Wyatt James K
Sleep Disorders Service and Research Center, Rush University Medical Center, Chicago, IL 60612-3833, USA.
Sleep. 2004 Sep 15;27(6):1195-203. doi: 10.1093/sleep/27.6.1195.
This paper presents a comprehensive review of delayed sleep phase syndrome (DSPS), a circadian-rhythm sleep disorder thought to result from the endogenous circadian pacemaker being "stuck" at a later-than-normal phase, relative to the desired sleep-wake schedule. A full understanding of this disorder is best appreciated from the context of shared modulation of sleep and wakefulness via sleep homeostatic and circadian systems. Typically emerging during adolescence, DSPS comes to clinical attention much less often than prevalence estimates would suggest, perhaps due to underrecognition by clinicians and misattribution of symptoms. Several treatment modalities have been suggested, including phototherapy, chronotherapy, and exogenous melatonin administration. However, caution is raised for the reason that more than 20 years after its initial description in the literature, the basic pathophysiology of DSPS remains poorly understood, as observed in the 2003 National Sleep Disorders Research Plan. Challenges for future research include elucidating the exact sleep homeostatic and circadian contributions to the disorder, improving the objective verification of this diagnosis instead of relying only on self-report information, and conducting treatment research aimed at determining efficacy, effectiveness, and mechanism or mechanisms of action.
本文对延迟睡眠相位综合征(DSPS)进行了全面综述,这是一种昼夜节律性睡眠障碍,被认为是由于内源性昼夜节律起搏器相对于期望的睡眠-觉醒时间表“停滞”在比正常时间更晚的阶段所致。从通过睡眠稳态和昼夜节律系统对睡眠和觉醒进行共同调节的背景下,能最好地全面理解这种障碍。DSPS通常在青春期出现,其临床关注度远低于患病率估计,这可能是由于临床医生认识不足以及症状的错误归因。已经提出了几种治疗方法,包括光疗、时间疗法和外源性褪黑素给药。然而,需要谨慎的是,正如2003年《国家睡眠障碍研究计划》中所指出的,自该病症在文献中首次被描述20多年后,DSPS的基本病理生理学仍知之甚少。未来研究面临的挑战包括阐明睡眠稳态和昼夜节律对该病症的确切影响,改进该诊断的客观验证方法,而不是仅依赖自我报告信息,以及开展旨在确定疗效、有效性和作用机制的治疗研究。