College of Medicine, Atal Bihari Vajpayee Institute of Medical Sciences & Dr Ram Manohar Lohia Hospital New Delhi, Delhi, India.
University College of Medical Sciences, University of Delhi, New Delhi, India.
Expert Rev Neurother. 2023 Jun;23(6):501-514. doi: 10.1080/14737175.2023.2214316. Epub 2023 Jun 2.
Alzheimer's disease (AD) is one of the most common neurodegenerative disorders among the older population. Sleep disruption and circadian rhythm disorders often develop in AD patients, and many experience sleeping difficulties requiring pharmacological and non-pharmacological interventions.
This review appraised the evidence from clinical studies on various pharmacological and non-pharmacological therapies for sleep disturbances in AD patients and proposed an algorithm to manage sleep disturbances in this population of patients.
Non-pharmacological interventions are generally preferred as the first-line approach to improve sleep-related symptoms in AD due to their favorable safety profile. However, when non-pharmacological interventions alone are insufficient, a range of pharmacological agents can be considered. Trazodone and melatonin are commonly used as adjunctive therapies, while Z-drugs including zopiclone and zolpidem are specifically employed to treat insomnia in patients with late-onset AD. Furthermore, a newer class of agents known as dual orexin receptor antagonists has emerged and gained approval for improving sleep onset and maintenance in AD patients.
阿尔茨海默病（AD）是老年人中最常见的神经退行性疾病之一。睡眠中断和昼夜节律紊乱常在 AD 患者中出现，许多患者经历睡眠困难，需要药物和非药物干预。
本综述评估了针对 AD 患者睡眠障碍的各种药物和非药物治疗的临床研究证据，并提出了管理该患者人群睡眠障碍的算法。
由于非药物干预具有良好的安全性，因此通常首选作为改善 AD 相关睡眠症状的一线治疗方法。然而，当非药物干预单独使用不足时，可以考虑一系列药物治疗。曲唑酮和褪黑素通常作为辅助治疗药物使用，而 Z 类药物（包括佐匹克隆和唑吡坦）则专门用于治疗晚发性 AD 患者的失眠症。此外，一种新的双食欲素受体拮抗剂类药物已经出现并获得批准，可改善 AD 患者的入睡和维持睡眠。
