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October 19, 2021; 97 (16) Research ArticleOpen Access

Subjective Sleep Quality and Sleep Architecture in Patients With Migraine

A Meta-analysis

View ORCID ProfileEmily Charlotte Stanyer, Hannah Creeney, Alexander David Nesbitt, View ORCID ProfilePhilip Robert Holland, View ORCID ProfileJan Hoffmann
First published September 22, 2021, DOI: https://doi.org/10.1212/WNL.0000000000012701
Emily Charlotte Stanyer
From the Wolfson Centre for Age-Related Diseases (E.C.S., H.C., P.R.H., J.H.), Institute of Psychiatry, Psychology & Neuroscience, King's College London; Department of Neurology (A.D.N.), Guy's and St Thomas NHS Foundation Trust; and NIHR-Wellcome Trust King's Clinical Research Facility/SLaM Biomedical Research Centre (J.H.), King's College Hospital, London, UK.
MPsych
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Hannah Creeney
From the Wolfson Centre for Age-Related Diseases (E.C.S., H.C., P.R.H., J.H.), Institute of Psychiatry, Psychology & Neuroscience, King's College London; Department of Neurology (A.D.N.), Guy's and St Thomas NHS Foundation Trust; and NIHR-Wellcome Trust King's Clinical Research Facility/SLaM Biomedical Research Centre (J.H.), King's College Hospital, London, UK.
MSc
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Alexander David Nesbitt
From the Wolfson Centre for Age-Related Diseases (E.C.S., H.C., P.R.H., J.H.), Institute of Psychiatry, Psychology & Neuroscience, King's College London; Department of Neurology (A.D.N.), Guy's and St Thomas NHS Foundation Trust; and NIHR-Wellcome Trust King's Clinical Research Facility/SLaM Biomedical Research Centre (J.H.), King's College Hospital, London, UK.
BM, BCh, PhD
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Philip Robert Holland
From the Wolfson Centre for Age-Related Diseases (E.C.S., H.C., P.R.H., J.H.), Institute of Psychiatry, Psychology & Neuroscience, King's College London; Department of Neurology (A.D.N.), Guy's and St Thomas NHS Foundation Trust; and NIHR-Wellcome Trust King's Clinical Research Facility/SLaM Biomedical Research Centre (J.H.), King's College Hospital, London, UK.
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Jan Hoffmann
From the Wolfson Centre for Age-Related Diseases (E.C.S., H.C., P.R.H., J.H.), Institute of Psychiatry, Psychology & Neuroscience, King's College London; Department of Neurology (A.D.N.), Guy's and St Thomas NHS Foundation Trust; and NIHR-Wellcome Trust King's Clinical Research Facility/SLaM Biomedical Research Centre (J.H.), King's College Hospital, London, UK.
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Subjective Sleep Quality and Sleep Architecture in Patients With Migraine
A Meta-analysis
Emily Charlotte Stanyer, Hannah Creeney, Alexander David Nesbitt, Philip Robert Holland, Jan Hoffmann
Neurology Oct 2021, 97 (16) e1620-e1631; DOI: 10.1212/WNL.0000000000012701

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Abstract

Background and Objectives Sleep disturbance is often associated with migraine. However, there is a paucity of research investigating objective and subjective measures of sleep in patients with migraine. This meta-analysis aims to determine whether there are differences in subjective sleep quality measured using the Pittsburgh Sleep Quality Index (PSQI) and objective sleep architecture measured using polysomnography (PSG) between adult and pediatric patients and healthy controls.

Methods This review was preregistered on PROSPERO (CRD42020209325). A systematic search of 5 databases (Embase, MEDLINE, Global Health, APA PsycINFO, and APA PsycArticles, last searched on December 17, 2020) was conducted to find case–control studies that measured PSG or PSQI in patients with migraine. Pregnant participants and those with other headache disorders were excluded. Effect sizes (Hedges g) were entered into a random effects model meta-analysis. Study quality was evaluated with the Newcastle Ottawa Scale and publication bias with the Egger regression test.

Results Thirty-two studies were eligible, of which 21 measured PSQI or Migraine Disability Assessment Test in adults, 6 measured PSG in adults, and 5 measured PSG in children. The overall mean study quality score was 5/9; this did not moderate any of the results and there was no risk of publication bias. Overall, adults with migraine had higher PSQI scores than healthy controls (g = 0.75, p < 0.001, 95% confidence interval [CI] 0.54–0.96). This effect was larger in those with a chronic rather than episodic condition (g = 1.03, p < 0.001, 95% CI 0.37–1.01; g = 0.63, p < 0.001, 95% CI 0.38–0.88, respectively). For polysomnographic studies, adults and children with migraine displayed a lower percentage of rapid eye movement sleep (g = −0.22, p = 0.017, 95% CI −0.41 to −0.04; g = −0.71, p = 0.025, 95% CI −1.34 to −0.10, respectively) than controls. Pediatric patients displayed less total sleep time (g = −1.37, p = 0.039, 95% CI −2.66 to −0.10), more wake (g = 0.52, p < 0.001, 95% CI 0.08–0.79), and shorter sleep onset latency (g = −0.37, p < 0.001, 95% CI −0.54 to −0.21) than controls.

Discussion People with migraine have significantly poorer subjective sleep quality and altered sleep architecture compared to healthy individuals. Further longitudinal empirical studies are required to enhance our understanding of this relationship.

Glossary

ICHD-3=
International Classification of Headache Disorders 3;
MIDAS=
Migraine Disability Assessment;
NOS=
Newcastle-Ottawa Scale;
NREM=
non-REM;
PSG=
polysomnography;
PRISMA=
Preferred Reporting Items for Systematic Reviews and Meta-analysis;
PSQI=
Pittsburgh Sleep Quality Index;
REM=
rapid eye movement;
SOL=
sleep onset latency;
TST=
total sleep time

Footnotes

  • Go to Neurology.org/N for full disclosures. Funding information and disclosures deemed relevant by the authors, if any, are provided at the end of the article.

  • The Article Processing Charge was funded by King's College London/MRC.

  • CME Course: NPub.org/cmelist

  • Received March 15, 2021.
  • Accepted in final form August 12, 2021.
  • Copyright © 2021 The Author(s). Published by Wolters Kluwer Health, Inc. on behalf of the American Academy of Neurology.

This is an open access article distributed under the terms of the Creative Commons Attribution License 4.0 (CC BY), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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Letters: Rapid online correspondence

  • Reader Response: Subjective Sleep Quality and Sleep Architecture in Patients With Migraine: A Meta-analysis
    • Vinod K Gupta, Physician-Medical Director, GUPTA MEDICAL CENTRE, MIGRAINE-HEADACHE INSTITUTE, S-407, Greater Kailash-Part Two, New Delhi, INDIA-110048
    Submitted September 30, 2021
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