慢性头痛患者睡眠障碍的临床特点及影响因素
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摘要
目的探讨慢性头痛(CH)患者睡眠障碍的临床特点及其影响因素。方法使用动态EEG、睡眠评估量表和医院焦虑抑郁量表分别对CH患者(CH组,n=20)、发作性头痛(EH)患者(EH组,n=20)和健康对照者(健康对照组,n=20)进行客观、主观睡眠分析和精神共患病的评估和对比分析。结果 CH组头痛家族史的比例明显高于健康对照组(P=0.008)。CH组的头痛病程明显长于EH组(P=0.025)。EH组与健康对照组简易版Karolinska睡眠问卷(KSQ),总分差异有统计学意义(P<0.05)。与健康对照组或EH组相比,CH组的匹兹堡睡眠质量指数量表(PSQI)总分、KSQ总分,以及睡眠障碍、白天过度嗜睡、失眠的比例均明显增高,共患焦虑抑郁者也明显增多(均P<0.05)。与健康对照组相比,CH组的焦虑或抑郁者也明显增多(均P<0.05)。与健康对照组或EH组相比,CH组睡眠潜伏期延长,1、2期睡眠增多,慢波睡眠和快速眼动睡眠减少,而觉醒总时间增加,觉醒次数和觉醒指数升高,睡眠效率明显降低(均P<0.05)。Spearman相关分析及逐步多重线性回归分析显示,CH患者的1期睡眠、睡眠潜伏期与焦虑呈正相关性(R~2=0.761,R~2=0.728;均P<0.001),觉醒次数与抑郁呈正相关性(R~2=0.321,P=0.009),失眠、PSQI总分与慢波睡眠呈负相关性(R~2=0.502,R~2=0.317;均P<0.05)。结论 CH更易伴发睡眠障碍和精神共患病。CH患者存在慢波睡眠减少和夜间频繁觉醒,且焦虑和抑郁对CH患者所伴发的睡眠障碍也有一定的影响。
Objective To observe the clinical features and risk factors of sleep disturbances in patients with chronic headache(CH). Methods Dynamic EEG,sleep questionnaires and Hospital Anxiety and Depression Scales were administrated to evaluate and compared the objective and subjective sleep and psychiatric comorbidity among CH patients(CH group,n = 20),episodic headache(EH) patients(EH group,n = 20) and healthy controls(healthy control group,n = 20). Results The proportion of family history of headache of CH group was obviously higher than that of healthy controls(P = 0. 008). The headache course of CH group was obviously longer than EH group(P =0. 025). The difference of Karolinska Sleep Question(KSQ) total score between EH group and health control group was statistically significant(P < 0. 05). Compared with the healthy control group and EH group,Pittsburgy Sleep Quality Index(PSQI) score,KSQ meant,insomnia and sleep disturbances,excessive daytime sleepiness of CH group were significantly increased,the proportion of the total risk of anxiety or depression were also significantly increased(all P < 0. 05). Compared with healthy controls,the anxiety or depression of CH group also increased significantly(all P < 0. 05). Compared with healthy control group and EH group,the sleep latency period,the number of stage 1 and stage 2 sleep,awaken total time,awakening times and index were increased,but the slowwave sleep,rapid-eye-movement sleep,and the sleep efficiency were significantly decreased in CH group(all P <0. 05). Spearman correlation analysis and stepwise multiple linear regression analysis of CH group showed that the stage 1 sleep and sleep latency period were positively correlated with anxiety(R~2= 0. 761,R~2= 0. 728; P < 0. 001),awakening times was positively correlated with depression(R~2= 0. 321,P = 0. 321),insomnia and PSQI scores were negatively correlated with slow-wave sleep(R~2= 0. 502,R~2= 0. 317; all P < 0. 05). Conclusions Patients with CH have a higher prevalence of sleep disturbances and psychiatric comorbidity. They suffer from a loss of slow wave sleep and higher awake frequency,anxiety and depression also have a key effect on sleep disturbances in CH patients.
