Subjective sleep quality and sleep architecture in patients with migraine: a meta-analysis

Objectives: Sleep disturbance is often associated with migraine. However, there is a paucity of research investigating objective and subjective measures of sleep in migraine patients. This meta-analysis aims to determine whether there are differences in subjective sleep quality measured using the Pittsburgh Sleep Quality Index (PSQI), and objective sleep physiology measured using polysomnography between adult and pediatric patients, and healthy controls. Methods: This review was pre-registered on PROSPERO (CRD42020209325). A systematic search of five databases (Embase, MEDLINE®, Global Health, APA PsycINFO, APA PsycArticles, last searched: 12/17/2020) was conducted to find case-controlled studies which measured polysomnography and/or PSQI in patients with migraine. Pregnant participants and those with other headache disorders were excluded. Effect sizes (Hedges' g) were entered into a random effects model meta-analysis. Study quality was evaluated with the Newcastle Ottawa Scale, and publication bias with Egger's regression test. Results: 32 studies were eligible, of which 21 measured PSQI and/MIDAS in adults, 6 measured PSG in adults and 5 in children. The overall mean study quality score was 5/9, and this did not moderate any of the results, and there was no risk of publication bias. Overall, adults with migraine had higher PSQI scores than healthy controls (g=0.75, p < .001, 95% confidence interval [95%CI]: 0.54 - 0.96). This effect was larger in those with chronic rather than episodic condition (g=1.03, p < .001, 95%CI: 0.37 - 1.01, g = 0.63, p < .001, 95%CI: 0.38 - 0.88 respectively). For polysomnographic studies, adults and children with migraine displayed a lower percentage of REM sleep (g=-0.22, p = 0.017, 95%CI: -0.41 - -0.04, g = -0.71, p = 0.025, 95%CI: -1.34 - -0.10 respectively) than controls. Pediatric patients displayed less total sleep time (g=-1.37, p = 0.039, 95%CI: -2.66 - -0.10), more wake (g=0.52, p < .001, 95%CI: 0.08 – 0.79) and shorter sleep onset latency (g=-0.37, p < .001, 95%CI: -0.54 - -0.21) than controls. Discussion: People with migraine have significantly poorer subjective sleep quality and altered sleep physiology compared to healthy individuals. Further longitudinal empirical studies are required to enhance our understanding of this relationship.There is a README file within the RStudio software project which explains how to run the necessary analysis scripts as well as a data-README which explains the abbreviations within the data files themselves. Funding provided by: Medical Research CouncilCrossref Funder Registry ID: http://dx.doi.org/10.13039/501100000265Award Number: MR/N013700/1This dataset includes the means and standard deviations from adult and paediatric migraine patients and healthy controls for global Pittsburgh Sleep Quality Index scores, and polysomnography parameters (REM, N1, N2, N3, wake percentages, total sleep time and sleep onset latency in minutes) as well as the n for each group taken directly from published journal articles. The dataset also includes other information such as the original article's authors, title of the article, country of publication, abstract, year published, journal published in, the measures of sleep that study collected, risk of bias/study quality assessment scores, and other information that could be potential moderating variables