The OSA severity was based on the apnea-hypopnea index (AHI) and the degree of oxygen desaturation as summarized in Table 1. 10 Hypopnea occurs when there is a reduction of airflow by 50% or more for at least 10 seconds. 10 Obstructive apnea occurs when there is presence of respiratory effort despite cessation of airflow.
9 Apnea is defined as a cessation of airflow for at least 10 seconds. Each polysomnographic study was scored manually and interpreted by a trained clinical polysomnographer.ĭiagnosis of OSA was based on the criteria recommended by the American Sleep Disorders Association. The polysmnographic study was conducted according to the guidelines recommended by the American Electroencephalographic Society 8 and the following parameters were measured: electroencephalographic activity, electrooculographic activity, submental electromyographic activity, intercostal electromyographic activity, chest movement, abdominal movement, snoring, airflow, oxygen saturation, lower limb movement, and electrocardiographic activity. Patients underwent a 1-night 8-hour polysomnogram attended and supervised by a qualified technologist. This is a retrospective study of 80 consecutive patients with OSA who underwent sleep polysomnography from December 1996 to March 1997. Finally, treatment of the OSA by continuous positive airway pressure (CPAP) or uvulopalatopharyngoplasty (UPPP) should reduce or eliminate these headaches. These headaches should also occur with greater severity and frequency the more severe the OSA. As such, patients with sleep disorders due to nonrespiratory causes should have a lower occurrence of headaches compared with patients with OSA. We believe that these headaches occur more frequently in OSA because oxygen desaturation causes cerebral vasodilation, and this may provoke headaches. We therefore sought to establish if an association between OSA and headaches exists. However, Aldrich and Chauncey 3 and Poceta and Dalessio 4 disputed these findings and concluded that morning headaches occurred just as frequently in other sleep-related disorders as in OSA. Boutros 2 found a similar relationship in 9 of 20 patients with OSA. Guilleminault et al 1 found that headaches occurred in 11 of 25 patients with OSA.
THERE IS conflicting evidence 1 - 7 regarding the association of headaches and obstructive sleep apnea (OSA). Treatment of OSA with continuous positive airway pressure or uvulopalatopharyngoplasty can reduce these headaches. These headaches are of brief duration, and their occurrence and severity increase with increasing OSA severity. Of the 29 patients with OSA who were treated with continuous positive airway pressure or uvulopalatopharyngoplasty, awakening headaches improved by a mean of 80% compared with minimal improvement of migraine, tension, and cervicogenic headaches.Ĭonclusions Awakening headaches are associated with OSA. The awakening headaches were brief (shorter than 30 minutes), and their occurrence and severity correlated with OSA severity. The proportion of common types of headaches in both groups was similar. These awakening headaches were significantly more common in the OSA group compared with the periodic limb movement disorder group, 9 (41%) of whom had headaches, none of which occurred on awakening. Of these 25 patients, 23 (48% of total group) reported awakening headaches. Twenty-five of the 48 patients had headaches that did not fit any category. Results Forty-eight (60%) patients had headaches in the year prior to study. Headache response to continuous positive airway pressure or uvulopalatopharyngoplasty in the patients with OSA was also assessed. Headache characteristics were compared with those of 22 control patients with periodic limb movement disorder. Headaches were classified according to International Headache Society criteria and the severity graded by the Chronic Pain Index. Patients were interviewed about their headache history. Methods This is a retrospective study of 80 consecutive patients with OSA who underwent sleep polysomnography from December 1996 to March 1997. This study investigates whether this relationship exists. Shared Decision Making and Communicationīackground There is a controversy regarding the association of obstructive sleep apnea (OSA) and morning headaches.
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