Monti Jaime M, Monti Daniel
Department of Pharmacology and Therapeutics, Clinics Hospital, 2833/602 Zudanez Street, Montevideo 11300, Uruguay.
Sleep Med Rev. 2004 Apr;8(2):133-48. doi: 10.1016/S1087-0792(02)00158-2.
Insomnia is a common feature in schizophrenia. However, it seldom is the predominant complaint. Nevertheless, severe insomnia is often seen during exacerbations of schizophrenia, and may actually precede the appearance of other symptoms of relapse. The sleep disturbances of either never-medicated or previously treated schizophrenia patients are characterized by a sleep-onset and maintenance insomnia. In addition, stage 4 sleep, slow wave sleep (stages 3 and 4), non-REM (NREM) sleep in minutes and REM latency are decreased. The atypical antipsychotics olanzapine, risperidone, and clozapine significantly increase total sleep time and stage 2 sleep. Moreover, olanzapine and risperidone enhance slow wave sleep. On the other hand, the typical antipsychotics haloperidol, thiothixene, and flupentixol significantly reduce stage 2 sleep latency and increase sleep efficiency. Future research should address: (1) the sleep patterns in subtypes of schizophrenia patients; (2) the role of neurotransmitters other than dopamine in the disruption of sleep in schizophrenia; (3) the functional alterations in CNS areas related to the pathophysiology of schizophrenia during NREM sleep and REM sleep (brain imaging studies); (4) the short-term, intermediate-term, and long-term effects of atypical antisychotics on sleep variables.
失眠是精神分裂症的常见特征。然而，它很少是主要的主诉症状。尽管如此，严重失眠在精神分裂症病情加重时经常出现，实际上可能先于其他复发症状出现。未接受过药物治疗或之前接受过治疗的精神分裂症患者的睡眠障碍特征为入睡和维持性失眠。此外，第4期睡眠、慢波睡眠（第3和第4期）、非快速眼动（NREM）睡眠时长以及快速眼动潜伏期均缩短。非典型抗精神病药物奥氮平、利培酮和氯氮平可显著增加总睡眠时间和第2期睡眠时间。此外，奥氮平和利培酮可增强慢波睡眠。另一方面，典型抗精神病药物氟哌啶醇、硫利达嗪和三氟噻吨可显著缩短第2期睡眠潜伏期并提高睡眠效率。未来的研究应关注：（1）精神分裂症患者亚型的睡眠模式；（2）除多巴胺外的其他神经递质在精神分裂症睡眠障碍中的作用；（3）在非快速眼动睡眠和快速眼动睡眠期间，与精神分裂症病理生理学相关的中枢神经系统区域的功能改变（脑成像研究）；（4）非典型抗精神病药物对睡眠变量的短期、中期和长期影响。
