巨乳症女性头颈部疼痛与阻塞性睡眠呼吸暂停的模式：一项横断面分析

文献信息

中文摘要

目的/背景： 症状性巨乳症，即乳房肥大，与肌肉骨骼和神经系统症状相关，包括头痛和颈部疼痛。尽管保险公司将头痛列为乳房缩小手术的指征，但其与特定头痛表型、颈部疼痛疾病和睡眠相关疾病的关系仍知之甚少。我们的目的是评估巨乳症与慢性偏头痛、颈部疼痛、颈神经根病、枕神经痛和阻塞性睡眠呼吸暂停（OSA）之间的潜在关系，并评估在学术神经科实践中影响接受缩乳术治疗可能性的因素。
方法： 我们通过回顾2017年1月1日至2024年12月31日在学术神经科实践机构接受治疗的被诊断和未被诊断巨乳症的女性病历（使用国际疾病分类第十版代码N62，乳房肥大），进行了一项有和无巨乳症女性的回顾性横断面研究。使用倾向性匹配按年龄、种族-民族和体重指数（BMI）对组进行匹配。在两组中，我们分析了慢性偏头痛、颈部疼痛、颈神经根病、枕神经痛和OSA的诊断代码。主要结局是巨乳症女性与对照组中查询的颅颈疼痛疾病（例如慢性偏头痛、颈部疼痛、枕神经痛和颈神经根病）的患病率。对于次要结局，我们按颅颈诊断代码类型检查了巨乳症女性中OSA的患病率和缩乳术的比率。
结果： 我们识别了347名巨乳症女性和340名匹配对照。匹配后平均BMI（28.0 [SD=6.7] vs. 26.5 [SD=6.5] kg/m2，标准化均数差=0.194）、抑郁（48.4% vs. 29.7%，p<0.001）和焦虑（57.3% vs. 32.9%，p<0.001）仍存在差异。在调整BMI、人口统计学和共病情绪障碍后，与对照组相比，巨乳症女性的慢性偏头痛（aPR=1.40；95% CI=1.16-1.68，p=0.003）、颈部疼痛（aPR=2.04；95% CI=1.65-2.53，p=0.003）、颈神经根病（aPR=2.38；95% CI=1.39-4.06，p=0.026）和OSA（aPR=1.54；95% CI=1.23-1.95，p=0.003）的调整患病率比（aPRs）显著更高，但枕神经痛（aPR=1.54；95% CI=0.98-2.39，p=0.054）无显著差异。在巨乳症女性中，只有那些有颈部疼痛的女性更可能接受缩乳术。
结论： 在我们的回顾性横断面研究中，与无巨乳症的女性相比，巨乳症女性慢性偏头痛、颈部疼痛、颈神经根病和OSA的患病率更高。有巨乳症和颈部疼痛的女性比无颈部疼痛的巨乳症女性更可能接受乳房缩小手术。需要前瞻性纵向研究来阐明驱动巨乳症对偏头痛和其他疾病影响的潜在机制，并评估巨乳症治疗对头痛结局的影响。

英文摘要

OBJECTIVES/BACKGROUND: Symptomatic macromastia, or breast hypertrophy, is associated with musculoskeletal and neurological symptoms, including headache and neck pain. Though insurers list headache as an indication for breast reduction surgery, its relationship to specific headache phenotypes, neck pain disorders, and sleep-related disorders remains poorly understood. Our objectives were to evaluate the potential relationship between macromastia and chronic migraine, neck pain, cervical radiculopathy, occipital neuralgia, and obstructive sleep apnea (OSA), and to assess factors that influence the likelihood of treatment with reduction mammoplasty in an academic neurology practice.
METHODS: We conducted a retrospective cross-sectional study of women with and without macromastia by reviewing the charts of women with and without diagnosed macromastia (using the International Classification of Diseases, Tenth Revision code N62, hypertrophy of the breast) treated at an academic neurology practice from January 1, 2017, to December 31, 2024. Groups were matched on age, race-ethnicity, and body mass index (BMI) using propensity matching. In both groups, we analyzed diagnostic codes for chronic migraine, neck pain, cervical radiculopathy, occipital neuralgia, and OSA. The primary outcome was the prevalence of queried craniocervical pain disorders (e.g., chronic migraine, neck pain, occipital neuralgia, and cervical radiculopathy) in women with macromastia versus controls. For our secondary outcome, we examined the prevalence of OSA and rates of reduction mammoplasty in women with macromastia by type of craniocervical diagnostic code.
RESULTS: We identified 347 women with macromastia and 340 matched controls. Postmatch differences remained for mean BMI (28.0 [SD = 6.7] vs. 26.5 [SD = 6.5] kg/m2, standardized mean difference = 0.194), depression (48.4% vs. 29.7%, p < 0.001), and anxiety (57.3% vs. 32.9%, p < 0.001). After adjusting for BMI, demographics, and comorbid mood disorders, women with macromastia had significantly higher adjusted prevalence ratios (aPRs) for chronic migraine (aPR = 1.40; 95% CI = 1.16-1.68, p = 0.003), neck pain (aPR = 2.04; 95% CI = 1.65-2.53, p = 0.003), cervical radiculopathy (aPR = 2.38; 95% CI = 1.39-4.06, p = 0.026), and OSA (aPR = 1.54; 95% CI = 1.23-1.95, p = 0.003), but not occipital neuralgia (aPR = 1.54; 95% CI = 0.98-2.39, p = 0.054), compared to controls. Among women with macromastia, only those with neck pain were more likely to undergo reduction mammoplasty.
CONCLUSION: In our retrospective, cross-sectional study, compared to women without macromastia, women with macromastia had a higher prevalence of chronic migraine, neck pain, cervical radiculopathy, and OSA. Women with macromastia and neck pain were more likely to have breast reduction surgery compared to women with macromastia without neck pain. Prospective, longitudinal studies are needed to clarify potential mechanisms driving macromastia's impact on migraine and other disorders and to assess the impact of macromastia treatment on headache outcomes.