Department of Neurology, University of Minnesota Medical Center, Sleep Disorders Center, University of Minnesota, Minnesota, MN, USA.
Neurotherapeutics. 2012 Oct;9(4):753-75. doi: 10.1007/s13311-012-0143-8.
Parasomnias are abnormal behaviors emanating from or associated with sleep. Sleepwalking and related disorders result from an incomplete dissociation of wakefulness from nonrapid eye movement (NREM) sleep. Conditions that provoke repeated cortical arousals, or promote sleep inertia lead to NREM parasomnias by impairing normal arousal mechanisms. Changes in the cyclic alternating pattern, a biomarker of arousal instability in NREM sleep, are noted in sleepwalking disorders. Sleep-related eating disorder (SRED) is characterized by a disruption of the nocturnal fast with episodes of feeding after an arousal from sleep. SRED is often associated with the use of sedative-hypnotic medications; in particular, the widely prescribed benzodiazepine receptor agonists. Recently, compelling evidence suggests that nocturnal eating may in some cases be a nonmotor manifestation of Restless Legs Syndrome (RLS). rapid eye movement (REM) Sleep Behavior Disorder (RBD) is characterized by a loss of REM paralysis leading to potentially injurious dream enactment. The loss of atonia in RBD often predates the development of Parkinson's disease and other disorders of synuclein pathology. Parasomnia behaviors are related to an activation (in NREM parasomnias) or a disinhibition (in RBD) of central pattern generators (CPGs). Initial management should focus on decreasing the potential for sleep-related injury followed by treating comorbid sleep disorders. Clonazepam and melatonin appear to be effective therapies in RBD, whereas paroxetine has been reported effective in some cases of sleep terrors. At this point, pharmacotherapy for other parasomnias is less certain, and further investigations are necessary.
睡眠障碍是指睡眠过程中出现的各种异常行为或事件，通常与睡眠和觉醒状态的转换有关。梦游症和相关障碍是由于非快速眼动（NREM）睡眠期间觉醒与睡眠的不完全分离引起的。反复引起皮质唤醒或促进睡眠惯性的情况会通过损害正常唤醒机制导致 NREM 睡眠障碍。在梦游障碍中，注意到周期性交替模式（NREM 睡眠中唤醒不稳定的生物标志物）的变化。睡眠相关进食障碍（SRED）的特征是夜间快速被打断，在睡眠觉醒后出现进食发作。SRED 通常与镇静催眠药物的使用有关；特别是广泛使用的苯二氮䓬受体激动剂。最近，令人信服的证据表明，夜间进食在某些情况下可能是非运动性不安腿综合征（RLS）的表现。快速眼动（REM）睡眠行为障碍（RBD）的特征是 REM 麻痹丧失，导致潜在的伤害性梦境执行。RBD 中的弛缓丧失通常先于帕金森病和其他突触核蛋白病的发展。睡眠障碍行为与中央模式发生器（CPGs）的激活（在 NREM 睡眠障碍中）或去抑制（在 RBD 中）有关。初始管理应侧重于减少与睡眠相关的伤害的可能性，然后再治疗合并的睡眠障碍。氯硝西泮和褪黑素似乎对 RBD 有效，而帕罗西汀已被报道对某些睡眠恐怖症有效。目前，其他睡眠障碍的药物治疗尚不确定，需要进一步研究。
