Background
Methods
Survey
Assessment of TTH
Assessment of insomnia
Assessment of sleep time and sleep quality
Assessment of anxiety and depression
Data analyses
Results
Survey
Survey participants | Total population | P | Tension-type headache |
P
| Insomnia |
P
| |
---|---|---|---|---|---|---|---|
N (%) | N (%) | N, % (95% CI) | N, % (95% CI) | ||||
Sex | |||||||
Men | 1345 (49.3) | 17,584,365 (50.6) | 0.854a
| 268, 19.9 (17.8–22.0) | 0.120b
| 117, 8.7 (7.2–1.2) | 0.001c
|
Women | 1350 (50.7) | 17,198,350 (49.4) | 302, 22.3 (20.1–24.6) | 173, 12.4 (11.0–14.6) | |||
Age | |||||||
19–29 | 542 (20.5) | 7,717,947 (22.2) | 0.917a
| 119, 22.0 (18.5–25.5) | 0.971b
| 59, 10.9 (8.3–13.5) | 0.427c
|
30–39 | 604 (21.9) | 8,349,487 (24.0) | 127, 21.0(17.8–24.3) | 53, 8.8 (6.5–11.0) | |||
40–49 | 611 (23.1) | 8,613,110 (24.8) | 131, 21.4 (18.2–24.7) | 66, 10.8 (8.3–13.3) | |||
50–59 | 529 (18.9) | 6,167,505 (17.7) | 107, 20.2 (16.8–23.7) | 63, 11.9 (9.1–14.7) | |||
60–69 | 409 (15.6) | 3,934,666 (11.3) | 86, 21.0 (17.1–25.0) | 49, 12.0 (8.8–15.1) | |||
Size of residential area | |||||||
Large city | 1248 (46.3) | 16,776,771 (48.2) | 0.921a
| 251, 20.1 (17.9–22.4) | 0.004b
| 136, 10.9 (9.2–12.6) | 0.943c
|
Medium-to-small city | 1186 (44.0) | 15,164,345 (43.6) | 243, 20.5 (18.2–22.8) | 125, 10.5 (8.8–12.2) | |||
Rural area | 261 (9.7) | 2,841,599 (8.2) | 76, 29.1 (23.6–34.7) | 29, 11.1 (7.3–14.9) | |||
Education level | |||||||
Middle school or less | 393 (14.9) | 6,608,716 (19.0) | 0.752a
| 96, 24.5 (20.1–28.7) | 0.327b
| 62, 15.8 (12.1–19.4) | 0.006c
|
High school | 1208 (44.5) | 15,234,829 (43.8) | 247, 20.5 (18.2–22.7) | 116, 9.6 (7.9–11.3) | |||
College or more | 1068 (39.6) | 12,939,170 (37.2) | 223, 20.9 (18.4–23.3) | 109, 10.2 (8.4–12.0) | |||
Not responded | 26 (1.0) | 4, 15.4 (0.5–30.2) | 3, 11.5 (0.0–24.7) | ||||
Total | 2695 (100.0) | 34,782,715 (100.0) | 570, 21.2 (19.6–22.7) | 290, 10.8 (9.6–11.9) |
Prevalence of TTH, non-headache controls, and insomnia
Prevalence of anxiety, depression, short sleep time and poor sleep quality
Prevalence of insomnia among individuals with TTH
Demographic characteristics and clinical presentation of TTH according to the presence of insomnia
TTH with insomnia, N = 75 | TTH without insomnia, N = 495 |
P
| |
---|---|---|---|
Demographics | |||
Age, Mean ± SD (years) | 44.5 ± 13.7 | 42.5 ± 13.7 | 0.236 |
Women, N (%) | 43 (57.3) | 259 (52.3) | 0.418 |
Headache characteristics | |||
Bilateral pain, N (%) | 45 (60.0) | 329 (66.5) | 0.272 |
Non-pulsating quality, N (%) | 29 (38.7) | 198 (40.0) | 0.824 |
