{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,27]],"date-time":"2026-07-27T09:07:49Z","timestamp":1785143269390,"version":"3.55.0"},"reference-count":74,"publisher":"MDPI AG","issue":"8","license":[{"start":{"date-parts":[[2026,7,27]],"date-time":"2026-07-27T00:00:00Z","timestamp":1785110400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Life"],"abstract":"<jats:p>Morning headaches (MHs) are a recognized but incompletely understood symptom in obstructive sleep apnea (OSA). Because symptoms and comorbidities that commonly coexist with OSA may influence both headache susceptibility and perceived sleep quality, the respective contributions of respiratory abnormalities and sleep disruption to MHs remain uncertain, particularly in women. We therefore aimed to identify clinical and sleep study factors associated with frequent MHs in patients with OSA. In this retrospective cohort study, 3227 adults with confirmed OSA evaluated between 2013 and 2023 were classified according to MH frequency (&lt;1 episode\/week vs. \u22651 episode\/week). Demographic, clinical, questionnaire and sleep study variables were analyzed using univariate and multivariable logistic regression. Frequent MHs were reported by 35.2% of patients. On univariate analysis, MHs were associated with female sex, higher body mass index and waist circumference, greater OSA severity, worse nocturnal oxygenation, fatigue, excessive daytime sleepiness, and insomnia symptoms. However, in multivariable analysis restricted to patients with complete polysomnographic data (N = 501), female sex (OR 4.23, 95% CI 1.39\u201312.85), waist circumference (OR 1.03, 95% CI 1.01\u20131.06), and arousal index (OR 1.05, 95% CI 1.01\u20131.08) emerged as independent predictors, whereas conventional respiratory severity indices did not. These findings suggest that sleep fragmentation, rather than OSA severity alone, may be a key determinant of MHs, particularly in women, underscoring the need for sex-specific approaches beyond apnea\u2013hypopnea index-based assessment.<\/jats:p>","DOI":"10.3390\/life16081239","type":"journal-article","created":{"date-parts":[[2026,7,27]],"date-time":"2026-07-27T08:15:56Z","timestamp":1785140156000},"page":"1239","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Morning Headaches as a Specific Obstructive Sleep Apnea Characteristic in a Large Sleep Clinic Population"],"prefix":"10.3390","volume":"16","author":[{"given":"Aliki","family":"Karkala","sequence":"first","affiliation":[{"name":"Center for Sleep and Wake Disorders (LUCS), University Hospitals Leuven Campus Gasthuisberg, Herestraat 49, 3000 Leuven, Belgium"},{"name":"Laboratory of Respiratory Disease and Thoracic Surgery (BREATHE), KU Leuven-University, Herestraat 49, 3000 Leuven, Belgium"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1740-6782","authenticated-orcid":false,"given":"Alexandros","family":"Kalkanis","sequence":"additional","affiliation":[{"name":"Center for Sleep and Wake Disorders (LUCS), University Hospitals Leuven Campus Gasthuisberg, Herestraat 49, 3000 Leuven, Belgium"},{"name":"Laboratory of Respiratory Disease and Thoracic Surgery (BREATHE), KU Leuven-University, Herestraat 49, 3000 Leuven, Belgium"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6092-1341","authenticated-orcid":false,"given":"Serafeim-Chrysovalantis","family":"Kotoulas","sequence":"additional","affiliation":[{"name":"Adult ICU, Ippokratio General Hospital of Thessaloniki, Konstantinoupoleos 49, 54642 Thessaloniki, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8701-6993","authenticated-orcid":false,"given":"\u015eakir Kaan","family":"\u00c7etinda\u011f","sequence":"additional","affiliation":[{"name":"Department of Biology, Leuven Brain Institute, KU Leuven, 3000 Leuven, Belgium"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7303-9799","authenticated-orcid":false,"given":"Dries","family":"Testelmans","sequence":"additional","affiliation":[{"name":"Center for Sleep and Wake Disorders (LUCS), University Hospitals Leuven Campus Gasthuisberg, Herestraat 49, 3000 Leuven, Belgium"},{"name":"Laboratory of Respiratory Disease and Thoracic Surgery (BREATHE), KU Leuven-University, Herestraat 49, 3000 Leuven, Belgium"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vasileios","family":"Paraschou","sequence":"additional","affiliation":[{"name":"Hellenic Police Medical Center, 54121 Thessaloniki, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2700-3976","authenticated-orcid":false,"given":"Dionisios","family":"Spyratos","sequence":"additional","affiliation":[{"name":"Pulmonary Department, Unit of Thoracic Malignancies Research, General Hospital of Thessaloniki \u201cGeorgios Papanikolaou\u201d, Aristotle University of Thessaloniki, Leoforos Papanikolaou Municipality of Chortiatis, 57010 Thessaloniki, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0001-2482-2127","authenticated-orcid":false,"given":"Dimitrios G.","family":"Raptis","sequence":"additional","affiliation":[{"name":"Cardiology Department, General Hospital of Thessaloniki \u201cGeorgios Papanikolaou\u201d, Leoforos Papanikolaou Municipality of Chortiatis, 57010 Thessaloniki, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7121-6253","authenticated-orcid":false,"given":"Paschalis","family":"Steiropoulos","sequence":"additional","affiliation":[{"name":"Department of Respiratory Medicine, Medical School, Democritus University of Thrace, University General Hospital Dragana, 68100 Alexandroupolis, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3252-6694","authenticated-orcid":false,"given":"Athanasia","family":"Pataka","sequence":"additional","affiliation":[{"name":"Respiratory Failure Clinic and Sleep Laboratory, General Hospital of Thessaloniki \u201cGeorgios Papanikolaou\u201d, Aristotle University of Thessaloniki, Leoforos Papanikolaou Municipality of Chortiatis, 57010 Thessaloniki, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,7,27]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"97","DOI":"10.1001\/archinte.164.1.97","article-title":"Prevalence and risk factors of morning headaches in the general population","volume":"164","author":"Ohayon","year":"2004","journal-title":"Arch. 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