Obstrüktif Uyku Apne Sendromu ve Sabah Baş Ağrısı Birlikteliğinde Klinik ve Polisomnografik Değerlendirme

Öz

Amaç: Bu çalışmada polisomnografik olarak obstrüktif uyku apne sendromu (OUAS) tanısı konulan hastalarda sabah başağrısı (SBA) olan ve olmayan grupların klinik ve polisonmografi (PSG) sonuçları ile nazal pozitif basınçlı havayolu tedavisinin (n-CPAP) baş ağrısı üzerine etkileri araştırılmıştır. Yöntemler: OUAS şüphesi ile uyku laboratuarına yönlendirilen hastalar prospektif olarak takip edilerek SBA olan (grup 1) ve SBA olmayan (grup 2) olmak üzere iki gruba ayrıldı. Yaş, cinsiyet, vücut kitle indeksi (VKI), Epworth uykululuk skalası (EUS), Pittsburg uyku kalitesi indeksi (PUKI), Hamilton depresyon skalası (HDS), Hamilton anksiyete skalası (HAS), and PSG sonuçları karşılaştırıldı. Grup 1’deki hastalardan n-CPAP tedavisi alanların son takipteki baş ağrıları değerlendirildi. Bulgular: OUAS tanısı alan 78 hastanın dahil edildiği çalışmada hastaların 28’inde (%35.9) SBA vardı. Kadın cinsiyet ve ortalama VKI grup 1’ de istatistiksel olarak fazla idi (sırasıyla %43 ve %20, p=0.03; 33.14.9 ve 30.64.8 kg/m2, p=0.04). EUS sonuçları grup 1’de daha yüksek saptandı (10.8±4.4 vs. 8.4±4.1, p=0.02). PUKI, HDS and HAS iki grup arasında karşılaştırıldığında fark bulunmadı. Ortalama SpO2 (903.64 ve 92.42.88) and minimum SpO2 (78.1±10.7 ve 83.2±6.8) grup 1’de anlamlı düşük saptandı (p=0.02 ve p=0.03). Grup 1’de uyku süresi boyunca SpO2 90’ın altında olduğu süre istatistiksel olarak daha yüksek idi (17.9817.67 ve 11.0712.37, p=0.04). n-CPAP tedavisi olan 22 hastanın 19’unda (86.4%) son takipte baş ağrısı saptanmadı. Sonuç: Minimum SpO2 değerleri ve uyku sırasındaki desatürasyon süresi, kadın cinsiyet ve VKI SBA ile ilişkilidir. n-CPAP tedavisi SBA olan OUAS hastalarında etkili bir yöntemdir.

Anahtar Kelimeler

• Sabah baş ağrısı
• uyku apne sendromu
• pozitif basınçlı havayolu tedavisi

Clinical and Polysomnographic Evaluation of Morning Headache in Patients with Obstructive Sleep Apnea Syndrome

Abstract

Aim: The aim of the present study was to investigate the clinical and polysomnographic (PSG) characteristics in patients with PSG-verified obstructive sleep apnea syndrome (OSAS) with or without morning headache (MH) and to evaluate the response to nasal continuous positive airway pressure (n-CPAP) treatment. Methods: Patients who were referred to the sleep laboratory due to suspected OSAS were prospectively evaluated and divided into two groups: with MH (group 1) and without MH (group 2). Age, sex, body mass index (BMI), Epworth Sleepiness Scale (ESS), Pittsburg Sleep Quality Index (PSQI), Hamilton Depression Scale (HDS), Hamilton Anxiety Scale (HAS), and PSG variables were compared. Patients in group 1 who received n-CPAP treatment were also evaluated for headache persistence. Results: Seventy-eight patients with OSAS were included and 28 (35.9%) patients reported MH. Female gender and mean BMI were significantly higher in group 1 (43% vs. 20%, p=0.03; 33.14.9 vs. 30.64.8 kg/m2, p=0.04, respectively). The ESS was higher in group 1 (10.8±4.4 vs. 8.4±4.1, p=0.02). PSQI score, HDS, and HAS did not differ between the groups. Average SpO2 (903.64 vs. 92.42.88) and minimum SpO2 (78.1±10.7 vs. 83.2±6.8) were significantly lower in the MH group (p=0.02 and p=0.03). In addition, the duration of SpO2 <90 was significantly higher in the MH group (17.9817.67 vs. 11.0712.37, p=0.04). Nineteen (86.4%) of the 22 patients who received n-CPAP treatment were headache free. Conclusion: Minimum SpO2 levels and duration of desaturation during sleep were associated with MH. The other risk factors were female gender and higher BMI. N-CPAP therapy is an effective treatment for patients with MH.

Keywords

• Morning headache
• sleep apnea headache
• continuous positive airway pressure

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