Migraine significantly worsens sleep quality, architecture

Individuals with migraine had much poorer subjective sleep quality and altered sleep architecture vs. healthy individuals, according to results of a meta-analysis published in Neurology.

“Despite its association, there remains a paucity of research into sleep in migraine, and there is no consensus on whether patients exhibit objective changes in sleep architecture,” Emily Charlotte Stanyer, MPsych, of the Wolfson Centre for Age-Related Diseases at King’s College London’s Institute of Psychiatry, Psychology & Neuroscience in the U.K., and colleagues wrote. “This is partly due to the small sample sizes of polysomnographic (PSG) studies which measure sleep.

“The current meta-analysis aims to overcome this by aggregating data from multiple studies investigating differences in subjective sleep quality as measured by the Pittsburgh Sleep Quality Index (PSQI) and objective sleep architecture measured using PSG between patients with migraine and healthy controls,” they added.

The investigators sought to assess whether differences existed in subjective sleep quality measured via the PSQI and objective sleep architecture measured via polysomnography for adult and pediatric patients and healthy controls. They systematically searched five databases for case-controlled studies that measured polysomnography and/or PSQI among patients with migraine, excluding participants who were pregnant or who had other headache disorders. They entered effect sizes into a random effects model meta-analysis. They included 21 studies measuring PSQI and Migraine Disability Assessment Test scores among adults, as well as six studies and five studies measuring polysomnography among adults and children, respectively.

Results showed an overall mean study quality score of 5/9. The researchers observed no moderating effect of this score on any of the results, nor did they report any risk for publication bias. Adults with migraine had higher PSQI scores compared with health controls, with a larger effect among those with chronic vs. episodic condition. In polysomnographic studies, adults and children with migraine vs. controls had a lower percentage of rapid eye movement sleep. Pediatric patients vs. controls had less total sleep time, more wake and shorter sleep onset latency.

“Whilst offering significant insight into sleep in migraine, this study highlights the limitations of drawing conclusions from a small number of case-controlled PSG studies, given the significant confounds and heterogeneity involved,” Stanyer and colleagues wrote. “Future studies should analyze the interplay between migraine and subjective sleep on a large scale, as well as use standardized, population-based approaches to sleep architecture to minimize variability.”