Krystal Andrew D, Prather Aric A, Ashbrook Liza H
Department of Psychiatry, University of California San Francisco School of Medicine, San Francisco, CA, USA.
Department of Neurology, University of California San Francisco School of Medicine, San Francisco, CA, USA.
World Psychiatry. 2019 Oct;18(3):337-352. doi: 10.1002/wps.20674.
Insomnia poses significant challenges to public health. It is a common condition associated with marked impairment in function and quality of life, psychiatric and physical morbidity, and accidents. As such, it is important that effective treatment is provided in clinical practice. To this end, this paper reviews critical aspects of the assessment of insomnia and the available treatment options. These options include both non-medication treatments, most notably cognitive behavioral therapy for insomnia, and a variety of pharmacologic therapies such as benzodiazepines, "z-drugs", melatonin receptor agonists, selective histamine H1 antagonists, orexin antagonists, antidepressants, antipsychotics, anticonvulsants, and non-selective antihistamines. A review of the available research indicates that rigorous double-blind, randomized, controlled trials are lacking for some of the most commonly administered insomnia therapies. However, there are an array of interventions which have been demonstrated to have therapeutic effects in insomnia in trials with the above features, and whose risk/benefit profiles have been well characterized. These interventions can form the basis for systematic, evidence-based treatment of insomnia in clinical practice. We review this evidence base and highlight areas where more studies are needed, with the aim of providing a resource for improving the clinical management of the many patients with insomnia.
失眠给公众健康带来了重大挑战。它是一种常见病症，与功能和生活质量的显著受损、精神和身体疾病以及事故相关。因此，在临床实践中提供有效的治疗至关重要。为此，本文回顾了失眠评估的关键方面以及现有的治疗选择。这些选择包括非药物治疗，最显著的是失眠认知行为疗法，以及多种药物疗法，如苯二氮䓬类药物、“Z 类药物”、褪黑素受体激动剂、选择性组胺 H1 拮抗剂、食欲素拮抗剂、抗抑郁药、抗精神病药、抗惊厥药和非选择性抗组胺药。对现有研究的综述表明，一些最常用的失眠治疗方法缺乏严格的双盲、随机、对照试验。然而，在具有上述特征的试验中，有一系列干预措施已被证明对失眠有治疗效果，并且其风险/效益概况已得到充分描述。这些干预措施可构成临床实践中对失眠进行系统的、循证治疗的基础。我们回顾了这一证据基础，并强调了需要更多研究的领域，旨在为改善众多失眠患者的临床管理提供资源。