Mild-to-moderate severity, N (%) | 73 (97.3) | 490 (99.0) | 0.225 |
Non-aggravation by movement, N(%) | 58 (77.3) | 393 (79.4) | 0.682 |
Associated symptoms | |||
Photophobia, N (%) | 6 (8.0) | 40 (8.1) | 0.981 |
Phonophobia, N (%) | 31 (41.3) | 150 (30.3) | 0.056 |
Headache frequency, Median (IQR) | 1.0 (0.3–3.0) | 0.4 (0.2–1.0) | 0.002a
|
VAS score, Median (IQR) | 5.0 (4.0–7.0) | 4.0 (3.0–6.0) | < 0.001a
|
HIT-6 score, Median (IQR) | 46.0 (40.0–52.0) | 42.0 (38.0–46.0) | < 0.001a
|
Anxiety, N (%) | 21 (28.0) | 33 (6.7) | < 0.001 |
Depression, N (%) | 16 (21.3) | 8 (1.6) | < 0.001 |
Univariable and multivariable analyses for factors contributing to insomnia among individuals with TTH
Univariable analysis | Multivariable analysis | Multivariable analysis | Multivariable analysis | |
---|---|---|---|---|
OR, 95% CI, P-value
| Model 1 | Model 2 | Model 3 | |
Sex | ||||
1.2 (0.8–2.0), p = 0418
| 1.2 (0.7–2.0), p = 0.609
| 1.3 (0.8–2.4), p = 0.305
| 1.2 (0.7–2.2), p = 0.528
| |
Age | ||||
20s | Reference | |||
30s | 0.8 (0.3–1.8), p = 0.556
| 0.7 (0.2–1.6), p = 0.360
| 0.6 (0.2–1.5), p = 0.256
| 0.5 (0.2–1.4), p = 0.220
|
40s | 1.1 (0.5–2.4), p = 0.772
| 1.1 (0.5–2.5), p = 0.833
| 1.1 (0.5–2.6), p = 0.836
| 1.1 (0.4–2.6), p = 0.910
|
50s | 1.6 (0.8–3.4), p = 0.206
| 1.7 (0.7–4.2), p = 0.246
| 0.8 (0.3–2.1), p = 0.704
| 1.0 (0.4–2.8), p = 0.931
|
60s | 1.3 (0.6–3.0), p = 0.485
| 1.2 (0.4–3.5), p = 0.689
| 0.9 (0.3–2.6), p = 0.789
| 0.9 (0.3–3.0), p = 0.928
|
Size of residential area | ||||
Large city | Reference | |||
Medium-to-small city | 1.2(0.7–2.0), p = 0.508
| 1.2 (0.7–2.1), p = 0.566
| 1.4(0.8–2.4), p = 0.295
| 1.3(0.7–2.4), p = 0.395
|
Rural area | 0.5(0.2–1.2), p = 0.125
| 0.5 (0.2–1.5), p = 0.244
| 0.5(0.2–1.6), p = 0.268
| 0.6(0.2–1.8), P = 0.340
|
Education level | ||||
Middle school or less | Reference | |||
High school | 0.9(0.5–1.7), p = 0.732
| 0.9(0.4–2.0), p = 0.716
| 0.6(0.2–1.5), p = 0.260
| 0.6(0.2–1.4), p = 0.215
|
College or more | 0.7(0.3–1.3), p = 0.226
| 0.8(0.3–2.1), p = 0.622
| 0.5(0.2–1.4), p = 0.190
| 0.5(0.2–1.6), p = 0.250
|
Not responded | 1.8(0.2–18.5), p = 0.621
| 2.1(0.2–22.2), p = 0.543
| 1.9(0.1–28.8), p = 0.626
| 2.3(0.2–32.9), p = 0.539
|
Anxiety | 5.4 (2.9–10.0), p < 0.001
| 3.9(2.0–8.0), p < 0.001
| 3.0 (1.4–6.7), p = 0.006
| |
Depression | 16.5 (6.8–40.2), p < 0.001
| 14.8(5.5–39.7), p < 0.001
| 5.8 (2.0–16.3), p = 0.001
| |
Short sleep time | 3.1 (1.9–5.3), p < 0.001
| 1.2(0.7–2.3), p = 0.538
| 1.2 (0.6–2.4), p = 0.570
| |
Poor sleep quality | 12.8 (7.1–23.0), p < 0.001
| 13.4(7.1–25.3), p < 0.001
| 9.9 (5.1–19.2), p < 0.001
|