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[阿尔茨海默病及其他痴呆症中的睡眠障碍]

[Sleep disturbances in Alzheimer's disease and other dementias].

作者信息

Vecchierini Marie-Françoise

机构信息

Centre du sommeil et de la vigilance, Hôpital Hôtel-Dieu, Paris, France.

出版信息

Psychol Neuropsychiatr Vieil. 2010 Mar;8(1):15-23. doi: 10.1684/pnv.2010.0203.

Abstract

Sleep in dementias has been mainly studied in Alzheimer disease (AD). Sleep disturbances are found in 25 to 35% of subjects with AD. Subjective and objective disturbances are described. Long nocturnal awakenings disrupt sleep; total sleep time and sleep efficiency are reduced. Slow wave sleep is decreased and sometimes disappears. REM sleep percentage is also reduced and at a later stage of the disease, REM latency is increased. Sleep fragmentation can be associated with excessive daytime napping and sleepiness, and with other behavioral symptoms such as the sundowning syndrome and nocturnal agitation. Sleep abnormalities closely parallel the level of severity of dementia. The rest/activity ratio and the sleep-wake rhythms are more and more disturbed; the phase delay of the temperature rhythm is associated with the severity of the sundowning syndrome. Sleep disturbances and behavioral symptoms are the main reasons to institutionalize the patient. Sleep disturbances are related to multiple factors. Pathophysiological changes resulting of the disease itself, such as damage to the cholinergic pathways and to the circadian pacemaker in the suprachiasmatic nucleus, contribute to sleep changes in AD. Associated medical and psychiatric illness and their different treatments as well as environmental factors also induced sleep disturbances. Sleep-disordered breathing is a highly prevalent condition in AD patients and restless leg syndrome may account for nocturnal agitation. In Parkinson and in Lewy body dementias, sleep disturbances are more severe than in DA and REM sleep behavior disorder can precede by several years these diseases. Sleep attacks and sleepiness are very frequent in Parkinson disease. Specific etiologies should drive specific treatment. Several non pharmacologic treatments are usually associated to treat sleep disturbances in AD: information, increased daytime physical, social activities to minimize daytime naps and exposure to bright light. Some studies found advantages to associate melatonin in the evening.

摘要

痴呆症患者的睡眠情况主要是在阿尔茨海默病(AD)中进行研究的。25%至35%的AD患者存在睡眠障碍。主观和客观睡眠障碍均有描述。夜间长时间觉醒会扰乱睡眠;总睡眠时间和睡眠效率降低。慢波睡眠减少,有时甚至消失。快速眼动(REM)睡眠百分比也降低,且在疾病后期,REM潜伏期延长。睡眠片段化可能与白天过度小睡和嗜睡有关,也与日落综合征和夜间躁动等其他行为症状有关。睡眠异常与痴呆症的严重程度密切相关。休息/活动比例和睡眠-觉醒节律越来越紊乱;体温节律的相位延迟与日落综合征的严重程度有关。睡眠障碍和行为症状是患者被送入机构照料的主要原因。睡眠障碍与多种因素有关。疾病本身导致的病理生理变化,如胆碱能通路和视交叉上核中的昼夜节律起搏器受损,会导致AD患者的睡眠发生改变。相关的内科和精神疾病及其不同治疗方法以及环境因素也会引发睡眠障碍。睡眠呼吸障碍在AD患者中非常普遍,不安腿综合征可能是夜间躁动的原因。在帕金森病和路易体痴呆中,睡眠障碍比AD更严重,REM睡眠行为障碍可能在这些疾病出现前数年就已发生。帕金森病中睡眠发作和嗜睡非常常见。特定病因应采用特定治疗方法。通常会采用多种非药物治疗方法来治疗AD患者的睡眠障碍:提供信息、增加白天的体育和社交活动以尽量减少白天小睡以及接受强光照射。一些研究发现晚上联合使用褪黑素具有优势。

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