The assessment of headache and sleep quality in patients with chronic obstructive pulmonary disease
Keywords:COPD, Headache, Sleep quality, Hypoxia, Pulmonary functions
Background/Aim: It is known that sleep disorders and headaches are related. However, there are only very few studies examining this correlation in chronic obstructive pulmonary disease (COPD). The aim of this study was to evaluate the association between sleep disorders, headaches, and hypoxia in COPD patients. Methods: This study was designed as a prospective case-control study with 120 COPD and 83 controls patients of similar age/gender. International classification of headache disorders - version 3 (ICHD III) was used for the diagnosis of headache. Pain intensity was calculated using the visual analog scale (VAS). For the effect of headache, headache activities of daily living index (HADLI) questionnaire was applied. Pulmonary function tests were performed with a PC-based spirometry device. Blood pressure and blood oxygen saturation were measured by fingertip pulse oximetry. Sleep quality was assessed using the Pittsburgh sleep quality index (PSQI). Dyspnea severity was graded according to the modified medical research council (mMRC) scale. Results: Headache was detected in 54 patients (45%) with COPD. The most common type of headache was tension type (66.7%). Patients with headache had higher diastolic blood pressure, severity of dyspnea score, and lower forced expiratory volüme-1 (FEV1), forced vital capacity (FVC) (P = 0.037, P = 0.001, P = 0.001, P = 0.001 respectively). Sleep disturbance was quite common in COPD patients (79.2%). PSQI score was higher in patients with headache (P = 0.006). Patients with poor sleep quality had higher pain severity (P = 0.006). Female gender, high diastolic blood pressure and low forced expiratory volume-1 second (FEV1) increased the risk of headache (P = 0.004, P = 0.02, P = 0.032, respectively). Conclusion: Headache is a complex symptom in patients with COPD and associated with higher diastolic blood pressure and pulmonary dysfunction. These parameters should be evaluated in COPD patients with headache.
Rizzi M, Airoldi A, Cristiano A, et al. Oxygen therapy in COPD patients with isolated nocturnal hypoxemia; comparison of quality of life and sleep between bronchitis and emphysema phenotype: A prospective observational study. Eur J Intern Med. 2016;34:78-84.
Halbert RJ, Natoli JL, Gano A, Badamgarav E, Buist AS, Mannino DM. Global burden of COPD: systematic review and meta-analysis. Eur Respir J. 2006;28(3):523-32.
Vestbo J, Hurd SS, Rodriguez-Roisin R. The 2011 revision of the global strategy for the diagnosis, management and prevention of COPD (GOLD)--why and what?. Clin Respir J. 2012;6(4):208-14.
Feinstein L, Wilkerson J, Salo PM, et al. Validation of Questionnaire-based Case Definitions for Chronic Obstructive Pulmonary Disease. Epidemiology. 2020;31(3):459-66.
Fabbri L, Pauwels RA, Hurd SS; GOLD Scientific Committee. Global Strategy for the Diagnosis, Management, and Prevention of Chronic Obstructive Pulmonary Disease: GOLD Executive Summary updated 2003. COPD. 2004;1(1):105-4.
Lee SH, Kim KU, Lee H, Park HK, Kim YS, Lee MK. Sleep disturbance in patients with mild-moderate chronic obstructive pulmonary disease. Clin Respir J. 2019;13(12):751-7.
Cavalcante AG, de Bruin PF, de Bruin VM, et al. Restless legs syndrome, sleep impairment, and fatigue in chronic obstructive pulmonary disease. Sleep Med. 2012;13(7):842-7.
Nunes DM, Mota RM, de Pontes Neto OL, Pereira ED, de Bruin VM, de Bruin PF. Impaired sleep reduces quality of life in chronic obstructive pulmonary disease. Lung. 2009;187(3):159-63.
Rains JC, Poceta JS. Sleep-related headache syndromes. Semin Neurol. 2005;25(1):69-80.
Headache Classification Committee of the International Headache Society (IHS) The International Classification of Headache Disorders, 3rd edition. Cephalalgia. 2018;38(1):1-211.
