Centre ChronoS, GHU Paris - Psychiatry Neurosciences, 1, rue Cabanis, 75014 Paris, France.
Centre ChronoS, GHU Paris - Psychiatry Neurosciences, 1, rue Cabanis, 75014 Paris, France; Département de psychiatrie et d'addictologie, DMU Neurosciences, GHU Paris Nord, hôpital Bichat-Claude-Bernard, AP-HP, 75018 Paris, France; Université Paris Cité, NeuroDiderot, Inserm U1141, 75019 Paris, France; CNRS UPR 3212, Institute for Cellular and Integrative Neurosciences, 5, rue Blaise-Pascal, 67000 Strasbourg, France.
Rev Neurol (Paris). 2023 Oct;179(7):767-781. doi: 10.1016/j.neurol.2023.08.008. Epub 2023 Aug 22.
Insomnia is more prevalent in neurological disorders compared to the general population, with rates ranging from 11 to 74.2% in neurodegenerative disorders, 20 to 37% in vascular diseases, 13.3 to 50% in inflammatory diseases, 28.9 to 74.4% in epilepsy, and nearly 70% in migraines. Insomnia in neurological disorders stems from a variety of factors, encompassing physical and neuropsychiatric factors, behavioral patterns, and disruptions in the biological clock and circadian rhythm. There are bidirectional connections between neurological disorders and insomnia. Insomnia in neurological disorders worsens symptoms, resulting in heightened depressive symptoms, elevated mortality rates, reduced quality of life, and intensified acute symptoms. Managing comorbid sleep disorders, especially in the presence of psychiatric comorbidities, is crucial. Cognitive behavioral therapy for insomnia (CBT-I) is the first-line recommendation for insomnia management in neurological disorders. Other treatments are second-line strategies. Melatonin may demonstrate effectiveness in addressing insomnia, with soporific and chronobiotic effects. Furthermore, it has the potential to alleviate "sundowning" and behavioral disturbances, while generally being well-tolerated. Other treatment options that may be of interest include morning bright light therapy, sedative antidepressants, new orexin dual antagonists and levodopa specifically indicated for Parkinson's disease. Benzodiazepines and z-drugs can be used primarily during acute phases to prevent pharmacotolerance and minimize side effects. However, they should be avoided in patients with neurological disorders and not used in patients over 75 years old due to the risk of falls and confusion. In neurological disorders, insomnia has a profound impact on daytime functioning, making its management crucial. Effective treatment can result in improved outcomes, and additional research is necessary to investigate alternative therapeutic options and enhance patient care.
失眠在神经障碍中比在普通人群中更为普遍，其发生率在神经退行性疾病中为 11%至 74.2%，在血管疾病中为 20%至 37%，在炎症性疾病中为 13.3%至 50%，在癫痫中为 28.9%至 74.4%，在偏头痛中接近 70%。神经障碍中的失眠源于多种因素，包括身体和神经精神因素、行为模式以及生物钟和昼夜节律的紊乱。神经障碍和失眠之间存在双向联系。神经障碍中的失眠会加重症状，导致抑郁症状加重、死亡率升高、生活质量降低和急性症状加剧。管理共病性睡眠障碍，特别是在存在精神共病的情况下，至关重要。失眠的认知行为疗法（CBT-I）是神经障碍中失眠管理的一线推荐。其他治疗方法是二线策略。褪黑素可能对失眠有效，具有催眠和昼夜节律作用。此外，它有可能缓解“日落症候群”和行为障碍，并且通常具有良好的耐受性。其他可能感兴趣的治疗选择包括早晨明亮光疗法、镇静性抗抑郁药、新型食欲素双重拮抗剂和专门用于帕金森病的左旋多巴。苯二氮䓬类和 Z 类药物主要可在急性期使用，以防止药物耐受并减少副作用。然而，由于跌倒和混乱的风险，它们应避免在神经障碍患者中使用，并且不应在 75 岁以上的患者中使用。在神经障碍中，失眠对日间功能有深远影响，因此管理至关重要。有效的治疗可以改善预后，并且需要进一步研究以探索替代治疗选择并改善患者护理。
