Evaluation of the effect of polysomnography sleep variables on the development of morning headaches in obstructive sleep apnea syndrome

Abstract

Background & Objective: This study aimed to investigate the relationship between sleep variables in patients with obstructive sleep apnea syndrome (OSAS) with associated morning headaches and to determine the characteristic features of these headaches.

Methods: Among the 546 patients evaluated in the sleep laboratory, 154 individuals who were not diagnosed as having OSAS were excluded from the study. Sleep variables of 160 patients with morning headache and 232 patients without morning headache were compared.

Results: The mean Epworth Sleepiness Scale (ESS) scores (12.17±5.71) (p<0.001), mean Apnea-Hypnea Index (AHI) (36.48±24.47) (p=0.019), mean AHI during rapid eye movement (REM) sleep (AHI-REM) (37.45±28.83), and mean Oxygen Desaturation Index (ODI) (52.36±30.96) (p=0.015) were significantly higher in patients with morning headaches. The mean oxygen saturation (SpO2) of patients with headaches was (89.83±4.62) (p=0.038), and their mean lowest SpO2 (70.37±14.87) was significantly lower (p=0.049). It was observed that 87.5% of the patients with morning headaches had bilateral pain, 60% had mild pain, 65% had pain lasting 2 to 3 hours, and 72% had oppressive-compressive pain, 68% had a frequency of attacks of 5 to 15 per month, and 70% had no additional neurological symptom.

Conclusions: Our results suggest that the AHI is significantly increased during REM sleep in patients with OSAS with morning headaches. This suggests that the pathogenesis of headaches is due to the effects of apnea during REM sleep. Moreover, the fact that the ODI was higher, and oxygen saturations were lower in the headache group emphasizes that hypoxia should be considered in the pathophysiologic process.