Blackmer Allison Beck, Feinstein James A
Skaggs School of Pharmacy and Pharmaceutical Sciences, University of Colorado, Aurora, Colorado.
Department of Pharmacy/Special Care Clinic, Children's Hospital Colorado, Aurora, Colorado.
Pharmacotherapy. 2016 Jan;36(1):84-98. doi: 10.1002/phar.1686.
Neurodevelopmental disorders (NDDs) are defined as a group of disorders caused by changes in early brain development, resulting in behavioral and cognitive alterations in sensory and motor systems, speech, and language. NDDs affect approximately 1-2% of the general population. Up to 80% of children with NDDs are reported to have disrupted sleep; subsequent deleterious effects on daytime behaviors, cognition, growth, and overall development of the child are commonly reported. Examples of NDDs discussed in this review include autism spectrum disorder, cerebral palsy, Rett syndrome, Angelman syndrome, Williams syndrome, and Smith-Magenis syndrome. The etiology of sleep disorders in children with NDDs is largely heterogeneous and disease specific. The diagnosis and management of sleep disorders in this population are complex, and little high-quality data exist to guide a consistent approach to therapy. Managing sleep disorders in children with NDDs is critical both for the child and for the family but is often frustrating due to the refractory nature of the problem. Sleep hygiene must be implemented as first-line therapy; if sleep hygiene alone fails, it should be combined with pharmacologic management. The available evidence for the use of common pharmacologic interventions, such as iron supplementation and melatonin, as well as less common interventions, such as melatonin receptor agonists, clonidine, gabapentin, hypnotics, trazodone, and atypical antipsychotics is reviewed. Further, parents and caregivers should be provided with appropriate education on the nature of the sleep disorders and the expectation for modest pharmacologic benefit, at best. Additional data from well-designed trials in children with NDDs are desperately needed to gain a better understanding of sleep pharmacotherapy including efficacy and safety implications. Until then, clinicians must rely on the limited available data, as well as clinical expertise, when managing sleep disorders in the population of children with NDDs.
神经发育障碍（NDDs）被定义为一组由早期大脑发育变化引起的疾病，导致感觉和运动系统、言语及语言方面的行为和认知改变。NDDs影响着约1%-2%的普通人群。据报道，高达80%的NDDs儿童存在睡眠障碍；随后对儿童白天行为、认知、生长及整体发育产生的有害影响也屡见不鲜。本综述中讨论的NDDs实例包括自闭症谱系障碍、脑瘫、雷特综合征、天使综合征、威廉姆斯综合征和史密斯-马吉尼斯综合征。NDDs儿童睡眠障碍的病因在很大程度上具有异质性且因疾病而异。该人群睡眠障碍的诊断和管理较为复杂，几乎没有高质量数据可指导一致的治疗方法。管理NDDs儿童的睡眠障碍对儿童及其家庭都至关重要，但由于问题的难治性，往往令人沮丧。睡眠卫生必须作为一线治疗措施实施；如果仅靠睡眠卫生无效，则应与药物管理相结合。本文综述了使用常见药物干预措施（如补充铁剂和褪黑素）以及较少见干预措施（如褪黑素受体激动剂、可乐定、加巴喷丁、催眠药、曲唑酮和非典型抗精神病药物）的现有证据。此外，应向家长和护理人员提供关于睡眠障碍性质的适当教育，以及对适度药物疗效的期望，充其量也只能如此。迫切需要来自针对NDDs儿童的精心设计试验的更多数据，以更好地了解睡眠药物治疗，包括疗效和安全性影响。在此之前，临床医生在管理NDDs儿童人群的睡眠障碍时，必须依靠有限的现有数据以及临床专业知识。
