Matsui Kentaro, Takaesu Yoshikazu, Inoue Takeshi, Inada Ken, Nishimura Katsuji
Department of Psychiatry, Tokyo Women's Medical University.
Japan Somnology Center, Neuropsychiatric Research Institute.
Neuropsychiatr Dis Treat. 2017 May 19;13:1367-1371. doi: 10.2147/NDT.S136628. eCollection 2017.
Patients with non-24-hour sleep-wake rhythm disorder (N24SWD) exhibit a sleep pattern that is asynchronous with the external light-dark cycle, typically involving a cycling, relapsing-remitting pattern of sleep disturbances, including nighttime insomnia and daytime sleepiness. Here, we report the case of a patient with N24SWD comorbid with major depressive disorder, who was successfully treated with a low dose of aripiprazole.
A 47-year-old female presented with an 8-year complaint of difficulty falling asleep and waking up in the morning. The patient was diagnosed with major depressive disorder at the age of 35 years and was treated with various antidepressants since that time. At the age of 40 years, the patient's sleep-wake cycle began to extend without exacerbation of depressive symptoms. The patient was diagnosed with N24SWD at the age of 43 years. Ramelteon 8 mg/d and then melatonin 1 mg/d were administered, but these did not provide effective treatment. In January 2016, after treatment with aripiprazole 3 mg/d in the morning for 4 weeks, the patient's sleep-wake cycle became markedly synchronized to the environmental light-dark cycle. Her sleep-wake cycle remained synchronized when the same dose of aripiprazole was administered for at least 6 months.
Treatment-refractory asynchrony of the sleep-wake cycle in an N24SWD patient with depression was successfully treated with aripiprazole. Although the detailed mechanism of action is unclear, aripiprazole may be an appropriate treatment for patients with circadian rhythm sleep-wake disorders.
非24小时睡眠-觉醒节律障碍（N24SWD）患者表现出与外部昼夜明暗周期不同步的睡眠模式，通常包括睡眠障碍的周期性、复发-缓解模式，如夜间失眠和日间嗜睡。在此，我们报告1例合并重度抑郁症的N24SWD患者，该患者通过低剂量阿立哌唑成功治愈。
一名47岁女性，有8年入睡困难及早晨觉醒困难的主诉。该患者35岁时被诊断为重度抑郁症，自那时起接受多种抗抑郁药治疗。40岁时，患者的睡眠-觉醒周期开始延长，且抑郁症状未加重。43岁时，患者被诊断为N24SWD。先后给予8 mg/d雷美替胺及随后1 mg/d褪黑素治疗，但均未取得有效疗效。2016年1月，患者早晨服用3 mg/d阿立哌唑治疗4周后，其睡眠-觉醒周期与环境昼夜明暗周期明显同步。给予相同剂量阿立哌唑至少治疗6个月时，其睡眠-觉醒周期仍保持同步。
阿立哌唑成功治愈了1例合并抑郁症的N24SWD患者难治性的睡眠-觉醒周期不同步。虽然具体作用机制尚不清楚，但阿立哌唑可能是治疗昼夜节律性睡眠-觉醒障碍患者的一种合适药物。
