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

Yıl 2022, Cilt: 7 Sayı: 3, 72 - 76, 26.12.2022

Senay Yildiz Celik Özlem Öz

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

Öz

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.

Anahtar Kelimeler

Morning headache, sleep apnea headache, continuous positive airway pressure

Kaynakça

• 1. Sleep-related breathing disorders in adults: recommendations for syndrome definition and measurement techniques in clinical research. The Report of an American Academy of Sleep Medicine Task Force. Sleep 1999;22:667-89.
• 2. Punjabi NM, Caffo BS, Goodwin JL, Gottlieb DJ, Newman AB, O'Connor GT, et al. Sleep-disordered breathing and mortality: a prospective cohort study. PLoS Med 2009;6:e1000132.
• 3. Peppard PE, Young T, Barnet JH, Palta M, Hagen EW, Hla KM. Increased prevalence of sleep-disordered breathing in adults. Am J Epidemiol 2013;177:1006-14.
• 4. Fietze I, Laharnar N, Obst A, Ewert R, Felix SB, Garcia C, et al. Prevalence and association analysis of obstructive sleep apnea with gender and age differences - Results of SHIP-Trend. J Sleep Res 2019;28:e12770.
• 5. Sand T, Hagen K, Schrader H. Sleep apnoea and chronic headache. Cephalalgia 2003;23:90-5.
• 6. Mitsikostas DD, Vikelis M, Viskos A. Refractory chronic headache associated with obstructive sleep apnoea syndrome. Cephalalgia 2008;28:139-43.
• 7. Johnson KG, Ziemba AM, Garb JL. Improvement in headaches with continuous positive airway pressure for obstructive sleep apnea: a retrospective analysis. Headache 2013;53:333-43.
• 8. Neau JP, Paquereau J, Bailbe M, Meurice JC, Ingrand P, Gil R. Relationship between sleep apnoea syndrome, snoring and headaches. Cephalalgia 2002;22:333-9.
• 9. Aldrich MS, Chauncey JB. Are morning headaches part of obstructive sleep apnea syndrome? Arch Intern Med 1990;150:1265-7.
• 10. Poceta JS, Dalessio DJ. Identification and treatment of sleep apnea in patients with chronic headache. Headache 1995;35:586-9.
• 11. Goder R, Friege L, Fritzer G, Strenge H, Aldenhoff JB, Hinze-Selch D. Morning headaches in patients with sleep disorders: a systematic polysomnographic study. Sleep Med 2003;4:385-91.
• 12. Dodick DW, Eross EJ, Parish JM, Silber M. Clinical, anatomical, and physiologic relationship between sleep and headache. Headache 2003;43:282-92.
• 13. Headache Classification Committee of the International Headache Society (IHS) The International Classification of Headache Disorders, 3rd edition. Cephalalgia 2018;38:1-211.
• 14. Ohayon MM. Prevalence and risk factors of morning headaches in the general population. Arch Intern Med 2004;164:97-102.
• 15. Loh NK, Dinner DS, Foldvary N, Skobieranda F, Yew WW. Do patients with obstructive sleep apnea wake up with headaches? Arch Intern Med 1999;159:1765-8.
• 16. Alberti A, Mazzotta G, Gallinella E, Sarchielli P. Headache characteristics in obstructive sleep apnea syndrome and insomnia. Acta Neurol Scand 2005;111:309-16.
• 17. Goksan B, Gunduz A, Karadeniz D, Agan K, Tascilar FN, Tan F, et al. Morning headache in sleep apnoea: clinical and polysomnographic evaluation and response to nasal continuous positive airway pressure. Cephalalgia 2009;29:635-41.
• 18. Kristiansen HA, Kvaerner KJ, Akre H, Overland B, Sandvik L, Russell MB. Sleep apnoea headache in the general population. Cephalalgia 2012;32:451-8.
• 19. KoÇ G, Metİn KM, AkÇay BD, KaradaŞ Ö, Sayin R, Yetkİn S. Relationship between Apnea-Hypopnea Index and Oxygen Desaturation in REM-Sleep Period and Morning Headache in Patients with Obstructive Sleep Apnea Syndrome. Noro Psikiyatr Ars 2020;57:294-98.
• 20. Suzuki K, Miyamoto M, Miyamoto T, Numao A, Suzuki S, Sakuta H, et al. Sleep apnoea headache in obstructive sleep apnoea syndrome patients presenting with morning headache: comparison of the ICHD-2 and ICHD-3 beta criteria. J Headache Pain 2015;16:56.
• 21. Izci B, Ardic S, Firat H, Sahin A, Altinors M, Karacan I. Reliability and validity studies of the Turkish version of the Epworth Sleepiness Scale. Sleep Breath 2008;12:161-8.
• 22. Ağargün MY KH, Anlar Ö. The validity and reliability of the Pittsburgh Sleep Quality Index. Turk Psikiyatri Derg 1996;7:107-15. 23. Spałka J, Kędzia K, Kuczyński W, Kudrycka A, Małolepsza A, Białasiewicz P, et al. Morning Headache as an Obstructive Sleep Apnea-Related Symptom among Sleep Clinic Patients-A Cross-Section Analysis. Brain Sci 2020;10.
• 24. Greenough GP, Nowell PD, Sateia MJ. Headache complaints in relation to nocturnal oxygen saturation among patients with sleep apnea syndrome. Sleep Med 2002;3:361-4.
• 25. Basoglu OK, Tasbakan MS. Gender differences in clinical and polysomnographic features of obstructive sleep apnea: a clinical study of 2827 patients. Sleep Breath 2018;22:241-49.