1159 Objective-Subjective Discrepancy in Sleep Assessment in OSA Patients with a History of Migraine

Abstract Introduction A consistent relationship between chronic pain and poor sleep is found in numerous studies using self-reports, e.g., PSQI and ISI. However, PSG data are less consistent. Further, insomnia is associated with discrepancies between objective and subjective sleep measures. This analysis focuses on objective-subjective mismatch in migraine, a pain condition recently reported to have a stronger association with subjective sleep disturbance. Methods From 2001 adults undergoing consecutive clinical PSGs, 47 migraineurs (41 women, 20 Caucasian, M[Age]=46.5±12.4) were selected who were free from major medical and psychiatric conditions other than depression/anxiety (n=13) and other types of non-cancer chronic pain (n=18). Mismatch indices (MI=[objective-subjective]/objective) between PSG and PSQI were calculated for total sleep time (TST), sleep latency (SL) and sleep efficiency (SE). MIs between PSG and subjective post-PSG estimates (PPE) were calculated for TST, SL and WASO. Each MI was regressed on PSG variables—TST, SL, SE, N1%, N3%, REM%, REM latency, WASO, #awakenings, total arousal index (TAI), AHI, SpO2nadir—and self-reported measures—chronic pain intensity (CPI), PSQI, ISI, ESS, Center for Epidemiologic Studies Depression Scale-Revised (CESDR). Age, sex, BMI, other pain and depression/anxiety diagnoses were used as covariates. Results Regressions for PSG-PSQI MIs revealed significant associations for TST and SE only. Greater underestimation of TST was related to higher REM% (p=0.019), fewer awakenings (p=0.050), lower AHI (p=0.015), lower SpO2nadir (p=0.005), higher PSQI (p=0.001). Greater underestimation of SE was related to lower N1% (p=0.046), fewer awakenings (p=0.050), higher TAI (p=0.038), lower AHI (p=0.009), lower SpO2nadir (p=0.003), lower CPI (p=0.037), higher PSQI (p< 0.001). PSG-PPE MIs showed no significant associations with explanatory variables. Conclusion Underestimations of TST and SE on PSQI vs. PSG were associated with better gross measures of objective sleep—higher REM%, lower N1%, fewer awakenings and lower AHI—which indicates misperception. However, associations with higher TAI and lower SpO2nadir suggest contributions of more subtle physiological variables to these underestimations. Consistent with prior data on misperception in insomnia, in this sample of migraineurs greater underestimations of TST and SE were related to higher PSQI, which cautions against face-value interpretations of self-reported sleep disturbance without objective measures. Support (if any) none