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[一种治疗阿尔茨海默病痴呆患者睡眠障碍的时间生物学方法]

[A chronobiological approach in treatment of sleep disturbances in Alzheimer's dementia patients].

作者信息

Doljansky Julia T, Dagan Yaron

机构信息

Institute for Sleep and Fatigue Medicine, the Chaim Sheba Medical Center, Tel Hashomer .

出版信息

Harefuah. 2006 Jun;145(6):437-40, 470.

Abstract

Alzheimer's dementia (AD) is a neurodegenerative disease that is often accompanied by severe sleep disturbances. The manifestation of the sleep disturbances is twofold: nighttime hyperarousal sometimes accompanied by irritability and agitation, and daytime excessive sleepiness. Thus, although treatment with sedatives or hypnotics may offer some relief to the nighttime hyperarousal, the daytime excessive sleepiness remains mostly unresolved. Recently, however, more promising results in relief of excessive daytime sleepiness, as well as nighttime hyperarousal, are offered by the chronobiological approach. This approach attributes the sleep problems of AD patients to a dysfunction in a broader neuronal mechanism, namely the biological clock, that paces various physiological functions, among which is the sleep-wake cycle. The biological clock, situated in the suprachiasmatic nuclei (SCN) of the hypothalamus, receives environmental light input via neuronal signals from the retina. The SCN, in turn, innervates the pineal gland, that is responsible for the production and release of melatonin. Light stimulus causes the attenuation of melatonin secretion from the pineal gland; whereas the cessation of light increases melatonin secretion. In diurnal mammals, the dim light melatonin onset (DLMO) is in accordance with sleep onset. The chronobiological approach offers two main treatments to the sleep problems in AD patients: morning exposure to bright light and evening administration of melatonin, both of which show at least moderate success in restoring the sleep-wake cycle in AD patients, that is more marked in the early stages of the disease.

摘要

阿尔茨海默病性痴呆(AD)是一种神经退行性疾病,常伴有严重的睡眠障碍。睡眠障碍的表现有两方面:夜间高度觉醒,有时伴有易怒和躁动,以及白天过度嗜睡。因此,尽管使用镇静剂或催眠药治疗可能会缓解夜间高度觉醒,但白天过度嗜睡大多仍未得到解决。然而,最近,时间生物学方法在缓解白天过度嗜睡以及夜间高度觉醒方面取得了更有希望的成果。这种方法将AD患者的睡眠问题归因于更广泛的神经元机制功能障碍,即生物钟,它调节各种生理功能,其中包括睡眠 - 觉醒周期。位于下丘脑视交叉上核(SCN)的生物钟通过来自视网膜的神经元信号接收环境光输入。反过来,SCN支配松果体,松果体负责褪黑素的产生和释放。光刺激会导致松果体褪黑素分泌减少;而光照停止则会增加褪黑素分泌。在昼行性哺乳动物中,暗光褪黑素起始(DLMO)与睡眠起始一致。时间生物学方法为AD患者的睡眠问题提供了两种主要治疗方法:早晨暴露于强光下和晚上服用褪黑素,这两种方法在恢复AD患者的睡眠 - 觉醒周期方面都至少取得了中度成功,在疾病早期更为明显。

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