Rasmussen BK, Olesen J. Symptomatic and nonsymptomatic headaches in a general population. Neurology. 1992;42(6):1225-31.
Vernon H, Lawson G. Development of the headache activities of daily living index: initial validity study. J Manipulative Physiol Ther. 2015;38(2):102-11.
Ranu H, Wilde M, Madden B. Pulmonary function tests. Ulster Med J. 2011;80(2):84-90.
Richards JB. Calculated decisions: mMRC (Modified Medical Research Council) Dyspnea Scale. Emerg Med Pract. 2017;19(10):1-2.
Daskalopoulou SS, Khan NA, Quinn RR, et al. The 2012 Canadian hypertension education program recommendations for the management of hypertension: blood pressure measurement, diagnosis, assessment of risk, and therapy. Can J Cardiol. 2012;28(3):270-87.
Bertolazi AN, Fagondes SC, Hoff LS, et al. Validation of the Brazilian Portuguese version of the Pittsburgh Sleep Quality Index. Sleep Med. 2011;12(1):70-5.
Buysse DJ, Reynolds CF 3rd, Monk TH, Berman SR, Kupfer DJ. The Pittsburgh Sleep Quality Index: a new instrument for psychiatric practice and research. Psychiatry Res. 1989;28(2):193-213.
Bui SB, Petersen T, Poulsen JN, Gazerani P. Headaches attributed to airplane travel: a Danish survey [published correction appears in J Headache Pain. 2016;17:50]. J Headache Pain. 2016;17:33.
Wilson MH, Davagnanam I, Holland G, et al. Cerebral venous system and anatomical predisposition to high-altitude headache. Ann Neurol. 2013;73(3):381-9.
Lawley JS, Oliver SJ, Mullins PG, Macdonald JH. Investigation of whole-brain white matter identifies altered water mobility in the pathogenesis of high-altitude headache. J Cereb Blood Flow Metab. 2013;33(8):1286-94.
Arngrim N, Schytz HW, Britze J, et al. Migraine induced by hypoxia: an MRI spectroscopy and angiography study. Brain. 2016;139(3):723-37.
Kristiansen HA, Kværner KJ, Akre H, Øverland B, Sandvik L, Russell MB. Sleep apnoea headache in the general population. Cephalalgia. 2012;32(6):451-8.
Johnson KG, Ziemba AM, Garb JL. Improvement in headaches with continuous positive airway pressure for obstructive sleep apnea: a retrospective analysis. Headache. 2013;53(2):333-43.
Goksan B, Gunduz A, Karadeniz D, et al. Morning headache in sleep apnoea: clinical and polysomnographic evaluation and response to nasal continuous positive airway pressure. Cephalalgia. 2009;29(6):635-41.
Ozge A, Ozge C, Kaleagasi H, Yalin OO, Unal O, Ozgür ES. Headache in patients with chronic obstructive pulmonary disease: effects of chronic hypoxaemia. J Headache Pain. 2006;7(1):37-43.
Alberti A, Mazzotta G, Gallinella E, Sarchielli P. Headache characteristics in obstructive sleep apnea syndrome and insomnia. Acta Neurol Scand. 2005;111(5):309-16.
Nobeschi L, Zangirolami-Raimundo J, Cordoni PK, et al. Evaluation of sleep quality and daytime somnolence in patients with chronic obstructive pulmonary disease in pulmonary rehabilitation. BMC Pulm Med. 2020;20(1):14.
Economou NT, Ilias I, Velentza L, et al. Sleepiness, fatigue, anxiety and depression in Chronic Obstructive Pulmonary Disease and Obstructive Sleep Apnea - Overlap - Syndrome, before and after continuous positive airways pressure therapy. PLoS One. 2018;13(6):e0197342.
Chen R, Tian JW, Zhou LQ, et al. The relationship between sleep quality and functional exercise capacity in COPD. Clin Respir J. 2016;10(4):477-85.
Oh HW, Kim SH, Kim KU. The effects a respiration rehabilitation program on IADL, satisfaction with leisure, and quality of sleep of patients with chronic obstructive pulmonary disease. J Phys Ther Sci. 2016;28(12):3357-60.
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