Abstract
The main objective of this study is to investigate the relationship between tension-type headache and obstructive sleep apnea in the general population. The method involves a cross-sectional population-based study. A random age and gender stratified sample of 40,000 persons aged 20–80 years residing in Akershus, Hedmark or Oppland County, Norway were drawn by the National Population Register. A postal questionnaire containing the Berlin Questionnaire was used to classify respondents to be of either high or low risk of obstructive sleep apnea. Included in this study were 297 persons with high risk and 134 persons with low risk of sleep apnea, aged 30–65 years. They underwent an extensive clinical interview, a physical and a neurological examination by physicians, and in-hospital polysomnography. Those with apnea hypopnoea index (AHI) ≥5 were classified with obstructive sleep apnea. Tension-type headache was diagnosed according to the International Classification of Headache Disorders. Results showed the prevalence of frequent and chronic tension-type headache was 18.7 and 2.1% in the participants with obstructive sleep apnea. The logistic regression analyses showed no significant relationship between tension-type headache and obstructive sleep apnea, with adjusted odds ratios for frequent tension-type headache of 0.95 (0.55–1.62) and chronic tension-type headache of 1.91 (0.37–9.85). The results did not change when using cut-off of moderate (AHI ≥15) and severe (AHI ≥30) obstructive sleep apnea. Thus, we did not find any significant relationship between tension-type headache and the AHI. The presence and severity of sleep apneas seem not to influence presence and attack-frequency of tension-type headache in the general population.
Highlights
Headache and sleep has been linked together for more than a century [1]
The main objective of this study is to investigate the relationship between tension-type headache and obstructive sleep apnea in the general population
Included in this study were 297 persons with high risk and 134 persons with low risk of sleep apnea, aged 30–65 years. They underwent an extensive clinical interview, a physical and a neurological examination by physicians, and in-hospital polysomnography. Those with apnea hypopnoea index (AHI) C5 were classified with obstructive sleep apnea
Summary
Headache and sleep has been linked together for more than a century [1]. sleep in migraineurs has been studied repeatedly, less evidence exists regarding the relationship between tension-type headache and sleep [2]. One of the most common sleep disorders is obstructive sleep apnea syndrome, with an estimated prevalence of 2–4% among middle-aged adults [9, 10]. When obstructive sleep apnea is defined solely by an apnea hypopnea index (AHI) of C5, the estimated prevalence among middle-aged adults is approximately 20% in the general population [9, 11, 12]. This is a disorder with partly or complete obstruction of the upper airways during sleep which constitutes hypopnea and apnea and will typically result in repeated airflow cessation, oxygen desaturation and sleep disruption. The apnea-related headache may present itself as migraine, tension-type, cluster or a non-specific headache, and several studies have found it to merely be a non-specific symptom with no clear relationship with obstructive sleep apnea [15,16,17,18]
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