively. The severity of OSA was done by using the classification of AHI severity for children.ResultsThere were 114 patients (2–12 years old) with a mean age of 5.5 ± 2.1 years included in the present study. The main reasons for consultations were snoring (96.7%), a pause of breathing (57.1%), an effort to breathe (36.8%), unrefreshing sleep (32%), doziness (28.2%), and hyperactivity (26.3%). There were 36% of subjects with tonsillar hypertrophy grade 1–2, 48.2% with grade 3, and 15.8% with grade 4 (Brodsky classification); among them, there were 46.5% of subjects with grades 1–2 of adenoid hypertrophy, 45.6% with grade 3, and 7.0% with grade 4 (Likert classification). The mean AHI was 12.6 ± 11.2 event/h. There was a significant correlation between the mean AHI and the level of tonsillar and adenoid hypertrophy severity (r = 0.7601 and r = 0.7903; p < 0.05 and p < 0.05, respectively). The improvement of clinical symptoms of study subjects was found in both groups treated with ALR (antileukotriene receptor) or ST (surgery therapy). The symptoms related to OSA at night including snoring, struggle to breathe, sleeping with the mouth open, and stopping breathing during sleep were significantly improved after treatment with ATR and with ST (p < 0.001 and p = 0.001, respectively). The mean AHI was significantly reduced in comparison with before treatment in study subjects treated with ALR (0.9 ± 1.0 vs. 3.9 ± 2.7 events/h; p = 0.001) or with ST (3.5 ± 1.4 vs. 23.4 ± 13.1 events/h; p < 0.001).ConclusionThe treatment of OSA due to adeno-tonsillar hypertrophy with ALR for moderate OSA or surgery for severe OSA might reduce the symptoms related to OSA at night and during the day.
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Affiliation(s)
- Dien Tran-Minh
- Department of ENT, National Pediatric Hospital, Hanoi, Vietnam
| | | | | | - Sy Duong-Quy
- Sleep Lab Center, Lam Dong Medical College and Bio-Medical Research Center, Dalat, Vietnam
- Immuno-Allergology Division, Hershey Medical Center, Penn State Medical College, State College, PA, United States
- Department of Outpatient Expert Consultation, Pham Ngoc Thach University of Medicine, Ho Chi Minh City, Vietnam
- *Correspondence: Sy Duong-Quy
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Abstract
PURPOSE OF REVIEW Migraine is and continues to be a significant medical issue in older adults. Migraine can have different characteristics in older adults and specific diagnostic and treatment considerations need to be applied when managing headache and migraine in this population, which is increasing in both size and diversity. Contrary to widely held beliefs, migraine may not improve in older women following menopause and can have new onset in older age. The purpose of this review is to give an update on the diagnosis and treatment of episodic migraine in older adults. RECENT FINDINGS As the population ages, migraine in older adults will become a more significant public health issue. Migraine in older adults can present with different clinical symptoms than in a younger population and is primarily a diagnosis of exclusion in older adults. Migraine treatment considerations for older adults should include comorbidities and medication interactions. Recent findings suggest there are medications that should be avoided when treating seniors with migraine. The purpose of this review is to give an update on the most important aspects regarding the diagnosis and treatment of headache and migraine in older adults. In addition, recommendations will be made concerning medications that need careful consideration when prescribing to seniors.
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Cocores AN, Monteith TS. Headache as a Neurologic Manifestation of Systemic Disease. Curr Treat Options Neurol 2022; 24:17-40. [PMID: 35317303 PMCID: PMC8931180 DOI: 10.1007/s11940-022-00704-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/15/2021] [Indexed: 11/26/2022]
Abstract
Purpose of Review Recent Findings Summary
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Affiliation(s)
- Alexandra N. Cocores
- Division of Headache, Department of Neurology, Miller School of Medicine, University of Miami, 1120 NW 14 Street, Florida, Miami 33132 USA
| | - Teshamae S. Monteith
- Division of Headache, Department of Neurology, Miller School of Medicine, University of Miami, 1120 NW 14 Street, Florida, Miami 33132 USA
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Antonio Minni, Cialente F, Ralli M, Colizza A, Lai Q, Placentino A, Franco M, Rossetti V, De Vincentiis M. Uvulopalatopharyngoplasty and barbed reposition pharyngoplasty with and without hyoid suspension for obstructive sleep apnea hypopnea syndrome: A comparison of long-term functional results. Bosn J Basic Med Sci 2021; 21:364-369. [PMID: 32343940 PMCID: PMC8112555 DOI: 10.17305/bjbms.2020.4724] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Accepted: 04/26/2020] [Indexed: 11/25/2022] Open
Abstract
Obstructive sleep apnea hypopnea syndrome (OSAHS) is a common condition; when conservative approaches are not effective, surgical techniques aimed at reducing the airway obstruction effect are used. This retrospective study aimed at comparing the functional outcomes in patients with OSAHS undergoing uvulopalatopharyngoplasty (UPPP) according to Fairbanks and barbed reposition pharyngoplasty (BRP) according to Mantovani, with or without hyoid suspension (HS). One-hundred twenty-two consecutive OSAHS patients who underwent surgical treatment were included in the study. Patients were divided into 4 groups; all patients underwent preoperative and postoperative polysomnography (PSG) with apnea/hypopnea index (AHI) and oxygen desaturation index (ODI) evaluation, and Epworth Sleepiness Scale (ESS) evaluation. The results were analyzed according to the different surgical procedures in relation to the preoperative PSG and anthropometric data. A significant reduction was observed at 18-month follow-up for patients in BRP group for body mass index (p = 0.004), ESS (p < 0.0001), ODI (p < 0.0001), and AHI (p < 0.0001). Risk factors for poor postoperative AHI reduction were evaluated; preoperative AHI was the strongest independent protective factor, while preoperative ODI was the strongest risk factor. The association of HS with UPPP or BRP showed significant results in terms of higher postoperative AHI reduction only when associated to UPPP (p < 0.0001). This study showed that the BRP technique was more effective compared to UPPP for patients with OSAHS. The association of HS showed greater benefits in UPPP compared to BRP. Randomized prospective trials with longer follow-up are necessary to confirm our results and formulate a more accurate indication of the optimal therapeutic strategy.
