Do patients with obstructive sleep apnea wake up with headaches?

Background: There is a controversy regarding the association of obstructive sleep apnea (OSA) and morning headaches. This study investigates whether t his relationship exists. Methods: This is a retrospective study of 80 consecutive patients with OSA who underwent sleep polysomnography from December 1996 to March 1997. Patie nts were interviewed about their headache history. Headaches were classifie d according to International Headache Society criteria and the severity gra ded by the Chronic Pain Index. Headache characteristics were compared with those of 22 control patients with periodic limb movement disorder. Headache response to continuous positive airway pressure or uvulopalatopharyngoplas ty in the patients with OSA was also assessed. Results: Forty-eight (60%) patients had headaches in the year prior to stud y. Twenty-five of the 48 patients had headaches that did not fit any catego ry. Of these 25 patients, 23 (48% of total group) reported awakening headac hes. These awakening headaches were significantly more common in the OSA gr oup compared with the periodic limb movement disorder group, 9 (41%) of who m had headaches, none of which occurred on awakening. The proportion of com mon types of headaches in both groups was similar. The awakening headaches were brief (shorter than 30 minutes), and their occurrence and severity cor related with OSA severity. Of the 29 patients with OSA who were treated wit h continuous positive airway pressure or uvulopalatopharyngoplasty, awakeni ng headaches improved by a mean of 80% compared with minimal improvement of migraine, tension, and cervicogenic headaches. Conclusions: Awakening headaches are associated with OSA. These headaches a re of brief duration, and their occurrence and severity increase with incre asing OSA severity. Treatment of OSA with continuous positive airway pressu re or uvulopalatopharyngoplasty can reduce these headaches.