Afonso Pedro, Viveiros Vânia, Vinhas de Sousa Tiago
Centro Hospitalar Psiquiátrico de Lisboa, Lisboa, Portugal.
Acta Med Port. 2011 Dec;24 Suppl 4:799-806. Epub 2011 Dec 31.
Schizophrenia is often related with sleep disorders. In clinical practice insomnia is a common feature in schizophrenia. Difficulty falling asleep, maintaining or achieving a restful sleep is associated with symptoms severity and has been listed as a prodromal symptom of psychotic relapse. Sleep disturbances in schizophrenia may arise during the acute phase of illness and persists in many cases in chronic phase.
The authors intend to review the main sleep disturbances observed in schizophrenia, the possible pathophysiological mechanisms, their clinical impact, and the effects of antipsychotic medication on sleep architecture.
This study was carried out a systematic search of published literature from January 1965 to May 2010, through PubMed, using the following key words: sleep, REM sleep, NREM sleep, schizophrenia, polysomnography, actigraphy and antipsychotics.
Most changes found in objective studies using the polysomnography, in patients with schizophrenia are: reduction of total sleep time, decrease in slow wave sleep, REM latency and sleep efficiency. Studies using actigraphy also reveal that these patients experience changes in circadian rhythm sleep disorders, specifically the irregular type and phase advance. Although some sleep disorders improve with antipsychotic treatment, in many cases, even during the remission of the disease, sleep continues fragmented , suggesting that there are physiopathologic mechanisms involved in sleep disturbance in these patients.
Privation of adequate and restful sleep has a negative impact on rehabilitation strategies, quality of life of patients with schizophrenia, and may contribute to worsening of cognitive deficits.
精神分裂症常与睡眠障碍有关。在临床实践中，失眠是精神分裂症的常见特征。入睡困难、维持或获得安稳睡眠与症状严重程度相关，并被列为精神病复发的前驱症状。精神分裂症患者的睡眠障碍可能在疾病急性期出现，且在许多慢性期病例中持续存在。
作者旨在综述精神分裂症中观察到的主要睡眠障碍、可能的病理生理机制、它们的临床影响以及抗精神病药物对睡眠结构的影响。
本研究通过PubMed对1965年1月至2010年5月发表的文献进行系统检索，使用以下关键词：睡眠、快速眼动睡眠、非快速眼动睡眠、精神分裂症、多导睡眠图、活动记录仪和抗精神病药物。
使用多导睡眠图的客观研究发现，精神分裂症患者的大多数变化包括：总睡眠时间减少、慢波睡眠减少、快速眼动潜伏期缩短和睡眠效率降低。使用活动记录仪的研究还表明，这些患者存在昼夜节律睡眠障碍的变化，特别是不规则类型和相位提前。尽管一些睡眠障碍通过抗精神病治疗有所改善，但在许多情况下，即使在疾病缓解期，睡眠仍持续碎片化，这表明这些患者的睡眠障碍存在生理病理机制。
缺乏充足安稳的睡眠对康复策略、精神分裂症患者的生活质量有负面影响，且可能导致认知缺陷恶化。
