title: Sleep disturbances and quality of life in Sub-Saharan African migraineurs.
abstract: BACKGROUND
  Although in the past decade occidental countries have increasingly recognized the personal and societal burden of migraine, it remains poorly understood in Africa. No study has evaluated the impact of sleep disturbances and the quality of life (QOL) in sub-Saharan Africans with migraine.
  
  
  METHODS
  This was a cross-sectional study evaluating adults, ≥ 18 years of age, attending outpatient clinics in Ethiopia. Standardized questionnaires were utilized to collect demographic, headache, sleep, lifestyle, and QOL characteristics in all participants. Migraine classification was based on International Classification of Headache Disorders (ICHD)-II criteria. The Pittsburgh Sleep Quality Index (PSQI) and the World Health Organization Quality of Life (WHOQOL-BREF) questionnaires were utilized to assess sleep quality and QOL characteristics, respectively. Multivariable logistic regression models were fit to estimate adjusted odds ratio (OR) and 95% confidence intervals (95% CI).
  
  
  RESULTS
  Of 1,060 participants, 145 (14%) met ICHD-II criteria for migraine. Approximately three-fifth of the study participants (60.5%) were found to have poor sleep quality. After adjustments, migraineurs had over a two-fold increased odds (OR = 2.24, 95% CI 1.49-3.38) of overall poor sleep quality (PSQI global score >5) as compared with non-migraineurs. Compared with non-migraineurs, migraineurs were also more likely to experience short sleep duration (≤7 hours) (OR = 2.07, 95% CI 1.43-3.00), long sleep latency (≥30 min) (OR = 1.97, 95% CI 1.36-2.85), daytime dysfunction due to sleepiness (OR = 1.51, 95% CI 1.12-2.02), and poor sleep efficiency (<85%) (OR = 1.93, 95% CI 1.31-2.88). Similar to occidental countries, Ethiopian migraineurs reported a reduced QOL as compared to non-migraineurs. Specifically Ethiopian migraineurs were more likely to experience poor physical (OR = 1.56, 95% CI 1.08-2.25) and psychological health (OR = 1.75, 95% CI 1.20-2.56), as well as poor social relationships (OR = 1.56, 95% CI 1.08-2.25), and living environments (OR = 1.41, 95% CI 0.97-2.05) as compared to those without migraine.
  
  
  CONCLUSIONS
  Similar to occidental countries, migraine is highly prevalent among Ethiopians and is associated with poor sleep quality and a lower QOL. These findings support the need for physicians and policy makers to take action to improve the quality of headache care and access to treatment in Ethiopia.
authors.affiliation: Department of Epidemiology, Harvard T.H. Chan School of Public Health Multidisciplinary International Research Training Program, 677 Huntington Ave, K505F, Boston, 02115, MA, USA. morga22i@mtholyoke.edu.
authors.forename: Isabel
authors.initials: I
authors.lastname: Morgan
authors.affiliation: Department of Epidemiology, Harvard T.H. Chan School of Public Health Multidisciplinary International Research Training Program, 677 Huntington Ave, K505F, Boston, 02115, MA, USA. Eguia2121@aol.com.
authors.forename: Francisco
authors.initials: F
authors.lastname: Eguia
authors.affiliation: Department of Epidemiology, Harvard T.H. Chan School of Public Health Multidisciplinary International Research Training Program, 677 Huntington Ave, K505F, Boston, 02115, MA, USA. bgelaye@hsph.harvard.edu.
authors.forename: Bizu
authors.initials: B
authors.lastname: Gelaye
authors.affiliation: Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA. lpeterlin@jhmi.edu.
authors.forename: B Lee
authors.initials: BL
authors.lastname: Peterlin
authors.affiliation: Department of Epidemiology, Harvard T.H. Chan School of Public Health Multidisciplinary International Research Training Program, 677 Huntington Ave, K505F, Boston, 02115, MA, USA. mgt26@georgetown.edu.|Department of Mathematics & Statistics, Georgetown University, Washington, DC, USA. mgt26@georgetown.edu.
authors.forename: Mahlet G
authors.initials: MG
authors.lastname: Tadesse
authors.affiliation: Addis Continental Institute of Public Health, Addis Ababa, Ethiopia. sebeye2007@gmail.com.
authors.forename: Seblewengel
authors.initials: S
authors.lastname: Lemma
authors.affiliation: Addis Continental Institute of Public Health, Addis Ababa, Ethiopia. yemaneberhane@ethionet.et.
authors.forename: Yemane
authors.initials: Y
authors.lastname: Berhane
authors.affiliation: Department of Epidemiology, Harvard T.H. Chan School of Public Health Multidisciplinary International Research Training Program, 677 Huntington Ave, K505F, Boston, 02115, MA, USA. mawilliams@hsph.harvard.edu.
authors.forename: Michelle A
authors.initials: MA
authors.lastname: Williams
mesh_terms: D000328:Adult; D017954:Africa South of the Sahara; D015897:Comorbidity; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D008881:Migraine Disorders / Q000175:diagnosis / Q000453:epidemiology* / Q000523:psychology; D015995:Prevalence; D011788:Quality of Life; D012890:Sleep; D012893:Sleep Wake Disorders / Q000175:diagnosis / Q000453:epidemiology* / Q000523:psychology; D011795:Surveys and Questionnaires; D014944:World Health Organization; D055815:Young Adult