In a study to investigate the co-morbidity of chronic refractory headache with obstructive sleep apnoea syndrome, seventy-two patients (51 women and 21 men) with chronic and refractory headaches, whose headache occurred during sleep or whose sleep was accompanied by snoring, were submitted to polysomnography.
Patients diagnosed with obstructive sleep apnoea syndrome began continuous positive airway pressure (C-PAP) treatment and were followed up for >or= 6 months. Twenty-one cases of obstructive sleep apnoea syndrome were identified (29.2% of the total investigated).
Headaches were classified into several headache disorders, medication overuse headache and cluster headache being the most prevalent. Multivariate regression analysis revealed that age, male gender and body mass index were associated with obstructive sleep apnoea syndrome. C-PAP treatment improved both sleepapnoea and headache in only a third of the cases.
Patients suffering from chronic refractory headache associated with sleep or snoring, in particular those who are also middle-aged, overweight men, should be considered for polysomnography. C-PAP treatment alone does not seem to improve headache, but further investigation is needed. (Mitsikostas DD. Vikelis M. Viskos A. Refractory chronic headache associated with obstructive sleep apnoea syndrome. Cephalalgia. 28(2):139-43, 2008).
In another study, it was found that headache and neck pain were more likely among patients admitted for polysomnography compared with the general population (n = 41 340). This association was mainly restricted to those with frequent complaints (> or =7 days per month).
Chronic headache (headache > or = 15 days per month) was seven times more common among individuals with and without confirmed obstructive sleep apnoea syndrome than in the general population. There was no linear dose-response relationship between headache and neck pain and severity of apnoea or oxygen desaturation. Thus, hypoxia per se is less likely to explain the high headache prevalence among patients admitted for polysomnography. (Sand T. Hagen K. Schrader H. Sleep apnoea and chronic headache.Cephalalgia. 23(2):90-5, 2003 Mar)
It is essential to have chronic pain patients especially those on long-term narcotics complaining of sleep difficulties examined for sleep apnoea. There is a dose-dependent relationship between chronic opioid use and the development of a peculiar pattern of respiration consisting of central sleep apneas and ataxic breathing. (Walker JM. Farney RJ. Rhondeau SM. Boyle KM. Valentine K. Cloward TV. Shilling KC. Chronic opioid use is a risk factor for the development of central sleep apnea and ataxic breathing.[erratum appears in J Clin Sleep Med. 2007 Oct 15;3(6). Journal of Clinical Sleep Medicine. 3(5):455-61, 2007)