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神经疾病中的失眠

Insomnia in neurological diseases.

作者信息

Mayer Geert, Happe Svenja, Evers Stefan, Hermann Wiebke, Jansen Sabine, Kallweit Ulf, Muntean Maria-Lucia, Pöhlau Dieter, Riemann Dieter, Saletu Michael, Schichl Melanie, Schmitt Wolfgang J, Sixel-Döring Friederike, Young Peter

机构信息

Neurologische Abteilung der Hephata-Klinik, Schimmelpfengstrasse 6, 34613, Schwalmstadt-Treysa, Germany.

Neurologische Abteilung der Philipps-Universität Marburg, Mamburg, Germany.

出版信息

Neurol Res Pract. 2021 Mar 10;3(1):15. doi: 10.1186/s42466-021-00106-3.

Abstract

Insomnia is defined as difficulties of initiating and maintaining sleep, early awakening and poor subjective sleep quality despite adequate opportunity and circumstances for sleep with impairment of daytime performance. These components of insomnia - namely persistent sleep difficulties despite of adequate sleep opportunity resulting in daytime dysfunction - appear secondary or co-morbid to neurological diseases. Comorbid insomnia originates from neurodegenerative, inflammatory, traumatic or ischemic changes in sleep regulating brainstem and hypothalamic nuclei with consecutive changes of neurotransmitters. Symptoms of neurological disorders (i.e motor deficits), co-morbidities (i.e. pain, depression, anxiety) and some disease-specific pharmaceuticals may cause insomnia and/or other sleep problems.This guideline focuses on insomnias in headaches, neurodegenerative movement disorders, multiple sclerosis, traumatic brain injury, epilepsies, stroke, neuromuscular disease and dementia.The most important new recommendations are: Cognitive behavioral therapy (CBTi) is recommended to treat acute and chronic insomnia in headache patients. Insomnia is one of the most frequent sleep complaints in neurodegenerative movement disorders. Patients may benefit from CBTi, antidepressants (trazodone, doxepin), melatonin and gaba-agonists. Insomnia is a frequent precursor of MS symptoms by up to 10 years. CBTi is recommended in patients with MS, traumatic brain injury and. Melatonin may improve insomnia symptoms in children with epilepsies. Patients with insomnia after stroke can be treated with benzodiazepine receptor agonists and sedating antidepressants. For patients with dementia suffering from insomnia trazodone, light therapy and physical exercise are recommended.

摘要

失眠的定义为尽管有充足的睡眠机会和条件,但仍存在入睡困难、维持睡眠困难、早醒以及主观睡眠质量差,并伴有日间功能受损。失眠的这些表现——即尽管有充足的睡眠机会但仍持续存在睡眠困难并导致日间功能障碍——在神经系统疾病中似乎是继发性的或共病的。共病性失眠源于调节睡眠的脑干和下丘脑核团的神经退行性、炎症性、创伤性或缺血性变化,以及随之而来的神经递质变化。神经系统疾病的症状(如运动功能缺损)、共病(如疼痛、抑郁、焦虑)以及一些特定疾病的药物可能会导致失眠和/或其他睡眠问题。本指南聚焦于头痛、神经退行性运动障碍、多发性硬化症、创伤性脑损伤、癫痫、中风、神经肌肉疾病和痴呆中的失眠。最重要的新建议如下:推荐认知行为疗法(CBTi)治疗头痛患者的急性和慢性失眠。失眠是神经退行性运动障碍中最常见的睡眠主诉之一。患者可能从CBTi、抗抑郁药(曲唑酮、多塞平)、褪黑素和γ-氨基丁酸激动剂中获益。失眠是多发性硬化症症状出现前长达10年的常见先兆。推荐对多发性硬化症、创伤性脑损伤患者采用CBTi。褪黑素可能改善癫痫患儿的失眠症状。中风后失眠的患者可用苯二氮䓬受体激动剂和镇静性抗抑郁药治疗。对于患有失眠的痴呆患者,推荐使用曲唑酮、光照疗法和体育锻炼。

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