Wallace Douglas M, Wohlgemuth William K, Trotti Lynn Marie, Amara Amy W, Malaty Irene A, Factor Stewart A, Nallu Sagarika, Wittine Lara, Hauser Robert A
Department of Neurology, Sleep Medicine Division University of Miami Miller School of Medicine Miami FL USA.
Neurology Service Bruce W. Carter Department of Veterans Affairs Medical Center Miami FL USA.
Mov Disord Clin Pract. 2020 Feb 3;7(3):250-266. doi: 10.1002/mdc3.12899. eCollection 2020 Apr.
Insomnia is one of the most common nonmotor features of Parkinson's disease (PD). However, there are few practical guidelines for providers on how to best evaluate and treat this problem.
This review was developed to provide clinicians with a pragmatic approach to assessing and managing insomnia in PD. Recommendations were based on literature review and expert opinion. We addressed the following topics in this review: prevalence of insomnia in PD, sleep-wake mechanisms, theoretical models of insomnia, risk factors, assessment, pharmacologic and nonpharmacologic treatments. Insomnia treatment choices may be guided by PD severity, comorbidities, and patient preference. However, there is limited evidence supporting pharmacotherapy and nonpharmacologic treatments of insomnia in PD.
We provide a pragmatic algorithm for evaluating and treating insomnia in PD based on the literature and our clinical experience. We propose personalized insomnia treatment approaches based on age and other issues. Gaps in the existing literature and future directions in the treatment of insomnia in PD are also highlighted.
失眠是帕金森病（PD）最常见的非运动症状之一。然而，对于医疗服务提供者而言，关于如何最佳评估和治疗这一问题的实用指南却很少。
本综述旨在为临床医生提供一种评估和管理帕金森病患者失眠问题的实用方法。建议基于文献综述和专家意见。我们在本综述中探讨了以下主题：帕金森病患者失眠的患病率、睡眠-觉醒机制、失眠的理论模型、危险因素、评估、药物治疗和非药物治疗。失眠治疗的选择可能受帕金森病严重程度、合并症和患者偏好的指导。然而，支持帕金森病患者失眠药物治疗和非药物治疗的证据有限。
我们根据文献和临床经验提供了一种评估和治疗帕金森病患者失眠的实用算法。我们提出了基于年龄和其他因素的个性化失眠治疗方法。同时也强调了现有文献中的空白以及帕金森病失眠治疗的未来方向。
