1017 Sleep Duration, Fragmentation, And Quality And Risk Of Next-day Migraine

Abstract Introduction Migraine afflicts 10% of adults and is the sixth most disabling condition worldwide. Though >50% of migraineurs endorse sleep disturbance as a trigger, few studies have prospectively evaluated the nightly influence of sleep on migraine or used objective assessments. Our aim was to examine the association of nightly sleep duration, fragmentation, and quality, as triggers of next-day migraine. Methods We enrolled 101 patients with episodic migraine, aged ≥18 yrs, without sleep apnea. Daily data on sleep, headaches, and other health factors were collected using diaries and actigraphy for 6 weeks. We conducted a prospective self-matched case-crossover analysis, matched on day-of-week, to assess the associations of sleep duration, fragmentation, and self-rated sleep quality with risk of next-day migraine. By design, each participant serves as their own control, thereby accounting for time-invariant factors (e.g., age, sex, usual migraine frequency). We further adjusted for daily caffeine and alcohol use and stress. Results Participants were a mean age of 35.1 ± 11.9 years, 88.1% female, with an average of 5 migraines/month. Among 101 participants, 4,492 nights of data were collected and 884 headaches were reported. Average objective (actigraphy) nightly sleep duration was 436 ± 73 min, efficiency 89 ± 3%, and wake after sleep onset (WASO) 45 ± 17 minutes. Short sleep (≤6.5 hours) was observed on 24.6% of nights. Following a night of short sleep, adjusted incidence of next-day migraine was 1.10 (95% CI: 0.83, 1.46) times higher compared to days following a night of 6.5 to 8.5 hours of sleep. WASO less than or equal to 56 min (RR=1.58, 95% CI: 1.14, 2.20) and fragmentation index ≤23% (RR=1.79, 95% CI: 1.29, 2.50) were associated with higher risk of next-day migraine. Diary-reported short sleep duration, WASO, and poor/very poor quality were not associated with next-day migraine. Conclusion Less fragmented sleep, as assessed by actigraphy, is associated with higher risk of next-day migraine. Multiple, diary-reported sleep attributes were not associated with next-day migraine. Further research is needed to understand the clinical and pathophysiologic implications of objectively-measured sleep fragmentation and risk of migraine. Support (If Any) American Sleep Medicine Foundation; NIHR21NS091627; NIHUL1TR001102.