Objective To observe the clinical features and risk factors of sleep disturbances in patients with chronic headache(CH). Methods Dynamic EEG,sleep questionnaires and Hospital Anxiety and Depression Scales were administrated to evaluate and compared the objective and subjective sleep and psychiatric comorbidity among CH patients(CH group,n = 20),episodic headache(EH) patients(EH group,n = 20) and healthy controls(healthy control group,n = 20). Results The proportion of family history of headache of CH group was obviously higher than that of healthy controls(P = 0. 008). The headache course of CH group was obviously longer than EH group(P =0. 025). The difference of Karolinska Sleep Question(KSQ) total score between EH group and health control group was statistically significant(P < 0. 05). Compared with the healthy control group and EH group,Pittsburgy Sleep Quality Index(PSQI) score,KSQ meant,insomnia and sleep disturbances,excessive daytime sleepiness of CH group were significantly increased,the proportion of the total risk of anxiety or depression were also significantly increased(all P < 0. 05). Compared with healthy controls,the anxiety or depression of CH group also increased significantly(all P < 0. 05). Compared with healthy control group and EH group,the sleep latency period,the number of stage 1 and stage 2 sleep,awaken total time,awakening times and index were increased,but the slowwave sleep,rapid-eye-movement sleep,and the sleep efficiency were significantly decreased in CH group(all P <0. 05). Spearman correlation analysis and stepwise multiple linear regression analysis of CH group showed that the stage 1 sleep and sleep latency period were positively correlated with anxiety(R~2= 0. 761,R~2= 0. 728; P < 0. 001),awakening times was positively correlated with depression(R~2= 0. 321,P = 0. 321),insomnia and PSQI scores were negatively correlated with slow-wave sleep(R~2= 0. 502,R~2= 0. 317; all P < 0. 05). Conclusions Patients with CH have a higher prevalence of sleep disturbances and psychiatric comorbidity. They suffer from a loss of slow wave sleep and higher awake frequency,anxiety and depression also have a key effect on sleep disturbances in CH patients.
引文
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[2]Natoli JL,Manack A,Dean B,et al.Global prevalence of chronic migraine:a systematic review[J].Cephalalgia,2010,30:599.
[3]Yu SY,Han X.Update of chronic Tension-Type headache[J].Curr Pain Headache Rep,2015,19:469.
[4]Munksgaard SB,Jensen RH.Medication overuse headache[J].Headache,2014,54:1251.
[5]Cho SJ,Chu MK.Risk factors of chronic daily headache or chronic migraine[J].Curr Pain Headache Rep,2015,19:465.
[6]Rains JC,Penzien DB.Chronic headache and sleep disturbance[J].Curr Pain Headache Rep,2002,6:498.
[7]Sancisi E,Cevoli S,Vignatelli L,et al.Increased prevalence of sleep disorders in chronic headache:a case-control study[J].Headache,2010,50:1464.
[8]Odegard SS,Engstrom M,Sand T,et al.Associations between sleep disturbance and primary headaches:the third Nord-Trondelag Health Study[J].J Headache Pain,2010,11:197.
[9]Aurilia C,Vanacore N,Egeo G,et al.A case-control study on excessive daytime sleepiness in chronic migraine[J].Neurological Sciences,2011,32:S204.
[10]Lin YK,Lin GY,Lee JT,et al.Associations between sleep quality and migraine frequency a Cross-Sectional Case-Control study[J].Medicine,2016,95:e3554.
[11]Kim J,Cho SJ,Kim WJ,et al.Excessive daytime sleepiness is associated with an exacerbation of migraine:A population-based study[J].J Headache Pain,2016,17:62.
[12]Karthik N,Sinha S,Taly AB,et al.Alteration in polysomnographic profile in‘migraine without aura’compared to healthy controls[J].Sleep Med,2013,14:211.
[13]Engstr9m M,Hagen K,Bjork M,et al.Sleep quality,arousal and pain thresholds in tension-type headache:A blinded controlled polysomnographic study[J].Cephalalgia,2014,34:455.
[14]Vendrame M,Kaleyias J,Valencia I,et al.Polysomnographic findings in children with headaches[J].Pediatr Neurol,2008,39:6.
[15]Guidetti V,Dosi C,Bruni O.The relationship between sleep and headache in children:implications for treatment[J].Cephalalgia,2014,34:767.
[16]Hering-Hanit R,Yavetz A,Dagan Y.Effect of withdrawal of misused medication on sleep disturbances in migraine sufferers with chronic daily headache[J].Headache,2000,40:809.
[17]Lai TH,Protsenko E,Cheng YC,et al.Neural plasticity in common forms of chronic headaches[J].Neural Plast,2015,2015:205985.
[18]Schwedt T,Chiang CC,Chong CD,et al.Functional MRI of migraine[J].Lancet Neurol,2015,14:81.
[19]Jin CW,Yuan K,Zhao LM,et al.Structural and functional abnormalities in migraine patients without aura[J].NMR Biomed,2013,26:58.
[20]Reyngoudt H,Achten E,Paemeleire K.Magnetic resonance spectroscopy in migraine:what have we learned so far?[J].Cephalalgia,2012,32:845.
[21]de Tommaso M,Delussi M,Vecchio EA,et al.Sleep features and central sensitization symptoms in primary headache patients[J].J Headache Pain,2014,15:64.
[22]Zebenholzer K,Lechner A,Broessner G,et al.Impact of depression and anxiety on burden and management of episodic and chronic headaches’a cross-sectional multicentre study in eight Austrian headache centres[J].J Headache Pain,2016,17:15.