睡眠障碍与慢性头痛关系的病例对照研究

A CASE-CONTROL STUDY ON SLEEP DISORDERS IN CHRONIC HEADACHE

目的:调查慢性头痛患者中睡眠障碍所占比率,同时评估其与精神共患病和慢性头痛的关系。方法:对210例慢性头痛组患者和204例间断头痛组患者先进行年龄、性别和头痛类型的匹配,然后进行睡眠障碍和精神共患病的结构式访谈。结果:210例慢性头痛组患者中,148例为药物过度使用性头痛。与间断头痛组相比,慢性头痛组患者失眠(68.6%vs 39.7%)、白天过度嗜睡(34.8%vs 22.5%)、阻塞性睡眠呼吸暂停综合征(46.7%vs 31.9%)的发生率较高。慢性头痛组患者中92例(43.8%)有精神共患病(焦虑和/或抑郁),而间断头痛组仅有55例(27.0%)。多元分析显示低教育水平、低龄开始头痛、失眠与慢性头痛独立相关。结论:慢性头痛患者常伴睡眠障碍。失眠可能是头痛慢性化的一个独立危险因素。不论与抑郁或焦虑是否相关,重视睡眠障碍治疗有利于阻止间断头痛慢性化。

Objective： To investigate the ratio of sleep disorders in chronic headache patients and to eval-uate the correlationship of sleep disorders with psychiatric comorbidity and chronic headache.Method： 210 patients with chronic headache and 204 patients with episodic headache,matched by age,sex,and type of headache,underwent a structured direct interview about their sleep habits and psychiatric disea-ses.Result： 148 out of 210 patients with chronic headache received a diagnosis of medication overuse headache.Patients with chronic headache showed a high prevalence of insomnia（68.6% vs 39.7%）,daytime sleepiness（34.8% vs 22.5%）,and obstructive sleep apnea syndrome（46.7% vs 31.9%） with respect to controls.92 patients with chronic headache（43.8%） had psychiatric comorbidity（anxiety and / or depressive disorders）,vs 55 episodic headache patients（27.0%）.Multivariate anal-ysis disclosed that low educational level,lower mean age at headache onset,and insomnia are independ-ently associated with chronic headache.Conclusion： Patients with chronic headache had a high ratio of sleep complaints.Insomnia may thus represent an independent risk factor for headache chronification.Recognition of sleep disorders,alone or in association with depression or anxiety,may be useful in epi-sodic headache patients to prevent chronification.