Clinical Characteristics Of Sleep Disorders In Patients With Vestibular Migraine

Background and ObjectiveVestibular migraine(VM)is a vestibular paroxysm disease induced by various factors.The incidence rate is about 1%.It is common in women.Clinically,it is usually characterized by paroxysmal vertigo(or dizziness),accompanied by or without migraine symptoms(or history),and is one of the common causes of vertigo.In 2012,the Barany society and the International Headache Society(IHS)released a consensus document on the diagnostic criteria of VM.As a new vestibular central disease,VM has attracted more and more attention.The study of the pathophysiological mechanism of VM suggests that there is an overlapping neural pathway between VM and migraine.The results show that trigeminal nerve and vestibular ganglion cells have the same neurochemical properties and express 5-hydroxytryptamine,capsaicin and purinergic receptors.Neurochemically similar painful and vestibular afferent structures in the brain stem,such as the parabrachial nucleus,the raphe nucleus,and the locus coeruleus confluence.These structures play an important role in regulating the sensitivity of pain conduction pathway.In addition,they also participate in the formation of anxiety response,partly explaining the common diseases of abnormal balance,anxiety and migraine,and have mutual influence on sleep.In migraine patients,insomnia and other sleep disorders can induce migraine,migraine can also lead to insomnia and other sleep problems.However,there is no further study on the characteristics of sleep disorders.At present,sleep disorders,including insomnia,have become a concern.According to Pittsburgh sleep quality index(PSQI)and other related questionnaires,dizziness is closely related to the severity of sleep disorders.The purpose of this study is to explore the clinical characteristics of VM patients with sleep disorders,further understand the relationship between VM and sleep disorders,and provide clinical basis and guidance for the treatment and prevention of VM.Materials and MethodsThe cross-sectional case-control study design was adopted in this study,and the patients were included in the neurology department and vertigo clinic of our hospital from January 2017 to December 2018.There were 49 VM patients and 52 migraine patients as VM group and migraine group respectively,and 54 healthy volunteers as the control group.PSQI questionnaire was used to evaluate the sleep quality of patients in the past month.All the participants were monitored for sleep all night,and the body mass index,sleep apnea hypopnea index,total sleep time,sleep efficiency,wake-up time after sleep onset,number of wakes,sleep latency,REM sleep latency,N1%,N2%,N3%,REM%,wakefulness index,periodic leg movement index were statistically analyzed.Results(1)The mean age of VM group was 52.86 ± 13.31 years,that of migraine group was 49.40± 11.90 years,and that of control group was 48.28 ± 11.88 years.There was no significant difference in gender and age among the three groups(P>0.05).Compared with migraine group(59.62%)and control group(12.96%),the incidence of poor sleep quality in VM group(67.35%)was significantly higher(P<0.05).(2)There were significant differences between VM group and migraine group in sleep time,sleep efficiency,sleep quality,sleep disorders,daytime dysfunction,PSQI total score(P<0.05).The total score of PSQI was 8.60±3.86 in VM group,7.69 ±4.64 in migraine group and 3.90±1.80 in control group.There was no significant difference in sleep quality between VM patients and migraine patients.However,compared with migraine patients and control group,VM patients have lower sleep quality and higher incidence of sleep disorders.(3)There was no significant difference in BMI among the three groups(P>0.05).Compared with the control group,the total sleep time,sleep efficiency,the proportion of N3 stage and REM stage in VM group were significantly reduced(P<0.05).The proportion of awake time,sleep latency,rapid eye movement latency,N1 and N2 were significantly longer than that of the control group(P<0.05).The AHI and PLMI of migraine patients were significantly higher than those of VM group(P<0.05).Compared with the control group,the sleep structure changes of VM group and migraine group were similar.Conclusions(1)VM patients can cause secondary sleep disorders,such as poor sleep quality at night,difficulty in falling asleep,difficulty in maintaining sleep,and easy to wake up;(2)The main sleep changes of VM and migraine are sleep efficiency reduction,sleep latency extension,REM sleep latency extension,slow wave sleep reduction,REM sleep reduction,wake-up time increase,sleep fragmentation,which can cause slight abnormal changes of apnea hypopnea index and periodic limb movement index;(3)The effect of vestibular migraine on sleep is like that of migraine,which may cause secondary sleep disorder by affecting the hypothalamic sleep regulating central nervous nucleus.