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Sleep disordered breathing in patients with cluster headache

From the Sleep Disorders Center, Department of Neurology (Drs. Chervin and Nath Zallek, J.M. Hall, N. Sharma, and K.M. Hedger) and the Department of Biostatistics (Dr. Lin), University of Michigan, Ann Arbor, MI.

Address correspondence and reprint requests to Dr. Ronald D. Chervin, Sleep Disorders Center, University Hospital 8D8702, Box 0117, 1500 E. Medical Center Dr., Ann Arbor, MI 48109-0117; e-mail: chervin{at}umich.edu

OBJECTIVE: To study subjects with active or inactive cluster headache (CH) for occult sleep disordered breathing (SDB).

BACKGROUND: CH frequently occurs during sleep. The authors previously found that symptoms of SDB predicted reported occurrence of CH in the first half of the night, which suggested that CH could be triggered in some cases by unrecognized SDB.

METHODS: The authors performed polysomnography in 25 adults (22 men) with CH. Subjects were not selected for any sleep-related complaint. In addition to standard measures, studies included monitoring of end-tidal carbon dioxide (n = 22), and esophageal pressure (n = 20).

RESULTS: The rate of apneas and hypopneas per hour of sleep was >5 in 20 subjects (80%; 95% CI, 64% to 96%), minimum oxygen saturation was <90% in 10 subjects, maximum negative esophageal pressure ranged from -13 to -65 cm H₂O, and maximum end-tidal carbon dioxide was 50 mm Hg in eight subjects. The eight subjects with active (versus inactive) CH at the time of study had higher maximum end-tidal carbon dioxide levels (50 ± 3 versus 44 ± 5 mm Hg; p = 0.0007). More severe oxygen desaturation was associated with reports that CH typically occurred in the first half of the nocturnal sleep period (p = 0.008).

CONCLUSIONS: SDB occurred in the majority of patients with CH. Evaluation of a patient with CH should include consideration that SDB may be present.

Key words: Cluster headache—Obstructive sleep apnea—Polysomnography—Hypercapnia—Hypoxemia.

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