Analysis of Sleep Quality and Its Associated Factors in Adolescents with Migraine

This study was designed to investigate sleep quality and its associated factors in adolescents with migraine.

Subjects were enrolled and assessed using the Pediatric Migraine Disability Assessment (PedMIDAS) questionnaire, the Hamilton Anxiety Rating Scale (HAMA), the 24-item Hamilton Depression Rating Scale (HAMD-24), and the Pittsburgh Sleep Quality Index (PSQI) to evaluate migraine-related disability, anxiety, depression, and sleep quality.

A total of 168 adolescents were enrolled, including 50 healthy controls and 118 migraine patients, of whom 25 had good sleep quality (PSQI ≤ 5) and 93 had poor sleep quality (PSQI > 5). Adolescents with migraine exhibited significantly higher HAMA, HAMD-24, and PSQI global scores than healthy controls (all p < 0.05). Within the migraine cohort, those with poor sleep quality reported significantly more monthly headache days, higher numerical rating scale (NRS) pain intensity, and elevated PedMIDAS, HAMA, and HAMD-24 scores compared to those with good sleep quality (all p < 0.05). Moreover, the PSQI global score showed statistically significant positive correlations with disease duration (r = 0.266, p = 0.004), monthly headache days (r = 0.428, p < 0.001), NRS pain intensity (r = 0.298, p = 0.001), PedMIDAS score (r = 0.580, p < 0.001), HAMA score (r = 0.513, p < 0.001), and HAMD-24 score (r = 0.462, p < 0.001). After multivariate adjustment, NRS pain intensity (OR = 2.61; 95% CI, 1.56-4.37; p < 0.001), and PedMIDAS score (OR = 1.59; 95% CI, 1.31-1.94; p < 0.001) emerged as independently associated factors of poor sleep quality in adolescents with migraine. Both HAMA and HAMD-24 scores partially mediated the association between NRS pain intensity and PSQI global score, whereas the HAMA score alone partially mediated the association between PedMIDAS score and PSQI global score.

Adolescents with migraine exhibit an elevated prevalence of comorbid anxiety disorders, depressive disorders, and sleep disturbances. Within this population, sleep quality is negatively correlated with disease duration, monthly headache frequency, pain intensity, migraine-related disability, anxiety severity, and depression severity. Furthermore, pain intensity, and migraine-related disability are independently associated with poor sleep quality. These findings underscore the clinical imperative to routinely assess and manage sleep quality in adolescents with migraine, especially those experiencing high headache frequency and severe pain intensity. Nevertheless, the relatively small sample size and class imbalance may limit the statistical power of subgroup analyses. Therefore, future longitudinal multicenter studies employing larger and more balanced samples are warranted.