治疗昼夜节律失调性睡眠障碍的研究进展

光照治疗和应用外源性褪黑素是近几年治疗昼夜节律失调性睡眠障碍的研究热点,然而不恰当的治疗时间不但不能缓解病情反而使病情加重,所以正确评估睡眠时相是决定治疗时间的前提。目前测量核心体温和掌握人在睡眠时内源性褪黑素的释放曲线是评估睡眠时相的主要手段,由于临床工作繁忙,这些方法很少被应用。本文将介绍一种评估睡眠时相的简便方法,以及用光照和褪黑素治疗最具代表性的昼夜节律失调性睡眠障碍,即睡眠时相延迟综合征和睡眠时相提前综合征,对其理论基础和研究进展进行综述。

Bright light treatment and exogenous melatonin administration are considered to be the treatments of choice for these circadian rhythm sleep disorders recently. Inappropriately timed treatments not only cannot release the disease but likely worsen the condition. So circadian phase needs to be estimated in order to time the treatments appropriately. Measurements of core body temperature or endogenous melatonin rhythms will objectively assess circadian phase; However, such measurements are seldom or never used in a busy clinical practice. This review will focus on how to estimate circadian phase based on a careful patient history, as well as the theories and development of the delayed sleep phase disorder and the advanced sleep phase disorder, which are the most representative of the circadian rhythm sleep disorders.