Wichniak Adam, Jankowski Konrad S, Skalski Michał, 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):815-832. doi: 10.12740/PP/68918.
Circadian rhythm sleep-wake disorders (CRSWD) are a group of disorders, in which the timing of sleep and wakefulness significantly differs from a patient's expectations or socially acceptable times. The aimof the article is to present the current principles for the diagnosis and treatment of CRSWD in adults and children.
Guidelines proposed as CRSWD treatment standard are based on the recommendations from the scientific societies involved in the sleep research and medicine. Researchers participating in the guidelines preparation were invited by the Polish Sleep Research Society and the Section of Biological Psychiatry of the Polish Psychiatric Association based on their significant contribution to the circadian rhythm research and/or clinical experience in the treatment of these disorders. Finally, the guidelines were adjusted to the questions and comments given by the members of both Societies.
Patients with endogenous CRSWD are often misdiagnosed and treated for insomnia or hypersomnia. Therefore, each patient reporting sleep-wake disorders should be interviewed about the quality of sleep and its timing during free days (e.g. weekends, holidays). Avalid CRSWD diagnosis can be also established by using sleep diaries/logs and actigraphy. The treatment of choice for CRSWD is chronotherapy, which involves melatonin application, light therapy, and behavioral interventions. Sleep disorders associated with shift work and time zone changes are a growing health problem. Interventions for these disorders should primarily focus on prevention.
The main problem in the treatment of CRSWD is an invalid diagnosis. Hypnotics and/or psychostimulants are often used instead of chronotherapeutic interventions, what can alleviate symptoms but is not an effective treatment.
昼夜节律性睡眠-觉醒障碍（CRSWD）是一组疾病，其中睡眠和觉醒的时间与患者的期望或社会可接受的时间存在显著差异。本文的目的是介绍成人和儿童CRSWD诊断和治疗的当前原则。
作为CRSWD治疗标准提出的指南基于参与睡眠研究和医学的科学协会的建议。参与指南制定的研究人员由波兰睡眠研究协会和波兰精神病学协会生物精神病学分会邀请，基于他们对昼夜节律研究的重大贡献和/或这些疾病治疗的临床经验。最后，根据两个协会成员提出的问题和意见对指南进行了调整。
内源性CRSWD患者常被误诊为失眠或嗜睡并接受相应治疗。因此，每个报告睡眠-觉醒障碍的患者都应接受关于休息日（如周末、节假日）睡眠质量及其时间的询问。使用睡眠日记/日志和活动记录仪也可以做出有效的CRSWD诊断。CRSWD的首选治疗方法是时间疗法，包括褪黑素应用、光照疗法和行为干预。与轮班工作和时区变化相关的睡眠障碍是一个日益严重的健康问题。针对这些障碍的干预应主要侧重于预防。
CRSWD治疗的主要问题是诊断无效。催眠药和/或精神兴奋剂常被用于替代时间治疗干预，这可能会缓解症状，但不是有效的治疗方法。
