Mayo Center for Sleep Medicine, Rochester, Minnesota, USA.
Department of Neurology, Rochester, Minnesota, USA.
Neurotherapeutics. 2021 Jan;18(1):53-74. doi: 10.1007/s13311-021-01031-8. Epub 2021 Apr 12.
Circadian rhythms oscillate throughout a 24-h period and impact many physiological processes and aspects of daily life, including feeding behaviors, regulation of the sleep-wake cycle, and metabolic homeostasis. Misalignment between the endogenous biological clock and exogenous light-dark cycle can cause significant distress and dysfunction, and treatment aims for resynchronization with the external clock and environment. This article begins with a brief historical context of progress in the understanding of circadian rhythms, and then provides an overview of circadian neurobiology and the endogenous molecular clock. Various tools used in the diagnosis of circadian rhythm sleep-wake disorders, including sleep diaries and actigraphy monitoring, are then discussed, as are the therapeutic applications of strategically timed light therapy, melatonin, and other behavioral and pharmacological therapies including the melatonin agonist tasimelteon. Management strategies towards each major human circadian sleep-wake rhythm disorder, as outlined in the current International Classification of Sleep Disorders - Third Edition, including jet lag and shift work disorders, delayed and advanced sleep-wake phase rhythm disorders, non-24-h sleep-wake rhythm disorder, and irregular sleep-wake rhythm disorder are summarized. Last, an overview of chronotherapies and the circadian dysregulation of neurodegenerative diseases is reviewed.
昼夜节律在 24 小时内波动，影响许多生理过程和日常生活的各个方面，包括进食行为、睡眠-觉醒周期的调节和代谢稳态。内源性生物钟与外源性光-暗周期之间的失同步会导致明显的痛苦和功能障碍，治疗的目的是使生物钟和环境重新同步。本文首先简要介绍了对昼夜节律理解的历史进展，然后概述了昼夜节律的神经生物学和内源性分子钟。接着讨论了用于诊断昼夜节律睡眠-觉醒障碍的各种工具，包括睡眠日记和活动监测，以及光疗法、褪黑素和其他行为和药物治疗策略的治疗应用，包括褪黑素激动剂替马曲林。根据当前的《国际睡眠障碍分类-第三版》，总结了每种主要的人类昼夜睡眠-觉醒节律障碍的管理策略，包括时差和轮班工作障碍、睡眠-觉醒时相延迟和提前障碍、非 24 小时睡眠-觉醒节律障碍和不规则睡眠-觉醒节律障碍。最后，综述了时间治疗学和神经退行性疾病的昼夜节律失调。
