Department of Pharmacology and Therapeutics, Clinics Hospital, Montevideo, 11600, Uruguay.
Prog Neuropsychopharmacol Biol Psychiatry. 2013 Jun 3;43:209-16. doi: 10.1016/j.pnpbp.2012.12.021. Epub 2013 Jan 11.
Sleep-onset and maintenance insomnia is a common symptom in schizophrenic patients regardless of either their medication status (drug-naive or previously treated) or the phase of the clinical course (acute or chronic). Regarding sleep architecture, the majority of studies indicate that non-rapid eye movement (NREM), N3 sleep and REM sleep onset latency are reduced in schizophrenia, whereas REM sleep duration tends to remain unchanged. Many of these sleep disturbances in schizophrenia appear to be caused by abnormalities of the circadian system as indicated by misalignments of the endogenous circadian cycle and the sleep-wake cycle. Circadian disruption, sleep onset insomnia and difficulties in maintaining sleep in schizophrenic patients could be partly related to a presumed hyperactivity of the dopaminergic system and dysfunction of the GABAergic system, both associated with core features of schizophrenia and with signaling in sleep and wake promoting brain regions. Since multiple neurotransmitter systems within the CNS can be implicated in sleep disturbances in schizophrenia, the characterization of the neurotransmitter systems involved remains a challenging dilemma.
睡眠起始和维持性失眠是精神分裂症患者的常见症状，无论其用药状态（未用药或以前用过药）或临床病程阶段（急性或慢性）如何。关于睡眠结构，大多数研究表明，非快速眼动（NREM）、N3 睡眠和 REM 睡眠潜伏期在精神分裂症中缩短，而 REM 睡眠持续时间往往保持不变。精神分裂症中的许多这些睡眠障碍似乎是由昼夜节律系统的异常引起的，这表现为内源性昼夜节律周期和睡眠-觉醒周期的不匹配。昼夜节律紊乱、入睡困难和维持睡眠困难在精神分裂症患者中可能部分与多巴胺能系统的过度活跃和 GABA 能系统的功能障碍有关，这两者都与精神分裂症的核心特征以及睡眠和觉醒促进大脑区域的信号有关。由于中枢神经系统内的多个神经递质系统可能与精神分裂症的睡眠障碍有关，因此涉及的神经递质系统的特征仍然是一个具有挑战性的难题。
