O'Donnell Joseph F
Dartmouth Medical School, Hanover, New Hampshire 03755, USA.
Clin Cornerstone. 2004;6 Suppl 1D:S6-14. doi: 10.1016/s1098-3597(05)80002-x.
Insomnia affects up to 50% of patients with cancer, but has received little attention from the oncology community compared with other symptoms such as pain and fatigue. Insomnia and subsequent sleep disturbances can lead to fatigue, mood disturbances, and contribute to immunosuppression, which can have a profound impact on quality of life and perhaps affect the course of disease. Insomnia in cancer patients must be distinguished from cancer-related fatigue. Although they are 2 distinct conditions, insomnia and fatigue are interrelated. Insomnia often leads to daytime fatigue that interferes with normal functioning. Conversely, daytime fatigue can lead to behaviors such as napping, which result in insomnia. The primary goal of insomnia treatment should first be to relieve any underlying disorder (eg, cancer pain, depression, anxiety) that may be causing the sleep disturbance. Because insomnia in this patient population may be due to a variety of causes, treatment must be multimodal and include both pharmacologic and nonpharmacologic therapies. A plan that combines attention to sleep hygiene and cognitive-behavioral therapy with prescription of hypnotic medications can help relieve the symptoms of insomnia in cancer patients and improve their quality of life.
高达50%的癌症患者受失眠影响，但与疼痛和疲劳等其他症状相比，肿瘤学界对其关注较少。失眠及随后的睡眠障碍可导致疲劳、情绪紊乱，并导致免疫抑制，这会对生活质量产生深远影响，甚至可能影响疾病进程。癌症患者的失眠必须与癌症相关疲劳区分开来。尽管它们是两种不同的情况，但失眠和疲劳相互关联。失眠常导致日间疲劳，干扰正常功能。相反，日间疲劳可导致诸如午睡等行为，进而导致失眠。失眠治疗的首要目标应是缓解可能导致睡眠障碍的任何潜在病症（如癌症疼痛、抑郁、焦虑）。由于该患者群体的失眠可能由多种原因引起，治疗必须是多模式的，包括药物治疗和非药物治疗。将关注睡眠卫生和认知行为疗法与催眠药物处方相结合的方案，有助于缓解癌症患者的失眠症状，提高其生活质量。