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Affiliation(s)
- Antonio Minni
- Department of Sense Organs, Sapienza University of Rome, Rome, Italy
| | - Fabrizio Cialente
- Department of Sense Organs, Sapienza University of Rome, Rome, Italy
| | - Massimo Ralli
- Department of Sense Organs, Sapienza University of Rome, Rome, Italy
| | - Andrea Colizza
- Department of Sense Organs, Sapienza University of Rome, Rome, Italy
| | - Quirino Lai
- Hepato-bilio-pancreatic and Liver Transplant Unit, Department of Surgery, Sapienza University of Rome, Rome, Italy
| | | | - Melania Franco
- Department of Sense Organs, Sapienza University of Rome, Rome, Italy
| | - Valeria Rossetti
- Department of Sense Organs, Sapienza University of Rome, Rome, Italy
| | - Marco De Vincentiis
- Department of Oral and Maxillofacial Sciences, Sapienza University of Rome, Rome, Italy
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Kuczyński W, Kudrycka A, Małolepsza A, Karwowska U, Białasiewicz P, Białas A. The Epidemiology of Obstructive Sleep Apnea in Poland-Polysomnography and Positive Airway Pressure Therapy. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18042109. [PMID: 33671515 PMCID: PMC7927121 DOI: 10.3390/ijerph18042109] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Revised: 02/15/2021] [Accepted: 02/18/2021] [Indexed: 01/27/2023]
Abstract
The aim of this study is to provide a brief summary of the epidemiological data on obstructive sleep apnea syndrome (OSAS) diagnosis and therapy in different regions of Poland from 2010 to 2019. We performed a retrospective study in the sleep center of the Department of Sleep Medicine and Metabolic Disorders, Medical University of Lodz, Poland. We requested data from the National Health Service concerning the number of new diagnoses of OSAS, the polysomnographies (PSGs) that were performed, and reimbursements of positive airway pressure (PAP) therapy in each region of Poland in the period 2010–2019. The constant increase in the number of polysomnographies performed and PAP reimbursements suggests the need to create a national network between regional sleep centers to provide proper care for patients with OSAS, and PAP therapy.
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Affiliation(s)
- Wojciech Kuczyński
- Department of Sleep Medicine and Metabolic Disorders, Medical University of Lodz, 92-215 Lodz, Poland; (A.K.); (A.M.); (U.K.); (P.B.)
- Correspondence: ; Tel./Fax: +48-42-2725656
| | - Aleksandra Kudrycka
- Department of Sleep Medicine and Metabolic Disorders, Medical University of Lodz, 92-215 Lodz, Poland; (A.K.); (A.M.); (U.K.); (P.B.)
| | - Aleksandra Małolepsza
- Department of Sleep Medicine and Metabolic Disorders, Medical University of Lodz, 92-215 Lodz, Poland; (A.K.); (A.M.); (U.K.); (P.B.)
| | - Urszula Karwowska
- Department of Sleep Medicine and Metabolic Disorders, Medical University of Lodz, 92-215 Lodz, Poland; (A.K.); (A.M.); (U.K.); (P.B.)
| | - Piotr Białasiewicz
- Department of Sleep Medicine and Metabolic Disorders, Medical University of Lodz, 92-215 Lodz, Poland; (A.K.); (A.M.); (U.K.); (P.B.)
