Riemann Dieter, Baglioni Chiara, Bassetti Claudio, Bjorvatn Bjørn, Dolenc Groselj Leja, Ellis Jason G, Espie Colin A, Garcia-Borreguero Diego, Gjerstad Michaela, Gonçalves Marta, Hertenstein Elisabeth, Jansson-Fröjmark Markus, Jennum Poul J, Leger Damien, Nissen Christoph, Parrino Liborio, Paunio Tiina, Pevernagie Dirk, Verbraecken Johan, Weeß Hans-Günter, Wichniak Adam, Zavalko Irina, Arnardottir Erna S, Deleanu Oana-Claudia, Strazisar Barbara, Zoetmulder Marielle, Spiegelhalder Kai
Department of Psychiatry and Psychotherapy, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany.
University Hospital for Neurology, Inselspital Bern, Bern, Switzerland.
J Sleep Res. 2017 Dec;26(6):675-700. doi: 10.1111/jsr.12594. Epub 2017 Sep 5.
This European guideline for the diagnosis and treatment of insomnia was developed by a task force of the European Sleep Research Society, with the aim of providing clinical recommendations for the management of adult patients with insomnia. The guideline is based on a systematic review of relevant meta-analyses published till June 2016. The target audience for this guideline includes all clinicians involved in the management of insomnia, and the target patient population includes adults with chronic insomnia disorder. The GRADE (Grading of Recommendations Assessment, Development and Evaluation) system was used to grade the evidence and guide recommendations. The diagnostic procedure for insomnia, and its co-morbidities, should include a clinical interview consisting of a sleep history (sleep habits, sleep environment, work schedules, circadian factors), the use of sleep questionnaires and sleep diaries, questions about somatic and mental health, a physical examination and additional measures if indicated (i.e. blood tests, electrocardiogram, electroencephalogram; strong recommendation, moderate- to high-quality evidence). Polysomnography can be used to evaluate other sleep disorders if suspected (i.e. periodic limb movement disorder, sleep-related breathing disorders), in treatment-resistant insomnia, for professional at-risk populations and when substantial sleep state misperception is suspected (strong recommendation, high-quality evidence). Cognitive behavioural therapy for insomnia is recommended as the first-line treatment for chronic insomnia in adults of any age (strong recommendation, high-quality evidence). A pharmacological intervention can be offered if cognitive behavioural therapy for insomnia is not sufficiently effective or not available. Benzodiazepines, benzodiazepine receptor agonists and some antidepressants are effective in the short-term treatment of insomnia (≤4 weeks; weak recommendation, moderate-quality evidence). Antihistamines, antipsychotics, melatonin and phytotherapeutics are not recommended for insomnia treatment (strong to weak recommendations, low- to very-low-quality evidence). Light therapy and exercise need to be further evaluated to judge their usefulness in the treatment of insomnia (weak recommendation, low-quality evidence). Complementary and alternative treatments (e.g. homeopathy, acupuncture) are not recommended for insomnia treatment (weak recommendation, very-low-quality evidence).
本欧洲失眠诊断与治疗指南由欧洲睡眠研究学会的一个特别工作组制定，旨在为成年失眠患者的管理提供临床建议。该指南基于对截至2016年6月发表的相关荟萃分析的系统评价。本指南的目标受众包括所有参与失眠管理的临床医生，目标患者群体为患有慢性失眠症的成年人。采用GRADE（推荐分级评估、制定和评价）系统对证据进行分级并指导推荐。失眠及其合并症的诊断程序应包括临床访谈，内容涵盖睡眠史（睡眠习惯、睡眠环境、工作时间表、昼夜节律因素）、使用睡眠问卷和睡眠日记、关于躯体和心理健康的问题、体格检查以及必要时的其他检查措施（如血液检查、心电图、脑电图；强烈推荐，中高质量证据）。如果怀疑存在其他睡眠障碍（如周期性肢体运动障碍、睡眠相关呼吸障碍）、难治性失眠、职业高危人群以及怀疑存在严重睡眠状态误判时，可使用多导睡眠图进行评估（强烈推荐，高质量证据）。推荐将失眠认知行为疗法作为任何年龄成年慢性失眠的一线治疗方法（强烈推荐，高质量证据）。如果失眠认知行为疗法效果不佳或无法实施，可采用药物干预。苯二氮䓬类药物、苯二氮䓬受体激动剂和一些抗抑郁药在失眠短期治疗（≤4周）中有效（弱推荐，中等质量证据）。不推荐使用抗组胺药、抗精神病药、褪黑素和植物疗法治疗失眠（从强到弱推荐，低到极低质量证据）。光照疗法和运动疗法在治疗失眠中的有效性需要进一步评估（弱推荐，低质量证据）。不推荐使用补充和替代疗法（如顺势疗法、针灸）治疗失眠（弱推荐，极低质量证据）。
