Circadian rhythm abnormalities.
Circadian rhythm abnormalities.
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DOI：
10.1212/01.con.0000427209.21177.aa
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发表时间：
2013-02-01
期刊：
影响因子：
--
通讯作者：
Videnovic, Aleksandar
中科院分区：
文献类型：
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作者：
Zee, Phyllis C;Attarian, Hrayr;Videnovic, Aleksandar
目得：本文综述了最近的进展，了解昼夜节律的基本属性，并讨论了昼夜节律睡眠障碍（CRSDs）的临床特点，诊断和治疗。最近的发现：最近的证据有力地指出，几乎所有的生理功能的昼夜节律的时间无处不在的影响。因此，除了突出的睡眠和觉醒障碍外，昼夜节律障碍还与认知障碍、情绪障碍和心脏代谢障碍的风险增加相关。最近在临床实践中的生物标志物的昼夜节律的可用性提高了我们的能力，以确定和治疗这些CRSDs.SUMMARY：昼夜节律是内源性的节奏与周期约24小时。这些节奏通过各种光和非光刺激的社会和工作时间表与物理环境同步。CRSD是由于昼夜节律与外部环境（如时差和轮班工作）之间的时间不一致或昼夜节律或其传入和传出通路功能障碍（如睡眠期延迟、睡眠期提前、非24小时和不规则睡眠-觉醒节律障碍）所致。这些疾病最常见的症状是入睡困难和/或睡眠维持困难，以及与社会和职业功能受损相关的过度嗜睡。大多数CRSD的有效治疗需要多模式方法来加速昼夜节律的重新调整，定时暴露于光，在不适当的时间避免强光，并遵守预定的睡眠和唤醒时间。此外，对于某些CRSD，建议使用药物。对于延迟睡眠期，非24小时和轮班工作障碍，定时低剂量褪黑激素可以帮助推进或牵引昼夜节律;对于轮班工作障碍，咖啡因，莫达非尼和阿莫达非尼等唤醒剂是管理过度嗜睡的选择。
PURPOSE: This article reviews the recent advances in understanding of the fundamental properties of circadian rhythms and discusses the clinical features, diagnosis, and treatment of circadian rhythm sleep disorders (CRSDs).RECENT FINDINGS: Recent evidence strongly points to the ubiquitous influence of circadian timing in nearly all physiologic functions. Thus, in addition to the prominent sleep and wake disturbances, circadian rhythm disorders are associated with cognitive impairment, mood disturbances, and increased risk of cardiometabolic disorders. The recent availability of biomarkers of circadian timing in clinical practice has improved our ability to identify and treat these CRSDs.SUMMARY: Circadian rhythms are endogenous rhythms with a periodicity of approximately 24 hours. These rhythms are synchronized to the physical environment by social and work schedules by various photic and nonphotic stimuli. CRSDs result from a misalignment between the timing of the circadian rhythm and the external environment (eg, jet lag and shift work) or a dysfunction of the circadian clock or its afferent and efferent pathways (eg, delayed sleep-phase, advanced sleep-phase, non-24-hour, and irregular sleep-wake rhythm disorders). The most common symptoms of these disorders are difficulties with sleep onset and/or sleep maintenance and excessive sleepiness that are associated with impaired social and occupational functioning. Effective treatment for most of the CRSDs requires a multimodal approach to accelerate circadian realignment with timed exposure to light, avoidance of bright light at inappropriate times, and adherence to scheduled sleep and wake times. In addition, pharmacologic agents are recommended for some of the CRSDs. For delayed sleep-phase, non-24-hour, and shift work disorders, timed low-dose melatonin can help advance or entrain circadian rhythms; and for shift work disorder, wake-enhancing agents such as caffeine, modafinil, and armodafinil are options for the management of excessive sleepiness.