| | - Adam Białas
- Department of Pathobiology of Respiratory Diseases, Medical University of Lodz, 90-153 Lodz, Poland;
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Gorgoni M, De Gennaro L. Sleep in the Aging Brain. Brain Sci 2021; 11:brainsci11020229. [PMID: 33673285 PMCID: PMC7918041 DOI: 10.3390/brainsci11020229] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Revised: 02/06/2021] [Accepted: 02/08/2021] [Indexed: 02/05/2023] Open
Abstract
We have entered an era of a steep increase in the absolute and relative number of older people. This well-come phenomenon represents a major challenge for health care. However, maturational changes in sleep associated with aging do not easily appear as main factors, even though sleep alterations in the aging process lead to many detrimental consequences. In this editorial paper, we summarize the present knowledge about the main aging-related sleep modifications and their relevance for health problems and cognitive decline. Then, we present the papers published in the Special Issue “Disturbances of Sleep Among Older People”.
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Affiliation(s)
- Maurizio Gorgoni
- Department of Psychology, Sapienza University of Rome, 00185 Rome, Italy;
| | - Luigi De Gennaro
- Department of Psychology, Sapienza University of Rome, 00185 Rome, Italy;
- IRCCS Fondazione Santa Lucia, 00179 Rome, Italy
- Correspondence: ; Tel.: +39-06-4991-7647
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Khamsai S, Mahawarakorn P, Limpawattana P, Chindaprasirt J, Sukeepaisarnjaroen W, Silaruks S, Senthong V, Sawunyavisuth B, Sawanyawisuth K. Prevalence and factors correlated with hypertension secondary from obstructive sleep apnea. Multidiscip Respir Med 2021; 16:777. [PMID: 34650797 PMCID: PMC8447556 DOI: 10.4081/mrm.2021.777] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2021] [Accepted: 06/25/2021] [Indexed: 12/28/2022] Open
Abstract
Background In 2003, the JNC 7 reported obstructive sleep apnea (OSA) as a cause of secondary hypertension. The prevalence of OSA in hypertension ranges from 30-80%. There are limited data on the prevalence and risk factors of OSA in hypertensive patients. This study thus aimed to evaluate prevalence and clinical predictors of obstructive sleep apnea (OSA) in these patients. Methods This was a cross-sectional study and conducted at the hypertension clinic at Khon Kaen University’s Srinagarind Hospital, Thailand. We enrolled patients with hypertension treated at the clinic. OSA was defined as apnea-hypopnea index of 5 events/hour or over according to cardiopulmonary monitoring. Patients whose hypertension was due to any other causes were excluded. The prevalence of OSA was calculated and risk factors for OSA were analyzed using multivariate logistic regression. Results There were 726 hypertensive patients treated at the clinic. Out of those, 253 (34.8%) were randomly studied and categorized as either non-OSA (147 patients, 58.1%) or OSA (106 patients, 41.9%). There were four independent factors associated with OSA-induced hypertension: age, sex, history of snoring, and history of headache. Headache had an adjusted odds ratio (95% confidence interval) of 3.564 (95% confidence interval of 1.510, 8.411). Conclusion Age, male sex, history of snoring, and headache were independent predictors of hypertension caused by OSA.
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Affiliation(s)
| | | | | | | | | | | | | | - Bundit Sawunyavisuth
- Department of Marketing, Faculty of Business Administration and Accountancy, Khon Kaen University, Khon Kaen, Thailand
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Barloese M. Current Understanding of the Chronobiology of Cluster Headache and the Role of Sleep in Its Management. Nat Sci Sleep 2021; 13:153-162. [PMID: 33603525 PMCID: PMC7886233 DOI: 10.2147/nss.s278088] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Accepted: 01/15/2021] [Indexed: 12/11/2022] Open
Abstract
Cluster headache is uniquely rhythmic in its occurrence both diurnally and annually. This has implications for the clinical approach to the patient but also for our understanding of the role of central structures in its pathological basis. Many intrinsic and extrinsic factors seem to influence CH rhythmicity, including genetics. The proclivity for attacks to occur at night and the possible association with particular sleep phenomena, including sleep apnea, have motivated a number of studies which has improved our understanding but many questions remain unanswered. The sleep-headache interaction seems to be bidirectional and possibly both direct and indirect. The latter could involve more disperse networks of homeostatic regulation, which may better encompass recent observations. Treatment of the headache patient with concurrent sleep problems can be particularly challenging, especially considering side-effects and interactions of commonly used medications. While current treatment guidelines do not incorporate chronotherapeutic thinking, some evidence may suggest that application of such principles on an individual level may be beneficial.
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Affiliation(s)
- Mads Barloese
- Department of Clinical Physiology and Nuclear Medicine, Center for Functional and Diagnostic Imaging, Hvidovre Hospital, Hvidovre, Denmark.,Department of Neurology, Danish Headache Center, Rigshospitalet-Glostrup, Glostrup, Denmark
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