Ferini-Strambi Luigi, Galbiati Andrea, Casoni Francesca, Salsone Maria
Department of Clinical Neurosciences, "Vita-Salute" San Raffaele University, Milan, Italy.
Department of Clinical Neurosciences, Neurology-Sleep Disorder Center, IRCCS San Raffaele Scientific Institute, Milan, Italy.
Curr Treat Options Neurol. 2020 Feb 5;22(2):4. doi: 10.1007/s11940-020-0612-z.
There is strong evidence for a bidirectional association between sleep disorders and Alzheimer's disease (AD). In particular, insomnia may be a potentially modifiable risk factor for AD. The present review summarizes recent advances in treatment of sleep disorders in AD.
Some studies investigated the efficacy and safety of hypnotic agents as ramelteon and mirtazapine to treat sleep disorders in AD but no significant therapeutic effects have been observed. Benzodiazepines are the most frequently used medication for treatment of insomnia but they may cause significant side effects in old subjects. Suvorexant, an orexin receptor antagonist, showed a positive effect on AD insomnia. Recent report suggests an association between trazodone use and delayed cognitive decline in AD. With respect to circadian rhythm disorders, non-pharmacological treatments, especially bright light therapy, could be useful and safe options for treatment in AD. Some pharmacological and non-pharmacological treatments might have benefits in AD patients with sleep disturbances, but further well-designed controlled trials are needed.
有充分证据表明睡眠障碍与阿尔茨海默病（AD）之间存在双向关联。特别是，失眠可能是AD一个潜在的可改变的风险因素。本综述总结了AD睡眠障碍治疗的最新进展。
一些研究调查了诸如雷美替胺和米氮平之类的催眠药物治疗AD睡眠障碍的疗效和安全性，但未观察到显著的治疗效果。苯二氮䓬类药物是治疗失眠最常用的药物，但它们可能在老年受试者中引起显著的副作用。食欲素受体拮抗剂苏沃雷生对AD失眠显示出积极作用。最近的报告表明使用曲唑酮与AD认知衰退延迟之间存在关联。关于昼夜节律障碍，非药物治疗，尤其是强光疗法，可能是AD治疗中有用且安全的选择。一些药物和非药物治疗可能对有睡眠障碍的AD患者有益，但需要进一步设计良好的对照试验。
