Short Sleep Duration and Sleep Disturbance as a Trigger of Migraine

 描述(申请人提供)：超过10%的美国人患有偏头痛，这是一种知之甚少的慢性神经综合征，其特征是以剧烈疼痛、认知功能改变和生理障碍为特征的不可预测的反复发作。偏头痛是最令人残疾的疾病之一，在美国每年损失120亿美元的员工时间。尽管偏头痛的负担很重，而且有针对性的药物治疗(即Triptans)，但对许多患者来说，有效的治疗和预防仍然难以实现。50%的偏头痛患者认为睡眠中断，包括“睡眠时间太短”是偏头痛的诱因，临床实践要求偏头痛要注意睡眠卫生。然而， 很少有研究考察可能引发偏头痛的特定睡眠属性的确切时间关系，这在我们的知识中留下了一个空白，即夜间睡眠模式，包括睡眠时间短和睡眠受到干扰，与第二天偏头痛的风险有何关系。一致的是，很少有数据探索偏头痛影响睡眠的相互作用途径。我们提出了一项新的队列研究，以量化睡眠时间短的一晚与偏头痛发作之间的双向时间关系。我们还将探索零碎的睡眠(低睡眠效率)和偏头痛之间的独立的、暂时的联系。最后，我们将探索睡眠中点和短期累积睡眠的变化 失眠(两个晚上睡眠不足)预示着偏头痛的发作。解决这一知识差距对偏头痛的病因、预防和治疗具有重要意义。我们前瞻性地收集了100名偏头痛患者六周的每日目标(通过肌动描记)。使用最先进的流行病学方法-自身对照病例系列设计，我们将实现两个具体目标：(1)量化睡眠时间作为偏头痛的时间先例的独立贡献；(2)确定睡眠障碍的其他客观指标的时间性和影响，包括睡眠片断和睡眠中点的变化，作为偏头痛的触发因素。这项拟议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，将证明有理由进一步研究新颖的、有针对性的干预措施，以改变偏头痛患者的特定睡眠方面。我们的工作也将为未来的研究提供见解，揭示睡眠与偏头痛之间的神经生物学过程。我们预计，这项拟议的工作将有助于我们理解睡眠和偏头痛之间的双向关系，并支持对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.