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Does sleep aggravate tension-type headache An investigation using computerized ecological momentary assessment and actigraphy.doc

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Does sleep aggravate tension-type headache An investigation using computerized ecological momentary assessment and actigraphy

Kikuchietal.BioPsychoSocialMedicine2011,5:10 /content/5/1/10 RESEARCH OpenAccess Doessleepaggravatetension-typeheadache?:An investigationusingcomputerizedecological momentaryassessmentandactigraphy HiroeKikuchi1,2*,KazuhiroYoshiuchi2,YoshiharuYamamoto3,GenKomaki1andAkiraAkabayashi2 Abstract Background:Bothinsufficientsleepandoversleepinghavebeenreportedasprecipitatingandaggravatingfactors oftension-typeheadache(TTH).However,previousstudiesreliedonrecalledself-reports,andtherelationshiphas notbeenconfirmedprospectivelyandobjectivelyinadailylifesituation.Recently,ecologicalmomentary assessment(EMA)usingelectronicdiaries,i.e.,computerizedEMA,isusedtorecordsubjectivesymptomswiththe advantagesofavoidingrecallbiasandfakedcomplianceindailysettings.Inaddition,actigraphyhasbecomean establishedmethodtoassesssleepoutsidelaboratories.Therefore,theaimofthisstudywastoinvestigatethe within-individualeffectofsleeponthefollowingmomentaryheadacheintensityinTTHpatientsduringtheirdaily livesutilizingEMAandactigraphy. Methods:Twenty-sevenpatientswithTTHworewatch-typecomputersaselectronicdiariesforsevenconsecutive daysandrecordedtheirmomentaryheadacheintensityusingavisualanalogscaleof0-100approximatelyevery sixhours,onwakingup,whengoingtobed,andatthetimeofheadacheexacerbations.Theyalsorecordedtheir self-reportofsleepquality,hoursofsleepandnumberofawakeningswiththecomputerswhentheywokeup. Physicalactivitywascontinuouslyrecordedbyanactigraphinsidethewatch-typecomputers.Activitydatawere analyzedbyCole’salgorithmtoobtaintotalsleeptime,sleepefficiency,sleeplatency,waketimeaftersleeponset andnumberofawakeningsforeachnight.Multilevelmodelingwasusedtotesttheeffectofeachsubjectiveand objectivesleep-relatedvariableonmomentaryheadacheintensityonthefollowingday. Results:Objectivelymeasuredtotalsleeptimewassignificantlypositivelyassociatedwithmomentaryheadache intensityonthefollowingday,whileself-reportedsleepqualitywassignificantlynegativelyassociatedwith momentaryheadacheintensityonthefollowingda