Wichniak Adam, Jankowski Konrad S, Skalski Michal, Skwarło-Sońta Krystyna, Zawilska Jolanta B, Żarowski Marcin, Poradowska Ewa, Jernajczyk Wojciech
III Klinika Psychiatryczna i Ośrodek Medycyny Snu IPiN w Warszawie.
Wydział Psychologii UW.
Psychiatr Pol. 2017 Oct 29;51(5):793-814. doi: 10.12740/PP/OnlineFirst/66810.
Majority of the physiological processes in the human organism are rhythmic. The most common are the diurnal changes that repeat roughly every 24 hours, called circadian rhythms. Circadian rhythms disorders have negative influence on human functioning. The aim of this article is to present the current understanding of the circadian rhythms physiological role, with particular emphasis on the circadian rhythm sleep-wake disorders (CRSWD), principles of their diagnosis and chronobiological therapy. The guidelines are based on the review of recommendations from the scientific societies involved in sleep medicine and the clinical experiences of the authors. Researchers participating in the preparation of guidelines were invited by the Polish Sleep Research Society and the Section of Biological Psychiatry of the Polish Psychiatric Association, based on their significant contributions in circadian rhythm research and/or clinical experience in the treatment of such disorders. Finally, the guidelines were adjusted to the questions and comments given by the members of both Societies. CRSWD have a significant negative impact on human health and functioning. Standard methods used to assess CRSWD are sleep diaries and sleep logs, while the actigraphy, when available, should be also used. The most effective methods of CRSWD treatment are melatonin administration and light therapy. Behavioral interventions are also recommended. Afourteen-day period of sleep-wake rhythm assessment in CRSWD enables accurate diagnosis, adequate selection of chronobiological interventions, and planning adequate diurnal timing of their application. This type of assessment is quite easy, low-cost, and provides valuable indications how to adjust the therapeutic approach to the circadian phase of the particular patient.
人体生理过程大多具有节律性。最常见的是大约每24小时重复一次的昼夜变化，称为昼夜节律。昼夜节律紊乱会对人体机能产生负面影响。本文旨在介绍目前对昼夜节律生理作用的认识，特别强调昼夜节律性睡眠-觉醒障碍（CRSWD）、其诊断原则和时间生物学疗法。这些指南基于对睡眠医学领域科学学会的建议以及作者临床经验的综述。参与指南编写的研究人员由波兰睡眠研究学会和波兰精神病学协会生物精神病学分会邀请，基于他们在昼夜节律研究中的重大贡献和/或治疗此类疾病的临床经验。最后，根据两个学会成员提出的问题和意见对指南进行了调整。CRSWD对人类健康和机能有重大负面影响。用于评估CRSWD的标准方法是睡眠日记和睡眠记录，如有条件，也应使用活动记录仪。CRSWD最有效的治疗方法是服用褪黑素和光疗。也推荐行为干预。对CRSWD进行为期14天的睡眠-觉醒节律评估，有助于准确诊断、合理选择时间生物学干预措施，并规划其应用的适当昼夜时间。这种评估相当简单、成本低，并能提供有价值的指示，说明如何根据特定患者的昼夜节律阶段调整治疗方法。
