Morning headaches as a specific OSA characteristic in a large sleep clinic population

<bold>Background:</bold> Obstructive sleep apnea (OSA) is the most common sleep breathing disorder with different clinical presentation between genders. Classic symptoms include snoring, excessive daytime sleepiness and recurrent awakenings. In females, symptoms such as insomnia, fatigue, mood disturbances, nightmares, or morning headaches(MH) may be present. This study aimed to evaluate the presence of MH in a large sample of OSA patients and possible associations with OSA variables. <bold>Results:</bold> MH were reported in 29% of participants (mean age 56.7±13.2, ESS 10.5±4.6, AHI 34.4±25.4/h, ODI 34.4±25.9/h, AIS 11.2±5.19 and STOP BANG 5.1±1.7). Patients with MH were younger, sleepier with higher AHI, ODI and STOP BANG and more insomnia symptoms. Of all women 45.3% presented MH whereas 30% of men. MH were found in 37% from patients with apneas, 35.2% of those with snoring and 44.3 of those with tiredness. From the participants with MH 12.5% had no, 12,9% mild, 24.2%moderate and 50.4% severe OSA. No significant differences were found between patients with MH and co-morbidities as hypertension, diabetes, arrhythmias. In logistic regression analysis , MH associated with female sex (odds ratio, OR, 2.055,95% confidence interval, CI, 1.74–2.43, P=<0.001), age (OR 0.99, 95%CI 0.98-0.99,P=0.009),ESS (OR 1.06,95%CI 1.04-1.08,P<0.001) and AIS (OR 1.11, 95%CI 1.094-1.13, P<0.001)but not AHI <bold>Conclusion:</bold> MH is often reported among patients referred for possible OSA and should be considered as a symptom of the disease especially in females