Analysis of the Prevalence and Characteristics of Concomitant Sleep and Headache Disorders, and the Efficacy of CPAP Treatment for Headache Among Those Patients Diagnosed With Obstructive Sleep Apnea
| Status: | Completed |
|---|---|
| Conditions: | Insomnia Sleep Studies, Migraine Headaches, Pulmonary |
| Therapuetic Areas: | Neurology, Psychiatry / Psychology, Pulmonary / Respiratory Diseases |
| Healthy: | No |
| Age Range: | 18 - 80 |
| Updated: | 4/2/2016 |
| Start Date: | August 2007 |
| End Date: | August 2008 |
| Contact: | Timothy M. Quast, MD |
| Email: | timothy.quast@amedd.army.mil |
| Phone: | (301)295-4191 |
Analysis of the Prevalence and Characteristics of Co-Morbid Sleep and Headache Disorders in Patients Being Evaluated at the WRAMC Sleep Disorders Laboratory, and the Efficacy of CPAP Treatment on Headache Burden in Obstructive Sleep Apnea Patients With a Co-Morbid Headache Disorder
There is a well-documented but poorly understood relationship between headache disorders
(e.g. migraine, cluster headaches, awakening headaches, etc.) and sleep disorders. One
hypothesis includes an underlying disorder known as obstructive sleep apnea (OSA) with low
overnight oxygen saturations and possibly elevated carbon dioxide levels which result in
awakening headache. Bruxism, or grinding of the teeth, has also been anecdotally associated
with headache. The converse of these arguments is that the patient may have a primary
headache disorder, for example migraine, leading to disordered sleep patterns or insomnia.
The true relationship between the two, as alluded above, is unknown. The actual prevalence
of the two disorders occurring simultaneously is not known.
There have been several small, retrospective studies which have attempted to evaluate this
relationship. One of these studies evaluated those patients diagnosed with OSA who were
given the standard of care therapy - continuous positive airway pressure (CPAP) - and found
that headaches among these patients were improved after using CPAP. Again, this was a small,
retrospective study.
We propose a study whereby patients who are referred for polysomnography (PSG, or "sleep
study") are consented, then surveyed on the presence or absence of headache. A brief
questionnaire is followed up with a more detailed questionnaire to characterize whether this
headache that the patient has is truly a headache disorder. Following the survey and PSG,
the patient's sleep study parameters are evaluated to see whether there are certain
correlations between what has been recorded and the particular headache disorder present.
Lastly, if the patient was diagnosed with OSA and fitted with a CPAP device, the patient
will be queried several weeks later to evaluate whether there was improvement or cessation
of the headache disorder.
(e.g. migraine, cluster headaches, awakening headaches, etc.) and sleep disorders. One
hypothesis includes an underlying disorder known as obstructive sleep apnea (OSA) with low
overnight oxygen saturations and possibly elevated carbon dioxide levels which result in
awakening headache. Bruxism, or grinding of the teeth, has also been anecdotally associated
with headache. The converse of these arguments is that the patient may have a primary
headache disorder, for example migraine, leading to disordered sleep patterns or insomnia.
The true relationship between the two, as alluded above, is unknown. The actual prevalence
of the two disorders occurring simultaneously is not known.
There have been several small, retrospective studies which have attempted to evaluate this
relationship. One of these studies evaluated those patients diagnosed with OSA who were
given the standard of care therapy - continuous positive airway pressure (CPAP) - and found
that headaches among these patients were improved after using CPAP. Again, this was a small,
retrospective study.
We propose a study whereby patients who are referred for polysomnography (PSG, or "sleep
study") are consented, then surveyed on the presence or absence of headache. A brief
questionnaire is followed up with a more detailed questionnaire to characterize whether this
headache that the patient has is truly a headache disorder. Following the survey and PSG,
the patient's sleep study parameters are evaluated to see whether there are certain
correlations between what has been recorded and the particular headache disorder present.
Lastly, if the patient was diagnosed with OSA and fitted with a CPAP device, the patient
will be queried several weeks later to evaluate whether there was improvement or cessation
of the headache disorder.
There is a well-documented but poorly understood relationship between headache disorders
(e.g. migraine, cluster headaches, awakening headaches, etc.) and sleep disorders. The exact
prevalence of patients with concomitant headache disorder and sleep disorder is not even
known. Hypotheses surrounding the relationship include low overnight oxygen saturation
and/or hypercarbia in the case of obstructive sleep apnea (OSA) with awakening headache,
primary headache disorder as a contributor to secondary sleep disorder, atypical lengths or
percentages of time in various sleep stages resulting in disordered sleep patterns and
subsequent headache, bruxism causing tension type headaches, among others. Our review of the
literature shows there has not yet been a prospective trial evaluating headache disorders
and concomitant sleep disorders with attempts to find vagaries or abnormalities in terms of
sleep parameters as a way to explain headache disorder.
