Posted by Bob Johnson (12.19.49.2) on July 11, 2000 at 09:49:15:
Here are a couple of studies which support earlier studies showing low oxygen levels in the blood at night which seem to be associated with night time attacks. This information suggests that it might be worth considering sleep studies be done for those folks who regularly have night attacks: unrecognized sleep apnea may be a factor.
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1: Neurology 2000 Jun 27;54(12):2302-6 Related Articles, Books
Sleep disordered breathing in patients with cluster headache.
Chervin RD, Zallek SN, Lin X, Hall JM, Sharma N, Hedger KM
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.
[Medline record in process]
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.
PMID: 10881257, UI: 20342954
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2: Cephalalgia 1984 Mar;4(1):33-8 Related Articles, Books, LinkOut
Sleep apnea in cluster headache.
Kudrow L, McGinty DJ, Phillips ER, Stevenson M
The impetus to study sleep changes in a cluster population arose from a recent hypothesis that predicted the finding of sleep apnea in this disorder. It holds that cluster attacks may occur in response to oxygen desaturation. Proposed mechanisms involve impairment of carotid body activity secondary to hypothalamic-vasomotor regulatory dysfunction. Five chronic and five episodic cluster patients underwent nocturnal polysomnography, utilizing standard equipment for monitoring sleep status, cardiac activity, nasal and buccal air flow change, chest and abdominal breathing, muscle activity and oxygen saturation. All episodic patients and one of five chronic patients were found to have sleep apnea (60%). Mean apneas per hour during NREM sleep were similar to that of REM sleep; 26.7 and 28.2, respectively. Six patients with sleep apnea experienced 14 cluster headache attacks during the study period. Eight attacks (57%) followed episodes of oxygen desaturation ranging from 65% to 85%. In the sleep apnea group, 8 out of 14 attacks (57%) were associated with REM; three without, and five following oxygen desaturation. Of the non-apnea group, all of whom had chronic cluster headache, none of 5 attacks were associated with oxygen desaturation, and only 2/5 attacks occurred in relation to REM. Thus, our study showed that sleep apnea was a common finding in a randomly selected group of episodic cluster patients; and most nocturnal attacks were preceded by oxyhemoglobin desaturation and REM-related. These findings were uncommon in the chronic cluster group.
PMID: 6713522, UI: 84180669