Sleep in older adults: normative changes, sleep disorders, and treatment options.
Sleep in older adults: normative changes, sleep disorders, and treatment options.
复制标题
老年人睡眠：规范性变化，睡眠障碍和治疗选择。
DOI：
10.1016/j.cger.2014.04.007
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发表时间：
2014-08
影响因子：
3.3
通讯作者：
Vitiello MV
中科院分区：
文献类型：
--
作者：
Gooneratne NS;Vitiello MV
睡眠障碍在老年人中很常见：大约5%的老年人符合临床显著失眠障碍的标准，20%符合睡眠呼吸暂停综合征的标准。在考虑失眠症状时，重要的是要区分与年龄相适应的睡眠变化与临床显著的失眠，后者通过存在显著的日间症状（如疲劳）来区分。用睡眠日记进行评估和筛查共病情况，特别是情绪障碍，是必不可少的。非药物疗法，如失眠的认知行为疗法，可以非常有效，并具有持续的益处。也有广泛的药物治疗，但可能会产生不必要的精神影响。如果不治疗，失眠可能与抑郁症的风险增加和生活质量的显著损害有关。关于睡眠呼吸暂停，高怀疑指数对于有效诊断至关重要，因为在年轻患者中常见的症状，如肥胖或大声打鼾，可能不存在于老年患者中。不同年龄组的诊断和管理相当相似，除了在老年人中需要更细致入微的减肥方法。越来越多的家庭便携式多导睡眠图和自动滴定气道正压通气治疗的使用可以减少治疗障碍。
Sleep disorders are common in older adults: Approximately 5% of older adults meet criteria for clinically significant insomnia disorders and 20% for sleep apnea syndromes. When considering insomnia symptoms, it is important to distinguish age-appropriate changes in sleep from clinically significant insomnia, with the latter distinguished by the presence of significant daytime symptoms such as fatigue. Evaluation with a sleep diary and screening for comorbid conditions, especially mood disorders, is essential. Non-pharmacologic therapies, such as cognitive-behavioral therapy for insomnia, can be highly effective and have sustained benefit. A broad range of pharmacologic therapies are also available but can have unwanted psychomotor effects. If left untreated, insomnia can be associated with increased risk of depression and significant impairments in quality of life. In regards to sleep apnea, a high index of suspicion is crucial for effective diagnosis because symptoms commonly noted in younger patients, such as obesity or loud snoring, may not be present in older patients. Diagnosis and management is fairly similar across age groups, except that a more nuanced approach to weight loss is warranted in older adults. The increasing use of home-based portable polysomnography and auto-titrating positive-airway pressure therapy can reduce barriers to treatment.