Additionally, although there have been few retrospective reviews of small numbers of
patients examining an intervention (in this case, the addition of continuous positive airway
pressure - CPAP) as a means to correct a sleep disorder with a subsequent evaluation of the
patient's pre-existing headache disorders, there has yet to be a prospective trial
evaluating same. Our team identified at least one retrospective study that would suggest
that treating OSA with standard of care CPAP improved pre-existing symptoms of headache.
Our study proposes to - after obtaining consent - survey patients with suspected sleep
disorders who have been scheduled for a sleep study to evaluate the overall prevalence of
headache disorder among this particular population. We would then evaluate various standard
sleep study parameters such as lowest oxygen saturation, time in various sleep stages, sleep
latency, total sleep time, respiratory disturbance index, presence of bruxism, and so on, to
see whether there is a correlation between certain of these parameters and a particular
headache disorder. We also would survey those patients diagnosed with OSA following
institution of CPAP to see whether there was a decrement or cessation in headache frequency
or intensity.
Being that a significant proportion of our patients are returning war veterans with possible
traumatic brain injuries or post-traumatic stress disorder, we would also query patients
regarding the presence of these disorders. These data would be taken into account as a
sub-analysis of the overall data set.
The study will be of 12 months duration. Over 2000 sleep studies are performed at our
institution in 12 months. We anticipate an enrollment of between 400 to 800 subjects.
(e.g. migraine, cluster headaches, awakening headaches, etc.) and sleep disorders. The exact
prevalence of patients with concomitant headache disorder and sleep disorder is not even
known. Hypotheses surrounding the relationship include low overnight oxygen saturation
and/or hypercarbia in the case of obstructive sleep apnea (OSA) with awakening headache,
primary headache disorder as a contributor to secondary sleep disorder, atypical lengths or
percentages of time in various sleep stages resulting in disordered sleep patterns and
subsequent headache, bruxism causing tension type headaches, among others. Our review of the
literature shows there has not yet been a prospective trial evaluating headache disorders
and concomitant sleep disorders with attempts to find vagaries or abnormalities in terms of
sleep parameters as a way to explain headache disorder.
Additionally, although there have been few retrospective reviews of small numbers of
patients examining an intervention (in this case, the addition of continuous positive airway
pressure - CPAP) as a means to correct a sleep disorder with a subsequent evaluation of the
patient's pre-existing headache disorders, there has yet to be a prospective trial
evaluating same. Our team identified at least one retrospective study that would suggest
that treating OSA with standard of care CPAP improved pre-existing symptoms of headache.
Our study proposes to - after obtaining consent - survey patients with suspected sleep
disorders who have been scheduled for a sleep study to evaluate the overall prevalence of
headache disorder among this particular population. We would then evaluate various standard
sleep study parameters such as lowest oxygen saturation, time in various sleep stages, sleep
latency, total sleep time, respiratory disturbance index, presence of bruxism, and so on, to
see whether there is a correlation between certain of these parameters and a particular
headache disorder. We also would survey those patients diagnosed with OSA following
institution of CPAP to see whether there was a decrement or cessation in headache frequency
or intensity.
Being that a significant proportion of our patients are returning war veterans with possible
traumatic brain injuries or post-traumatic stress disorder, we would also query patients
regarding the presence of these disorders. These data would be taken into account as a
sub-analysis of the overall data set.
The study will be of 12 months duration. Over 2000 sleep studies are performed at our
institution in 12 months. We anticipate an enrollment of between 400 to 800 subjects.
Inclusion Criteria:
- Participants who have been screened at the Walter Reed Army Medical Center (WRMAC)
sleep clinic with chief complaint of sleep disorder and have been scheduled for an
overnight PSG at WRAMC. Sleep symptoms may include such difficulties as initiating
sleep, maintaining sleep, disturbed sleep, not feeling refreshed in the morning,
sleepiness during the day, and snoring
- Ages 18-80
- Satisfactory completion of sleep and headache inventory
- Satisfactory completion of overnight polysomnogram
- May have used sleeping preparations
- May have used anti-migraine medication
- May have other medical conditions and be on other medications
Exclusion Criteria:
- Age below 18 or over 80
- Inability to understand and sign an informed consent
We found this trial at
1
site
6900 Georgia Ave NW
Washington, District of Columbia 20307
Washington, District of Columbia 20307
(202) 782-6849
Walter Reed Army Medical Center The Walter Reed National Military Medical Center is one of...
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