Suzanne M Bertisch1, Wenyuan Li2, Catherine Buettner2, Elizabeth Mostofsky2, Michael Rueschman2, Emily R Kaplan2, Jacqueline Fung2, Shaelah Huntington2, Tess Murphy2, Courtney Stead2, Rami Burstein2, Susan Redline2, Murray A Mittleman2. 1. From the Program in Sleep Medicine Epidemiology, Division of Sleep and Circadian Disorders, Department of Medicine (S.M.B., M.R., E.R.K., S.R.), Brigham and Women's Hospital; Harvard Medical School (S.M.B., C.B., R.B., S.R., M.A.M.); Department of Epidemiology (W.L., E.M., M.A.M.), Harvard T.H. Chan School of Public Health; Cardiovascular Epidemiology Research Unit (W.L., E.M., M.A.M.), Harvard Catalyst (J.F., S.H., T.M., C.S.), and Department of Anesthesiology (R.B.), Beth Israel Deaconess Medical Center, Boston; and Department of Medicine (C.B.), Mount Auburn Hospital, Cambridge, MA. sbertisch@bwh.harvard.edu. 2. From the Program in Sleep Medicine Epidemiology, Division of Sleep and Circadian Disorders, Department of Medicine (S.M.B., M.R., E.R.K., S.R.), Brigham and Women's Hospital; Harvard Medical School (S.M.B., C.B., R.B., S.R., M.A.M.); Department of Epidemiology (W.L., E.M., M.A.M.), Harvard T.H. Chan School of Public Health; Cardiovascular Epidemiology Research Unit (W.L., E.M., M.A.M.), Harvard Catalyst (J.F., S.H., T.M., C.S.), and Department of Anesthesiology (R.B.), Beth Israel Deaconess Medical Center, Boston; and Department of Medicine (C.B.), Mount Auburn Hospital, Cambridge, MA.
Abstract
OBJECTIVE: To test the hypotheses that insufficient duration, high fragmentation, and poor sleep quality are temporally associated with migraine onset on the day immediately following the sleep period (day 0) and the following day (day 1). METHODS: In this prospective cohort study of 98 adults with episodic migraine, participants completed twice-daily electronic diaries on sleep, headaches, and other health habits, and wore wrist actigraphs for 6 weeks. We estimated the incidence of migraine following nights with short sleep duration, high fragmentation, or low quality compared to nights with adequate sleep with conditional logistic regression models stratified by participant and adjusted for caffeine intake, alcohol intake, physical activity, stress, and day of week. RESULTS: Participants were a mean age of 35.1 ± 12.1 years. We collected 4,406 days of data, with 870 headaches reported. Sleep duration ≤6.5 hours and poor sleep quality were not associated with migraine on day 0 or day 1. Diary-reported low efficiency was associated with 39% higher odds of headache on day 1 (odds ratio [OR] 1.39, 95% confidence interval [CI] 1.06-1.81). Actigraphic-assessed high fragmentation was associated with lower odds of migraine on day 0 (wake after sleep onset >53 minutes, OR 0.64, 95% CI 0.48-0.86; efficiency ≤88%, OR 0.74, 95% CI 0.56-0.99). CONCLUSION: Short sleep duration and low sleep quality were not temporally associated with migraine. Sleep fragmentation, defined by low sleep efficiency, was associated with higher odds of migraine on day 1. Further research is needed to understand the clinical and neurobiologic implications of sleep fragmentation and risk of migraine.
OBJECTIVE: To test the hypotheses that insufficient duration, high fragmentation, and poor sleep quality are temporally associated with migraine onset on the day immediately following the sleep period (day 0) and the following day (day 1). METHODS: In this prospective cohort study of 98 adults with episodic migraine, participants completed twice-daily electronic diaries on sleep, headaches, and other health habits, and wore wrist actigraphs for 6 weeks. We estimated the incidence of migraine following nights with short sleep duration, high fragmentation, or low quality compared to nights with adequate sleep with conditional logistic regression models stratified by participant and adjusted for caffeine intake, alcohol intake, physical activity, stress, and day of week. RESULTS:Participants were a mean age of 35.1 ± 12.1 years. We collected 4,406 days of data, with 870 headaches reported. Sleep duration ≤6.5 hours and poor sleep quality were not associated with migraine on day 0 or day 1. Diary-reported low efficiency was associated with 39% higher odds of headache on day 1 (odds ratio [OR] 1.39, 95% confidence interval [CI] 1.06-1.81). Actigraphic-assessed high fragmentation was associated with lower odds of migraine on day 0 (wake after sleep onset >53 minutes, OR 0.64, 95% CI 0.48-0.86; efficiency ≤88%, OR 0.74, 95% CI 0.56-0.99). CONCLUSION: Short sleep duration and low sleep quality were not temporally associated with migraine. Sleep fragmentation, defined by low sleep efficiency, was associated with higher odds of migraine on day 1. Further research is needed to understand the clinical and neurobiologic implications of sleep fragmentation and risk of migraine.
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