Schwartz Jonathan R L
Integris Sleep Disorders Center of Oklahoma, Oklahoma City, OK 73109, USA.
J Clin Psychiatry. 2004;65 Suppl 16:46-9.
Excessive daytime sleepiness and abnormal sleep-wake patterns are becoming increasingly pervasive in modern society. The major causes of excessive daytime sleepiness include pathologic abnormalities of the central nervous system, such as narcolepsy and idiopathic hypersomnia; deficiencies in quality or quantity of sleep, such as those caused by sleep apnea and poor sleep hygiene; disturbances to the body's natural circadian rhythm, such as those caused by shift work or jet lag; and drugs, which can increase sleepiness either therapeutically or as a side effect. Determining the cause of daytime sleepiness is the first step in treating it. Setting appropriate and realistic treatment goals with the patient and initiating treatment are the next steps. Although the medications available to improve daytime wakefulness (e.g., amphetamines, methylphenidate, pemoline, and modafinil) are effective, they are not a substitute for sleep. Finally, timely follow-up is necessary to monitor treatment adherence, response, and side effects.
白天过度嗜睡和异常的睡眠-觉醒模式在现代社会中越来越普遍。白天过度嗜睡的主要原因包括中枢神经系统的病理异常，如发作性睡病和特发性嗜睡症；睡眠质量或数量不足，如由睡眠呼吸暂停和不良睡眠卫生习惯引起的情况；身体自然昼夜节律的紊乱，如由轮班工作或时差反应引起的情况；以及药物，药物可通过治疗作用或作为副作用增加嗜睡感。确定白天嗜睡的原因是治疗的第一步。与患者设定适当且现实的治疗目标并开始治疗是接下来的步骤。尽管可用于改善白天清醒状态的药物（如苯丙胺、哌甲酯、匹莫林和莫达非尼）是有效的，但它们不能替代睡眠。最后，需要及时随访以监测治疗依从性、反应和副作用。
