Sleep Disorders

Sleep Architectural Disruption

A report on sleep architectural disruption as a contributor to sex-specific differences in quality of life measures, particularly those distinct to emotional processing. Migraine patients aged > 18 years seen in the Cleveland Clinic headache program with polysomnogram data were included. Migraine burden was measured by the migraine-specific quality of life (MSQOL) questionnaire, with a higher score indicating a worse quality of life. The 3 MSQOL domains are emotional function, role function-preventative, and role function-restrictive. The assessment of the association of MSQOL domains with sleep architectural measures and interaction by sex accounted for influence of age, race, BMI, and comorbidities as potential confounders.

Sleep Study Biomarkers of Sex-Specific Differences in Migraine

MSQOL-EF=migraine-specific quality of life-emotional function

Of 245 patients with migraine, 15.15 (N=37) were male. Males had a higher apnea-hypopnea index (median[interquartile range]: 10.0[5.3 - 18.5] vs. 5.7 [1.8 - 11.4] events/hour, P =0.006). The difference in MSQOL-EF scores was not statistically significant (males: 73.3 [53.3 - 86.7[ vs. females: 60 [33.3 - 80.0], P = 0.066). There was no statistical difference in %N2 or %REM between sexes, although males had a greater %N1 (10.9% [5.9 - 19.2] vs. 6.6% [4.1 - 11.9], P = 0.039) and lower %N3 (0% [0 - 5] vs. 4.3 [0.0 - 11.4], P < 0.001). The association of MSQOL-EF with %N2 and %REM differed by sex: for each 5% point increase in N2, the mean MSQOL-EF increased by 2.7 points in females (2.7, 95% CI=0.1 - 5.3, P = 0.042,) compared with a 6.8 point decrease in males (-6.8, 95% CI=15.9 - 2.2, P = 0.14) (interaction P = 0.044). For each 5% point increase in REM, the mean MSQOL-EF decreased by 3.7 points in females (-3.7, 95% CI=-6.7 - -0.8, P = 0.013) compared to a 6.3 point increase in males (6.3, 95% CI=-3.1 - 15.6, P = 0.19) (interaction P = 0.044).

Although males had greater sleep disruption compared with females, no significant difference in MSQOL-EF scores was found. Sex-specific differences of sleep stage composition and MSQOL-EF were observed, suggesting that sleep architectural alteration influences greater responsivity of migraine emotional processing in men vs. women. Future investigation should better characterize longitudinal relationships and underlying neurobiological mechanisms which may account for these findings.