PO-22 | Impact of sleep disorders on anti-CGRP monoclonal antibodies treatment response in migraine: a cross-sectional study

Costanza Sottani,¹ Valerio Brunetti,^1,2 Fabiana Cerulli,¹ Claudia Garattini,⁴ Gianluca Avino,⁵ Paolo Calabresi,^1,3 Catello Vollono^1,4 | ¹Università Cattolica del Sacro Cuore, Dipartimento di Neuroscienze, Rome; ²Stroke Unit, Fondazione Policlinico Agostino Gemelli IRCSS, Rome; ³UOC Neurologia, Fondazione Policlinico Agostino Gemelli IRCSS, Rome; ⁴UOC Neurofisiopatologia, Fondazione Policlinico Agostino Gemelli IRCSS, Rome; ⁵Unità di Neurologia, Ospedale Santo Stefano, Prato, Italy

Background: The relationship between migraine and sleep disorders (SDs) is well-established, but only few studies have investigated the impact of anti-CGRP monoclonal antibodies (mAbs) on sleep. To our knowledge, no study has specifically analysed the potential role of sleep in influencing the response to treatment with anti-CGRP mAbs. Aim of our study is to assess sleep quality and screen for SDs in patients undergoing treatment with anti-CGRP mAbs and to investigate the potential predictive role of these parameters in treatment response.

Methods: We included patients aged >18 years undergoing FRANCAVIg anti-CGRP mAbs treatment at standard dosages for at least three months with adequate compliance. Patients were grouped as follows after data collection: responders (>50% reduction in mean headache days (MHDs) compared to baseline) and non-responders (<50% MHDs). Additionally, we subdivided patients in super-responders, when observing a >75% reduction in MHDs. During the visit, we obtained anthropometric measurements (weight, height, and neck circumference), and patients completed a structured interview assessing sleep quality, chronotype, and screening for major SDs using the following questionnaires: Pittsburgh Sleep Quality Index (PSQI), Epworth Sleep Scale (ESS), Fatigue Assessement Scale (FAS), Morning-Eveningness Questionnaire (MEQ), STOP-Bang, Restless Leg Syndrome assessment test. Numeric variables were compared by means of one-way analysis of variance Kruskal-Wallis test or Mann-Whitney U-test. Categorial variables were analyzed by means of table of contingency Pearson’s chi-squared. A p-value<0.05 has been considered statistically significant.

Results: We included 50 patients: five (10%) were classified as non-responders, fourteen (28%) as responders and thirty-one (62%) as super-responders. Pearson’s chi-square test revealed a statistically significant association between optimal therapeutic response and the absence of concomitant sleep disturbances (p < 0.001) across the three groups. Notably, when the analysis was restricted to responders and super-responders, the absence of sleep disorders remained significantly associated with an excellent response to mAbs (p < 0.001). A higher PSQI score, as a continuous variable, was significantly associated with responders in comparison to super-responders (p=0.004).

Conclusion: Our results show that a good sleep quality and the absence of SDs correlates with a good response to anti-CGRP mAbs. Moreover, a diagnosis of sleep disorder or a poor-quality sleep is more often observed in non-responders and partial responders.