Mishima Kazuo
Department of Psychophysiology, National Institute of Mental Health, National Center for Neurology and Psychiatry.
Nihon Rinsho. 2013 Dec;71(12):2103-8.
Primary pathophysiology of circadian rhythm sleep disorders(CRSDs) is a misalignment between the endogenous circadian rhythm phase and the desired or socially required sleep-wake schedule, or dysfunction of the circadian pacemaker and its afferent/efferent pathways. CRSDs consist of delayed sleep phase type, advanced sleep phase type, free-running type, irregular sleep-wake type, shift work type and jet lag type. Chronotherapy using strong zeitgebers (time cues), such as bright light and melatonin/ melatonin type 2 receptor agonist, is effective when administered with proper timing. Bright light is the strongest entraining agent of circadian rhythms. Bright light therapy (appropriately-timed exposure to bright light) for CRSDs is an effective treatment option, and can shift the sleep-wake cycle to earlier or later times, in order to correct for misalignment between the circadian system and the desired sleep-wake schedule. Timed administration of melatonin, either alone or in combination with light therapy has also been shown to be useful in the treatment of CRSDs.
昼夜节律性睡眠障碍（CRSDs）的主要病理生理学是内源性昼夜节律相位与期望的或社会要求的睡眠-觉醒时间表之间的失调，或者是昼夜节律起搏器及其传入/传出通路的功能障碍。CRSDs包括睡眠时相延迟型、睡眠时相提前型、自由运行型、不规则睡眠-觉醒型、轮班工作型和时差型。使用强光和褪黑素/褪黑素2型受体激动剂等强时相因子（时间线索）进行时间疗法，在适当的时间给药时是有效的。强光 是昼夜节律最强的同步剂。针对CRSDs的强光疗法（在适当时间暴露于强光）是一种有效的治疗选择，并且可以将睡眠-觉醒周期提前或推迟，以纠正昼夜节律系统与期望的睡眠-觉醒时间表之间的失调。单独或与光疗联合定时给予褪黑素也已被证明对治疗CRSDs有用。
