Bjorvatn Bjørn, Pallesen Ståle
Department of Public Health and Primary Health Care, University of Bergen, Kalfarveien 31, N-5018 Bergen, Norway.
Sleep Med Rev. 2009 Feb;13(1):47-60. doi: 10.1016/j.smrv.2008.04.009. Epub 2008 Oct 8.
Circadian rhythm sleep disorders are common in clinical practice. The disorders covered in this review are delayed sleep phase disorder, advanced sleep phase disorder, free-running, irregular sleep-wake rhythm, jet lag disorder and shift work disorder. Bright light treatment and exogenous melatonin administration are considered to be the treatments of choice for these circadian rhythm sleep disorders. Circadian phase needs to be estimated in order to time the treatments appropriately. Inappropriately timed bright light and melatonin will likely worsen the condition. Measurements of core body temperature or endogenous melatonin rhythms will objectively assess circadian phase; however, such measurements are seldom or never used in a busy clinical practice. This review will focus on how to estimate circadian phase based on a careful patient history. Based on such estimations of circadian phase, we will recommend appropriate timing of bright light and/or melatonin in the different circadian rhythm sleep disorders. We hope this practical approach and simple recommendations will stimulate clinicians to treat patients with circadian rhythm sleep disorders.
昼夜节律性睡眠障碍在临床实践中很常见。本综述涵盖的障碍包括睡眠时相延迟障碍、睡眠时相提前障碍、非24小时睡眠-觉醒周期障碍、不规则睡眠-觉醒节律障碍、时差反应障碍和倒班工作睡眠障碍。强光治疗和外源性褪黑素给药被认为是这些昼夜节律性睡眠障碍的首选治疗方法。为了使治疗时间合适，需要估计昼夜节律相位。时机不当的强光和褪黑素可能会使病情恶化。测量核心体温或内源性褪黑素节律将客观地评估昼夜节律相位；然而，在繁忙的临床实践中很少或根本不会使用这种测量方法。本综述将重点关注如何基于仔细的患者病史来估计昼夜节律相位。基于对昼夜节律相位的此类估计，我们将推荐在不同的昼夜节律性睡眠障碍中强光和/或褪黑素的合适给药时间。我们希望这种实用的方法和简单的建议能促使临床医生治疗昼夜节律性睡眠障碍患者。
