台灣偏頭痛病患發生睡眠障礙之風險：一項全國性之世代研究

The risk of incident sleep disorder in migraine patients in Taiwan: a nationwide cohort study

目標：偏頭痛與睡眠障礙之相關性是複雜的，本研究探討偏頭痛與睡眠障礙之相關性，同時瞭解其他共病與偏頭痛之用藥是否會影響其相關性。方法：本研究為一回溯性世代研究，以承保抽樣歸人檔作為分析資料庫，以新發生之偏頭痛病患作為研究組，且排除曾出現睡眠障礙者，並利用傾向分數配對法，取得無偏頭痛之病患作為對照組。取得研究對象後，進一步控制相關變項，以Cox比例風險模式探討偏頭痛與發生睡眠障礙之相關性。本研究之控制變項為共病情況及偏頭痛之用藥型態。結果：偏頭痛患者之睡眠障礙發生率為6.86％。偏頭痛患者相較於無偏頭痛患者，其發生睡眠障礙之風險比為2.71倍（95％ CI＝2.50-2.94）。高血壓患者（HR＝1.45；95％ CI＝1.29-1.64）、重鬱症（單純發作）患者（HR＝1.94；95％ CI＝1.29-2.92）與精神官能性憂鬱症患者（HR＝1.61；95％ CI＝1.23-2.11），皆有較高之發生睡眠障礙之風險比。偏頭痛用藥與睡眠障礙則無相關性。結論：偏頭痛與發生睡眠障礙確實具有相關性，高血壓疾病、重鬱症（單純發作）及精神官能性憂鬱症，亦為睡眠障礙之危險因子。 Objectives: The correlation between migraine and sleep disorders is complex and may be causal in nature. This study investigated the correlation between migraine and sleep disorders and discussed whether other comorbidities or prescription patterns influence their relevance. Methods: This retrospective cohort study used data from the Longitudinal Health Insurance Database of Taiwan. The study subjects were patients with new-onset migraine who had not been diagnosed as having a sleep disorder prior to migraine diagnosis. To avoid selection bias, we applied propensity score matching to select patients without migraine as the control group. We used the Cox proportional hazard model to analyze differences in the risk of sleep disorder among patients with migraine after controlling for related variables, including comorbidities and migraine prescription patterns. Results: The rate of incident sleep disorders was 6.86% in patients with migraine. The hazard ratio (HR) in patients with migraine was higher than that in patients without migraine (HR = 2.71; 95% confidence interval [CI] = 2.50-2.94). Patients with hypertension (HR = 1.45; 95% CI = 1.29-1.64), major depression (single episode) (HR = 2.38; 95% CI = 1.47-3.84), or neurotic depression (HR = 1.93; 95% CI = 1.41-2.64) had a higher risk of sleep disorders. Furthermore, migraine medication was not related to sleep disorders. Conclusions: Patients with migraine have a higher risk of sleep disorders than do those without migraine. The rate of sleep disorders is highest in patients with hypertension, major depression (single episode), or neurotic depression.