Short Sleep Duration and Sleep Disturbance as a Trigger of Migraine

 描述（由申请人提供）：超过10%的美国人患有偏头痛，这是一种了解甚少的慢性神经系统综合征，其特征是以剧烈疼痛、认知功能改变和生理紊乱为标志的不可预测的复发性发作。偏头痛是最致残的医疗条件之一，在美国每年损失120亿美元的员工时间。尽管偏头痛的高负担和靶向药物治疗的可用性（即，曲坦类），但有效的治疗和预防对于许多患者来说仍然是难以实现的。睡眠中断，包括“睡眠过短”，被超过50%的偏头痛患者确定为偏头痛的触发因素，并且临床实践规定了偏头痛的睡眠卫生。然而， 很少有研究检查了可能引起偏头痛的特定睡眠属性的精确时间关系，在我们的知识中留下了关于夜间睡眠模式（包括短睡眠持续时间和干扰睡眠）如何与第二天偏头痛风险相关的空白。相应地，很少有数据探索偏头痛影响睡眠的相互途径。我们提出了一个新的队列研究，以量化一个单一的夜间短睡眠时间和偏头痛发作之间的双向，时间关系。我们还将探索碎片睡眠（低睡眠效率）和偏头痛之间的独立时间关联。最后，我们将探讨睡眠中点的变化和短期的累积睡眠 睡眠不足（2晚睡眠不足）可预测偏头痛发作。解决这一知识缺口对偏头痛的病因、预防和治疗具有重要意义。我们前瞻性地收集了100例偏头痛患者6周的每日客观（通过腕动记录仪）。使用最先进的流行病学方法-自我对照病例系列设计，我们将实现两个具体目标：（1）量化睡眠持续时间作为偏头痛的时间先例的独立贡献;（2）确定其他睡眠障碍客观指标的时间性和影响，包括睡眠片段化和睡眠中点偏移，作为偏头痛的触发因素。这项拟议中的研究将明确建立睡眠时间短与偏头痛发作风险之间的时间关系。完善我们对睡眠持续时间和睡眠中断在偏头痛发病机制中的因果作用的理解，将证明进一步研究新的，有针对性的干预措施，改变偏头痛患者睡眠的特定方面。我们的工作也将为未来的研究提供见解，解开睡眠与偏头痛之间的神经生物学过程。我们预计这项工作将大大有助于我们理解睡眠和偏头痛之间的双向关系，并支持偏头痛患者睡眠中断的创新和积极管理，从而减轻这种慢性神经血管疾病的巨大负担。

 DESCRIPTION (provided by applicant): More than 10% of Americans suffer from migraine, a poorly understood chronic neurological syndrome, characterized by unpredictable, recurrent attacks marked by intense pain, altered cognitive functioning, and physiologic disturbances. Migraine ranks among the most disabling medical conditions, and costs $12 billion/year in lost employee time in the United States. Despite the high burden of migraine and the availability of targeted pharmacotherapy (i.e., triptans), effective treatment and prevention remains elusive for many patients. Disrupted sleep, including "too short sleep," is identified by >50% of migraine sufferers as a trigger of migraine, and clinical practice dictates sleep hygiene to migraines. Yet, few studies have examined the precise temporal relationships of specific sleep attributes that may provoke migraine, leaving a gap in our knowledge as to how nightly patterns of sleep, including short sleep duration and disturbed sleep, relate to next-day risk of migraine. Congruently, there are few data exploring the reciprocal pathway whereby migraine impacts sleep. We propose a novel cohort study to quantify the bidirectional, temporal relationship between a single night of short sleep duration and migraine onset. We will also explore the independent, temporal association between fragmented sleep (low sleep efficiency) and migraine. Lastly, we will explore if shifts in sleep midpoint and short periods of cumulative sleep loss (2 nights of short sleep) predict migraine onset. Addressing this knowledge gap has critical implications for the etiology, prevention and treatment of migraine. We prospectively collect daily objective (via actigraphy) for six weeks in 100 patients with migraine. Using a state-of-the-art epidemiologic approach-the self-controlled case series design, we will achieve two specific aims: (1) to quantify the independent contribution of sleep duration as a temporal precedent of migraine; (2) to identify the temporality and impact of other objective measures of disturbed sleep, including sleep fragmentation and shifts in sleep midpoint, as triggers of migraine. The proposed study will definitively establish the temporal relationship between short sleep duration and risk of migraine attacks. Refining our understanding of the causal role of sleep duration and sleep disruption in migraine pathogenesis would justify further investigations of novel, targeted interventions that modify specific aspects of sleep for persons with migraine. Our work will also generate insights for future research disentangling the neurobiologic processes linking sleep with migraine. We anticipate this proposed work would contribute substantively to our understanding of the bidirectional relationship between sleep and migraine and support innovative and aggressive management of sleep disruption in patients with migraine, thereby mitigating the enormous burden of this chronic neurovascular disease.