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Study Summary: Sleep Apnea and Poor Sleep Quality Among People With Migraine



Migraine is a common neurologic disease that is classified based on the number of headache days per month. There is episodic migraine (EM, <15 headache days/month) or chronic migraine (CM, ≥15 headache days/month). Patients with either type may have comorbidities that can complicate therapy and reduce health-related quality of life. Sleep apnea, insomnia, circadian rhythm disorders, and sleep movement disorders are comorbidities that have not been frequently studied in patients with migraine.1

Sleep apnea is categorized as either obstructive apnea or central apnea. Blockage of the airway causes obstructive sleep apnea, and snoring is a marker for this type of apnea. In central sleep apnea, the brain malfunctions when signaling the muscles involved in breathing. The results of previous research show that snoring is associated with more frequent and severe migraine.1

The Chronic Migraine Epidemiology and Outcomes (CaMEO) study was a longitudinal, cross-sectional survey of adults in the United States with migraine. The study investigated sleep apnea and poor sleep quality as comorbidities of migraine.1


Participants in the CaMEO study were aged at least 18 years and had migraine according to modified International Classification of Headache Disorders (3rd edition) criteria. Sleep apnea was assessed by the Berlin Questionnaire for Sleep Apnea and by the patients’ self-reported history. Sleep quality was evaluated via the Medical Outcomes Study Sleep Measures. Body mass index (BMI) was also evaluated.1


The CaMEO study included 12,810 respondents with valid data. Most participants included in the study were women (74.9%) and white (84.4%); the mean age of participants was 41.3 years. When respondents with CM were compared with respondents with EM, the mean ages were similar (41.9 years and 41.3 years, respectively). Respondents in the CM group were more likely to be women (81.5% vs 74.2%) and have a higher mean BMI (28.7 kg/m2 vs 27.7 kg/m2). Respondents in the CM group were less likely to be employed (61.6% vs 69.8%).1

Sleep Apnea

Some respondents were classified as “high risk” for sleep apnea based on their responses to the Berlin Questionnaire (37.0%). When compared with respondents who had EM, respondents with CM were more likely to be at high risk for sleep apnea (51.8% vs 35.6%). Men were more likely to be “high risk” than women (44.4% vs 34.5%). They were also more likely to be older and considered obese. According to the results, respondents who were obese were 5 times more likely to be high risk than those with a normal weight (74.1% vs 14.4%); those who were overweight were twice as likely to be high risk than those with a normal weight (29.8% vs 14.4%).1

Sleep apnea was self-reported by 10.1% of the respondents. Those with CM were more likely to self-report sleep apnea than those with EM (14.1% vs 9.7%), and men were more likely to self-report sleep apnea than women (18.0% vs 7.4%). Of all respondents, 75.7% had received a diagnosis of sleep apnea from a healthcare provider; the percentage was slightly higher among respondents with CM compared with those with EM (82.8% vs 74.7%).1

Sleep Quality

Respondents with EM had better sleep quality compared with those with CM. The mean score on the sleep disturbances subscale was 37.9 versus 53.2, respectively. Scores on the snoring scale (CM, 38.0; EM, 31.0), short of breath scale (CM, 34.9; EM, 15.3), and somnolence scale (CM, 44.1; EM, 32.2) were higher among those with CM compared with EM. Patients in the EM group had a higher mean score on the sleep adequacy scale (EM, 39.2; CM, 34.0). Compared with respondents who had EM, those with CM were less likely to report having slept 7 to 8 hours (ie, optimal hours; 54.7% vs 40.7%, respectively).1


The CaMEO study explored the relationship of migraine with sleep apnea and sleep quality. Across all age groups and BMI categories, high-risk sleep apnea was more common in those with CM than with EM. Men, older respondents, and those with a higher BMI were more likely to be considered high risk. Thus, the study results suggest that older men with CM and a high BMI would be at a very high risk for sleep apnea. The baseline demographics of the CaMEO study population were similar to those of the American Migraine Prevalence and Prevention (AMPP) study population, and since the AMPP study population is representative of the US population, the CaMEO results could be generalized to the US population with migraine.1

The authors described several limitations to the analysis. For example, the data collection method of self-report from a web-based panel may be hampered by nonresponse bias. Based on the results of this analysis, it is not possible to determine the causality or directionality of the relationship between sleep apnea and migraine. There may be, however, a bidirectional relationship between these 2 conditions. They may trigger each other, exacerbate each other, or have a similar underlying causative mechanism.1


The authors concluded that sleep apnea is a prevalent disease and that older men with a high BMI are at very high risk of sleep apnea. The results of this analysis demonstrate that people with CM have a high risk of sleep apnea and experience high rates of poor sleep quality.1


  1. Buse DC, Rains JC, Pavlovic JM, et al. Sleep disorders among people with migraine: results from the chronic migraine epidemiology and outcomes (CaMEO) study. Headache. 2019;59(1):32-45. doi: 10.1111/head.13435.
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