Impact of Pharmacotherapy on Insomnia in Patients with Alzheimer's Disease.
Impact of Pharmacotherapy on Insomnia in Patients with Alzheimer's Disease.
复制标题
药物治疗对阿尔茨海默病患者失眠的影响
DOI：
10.1007/s40266-021-00891-1
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发表时间：
2021-11
期刊：
影响因子：
2.8
通讯作者：
Bliwise DL
中科院分区：
文献类型：
--
作者：
Roland JP;Bliwise DL
失眠是一种广泛性睡眠障碍，影响不同人口统计学人群和共病状态的许多患者。促成因素往往是生物、心理和社会因素的复杂相互作用，需要在诊断和管理方面采取多方面的方法。在阿尔茨海默病的背景下，失眠是一个更加复杂的问题，其总体患病率高于普通人群，病因更加复杂，诊断也存在差异（有时基于护理者对睡眠中断的观察而不是患有该障碍的个体的主观抱怨），并且在治疗方面需要更多的自由裁量权，特别是关于不利影响概况的关注。还有越来越多的证据表明睡眠中断和阿尔茨海默病的双向性，失眠可能会导致疾病进展，使病情更加重要。本综述的目的是为临床医生提供一个概述的治疗策略，可能有价值的治疗睡眠障碍的阿尔茨海默病。非药物治疗方法应首先用尽;然而，在某些临床情况下可能需要药物治疗，这对临床医生来说可能是一个挑战，因为缺乏证据和阿尔茨海默病亚群治疗指南。镇静抗抑郁药、褪黑激素和位点特异性γ-氨基丁酸激动剂等药物的使用通常基于历史使用情况，但不一定得到高质量试验的支持。较新的药物，如双重食欲素受体拮抗剂已显示出一定的前景，但仍需要进一步评估。
Insomnia is a pervasive sleep disorder affecting numerous patients across diverse demographical populations and comorbid disease states. Contributing factors are often a complex interaction of biological, psychological, and social components, requiring a multifaceted approach in terms of both diagnosis and management. In the setting of Alzheimer’s disease, insomnia is an even more complicated issue, with a higher overall prevalence than in the general population, greater complexity of contributing etiologies, and differences in diagnosis (at times based on caregiver observation of sleep disruption rather than subjective complaints by the individual with the disorder), and requiring more discretion in terms of treatment, particularly in regard to adverse effect profile concerns. There also is growing evidence of the bidirectional nature of sleep disruption and Alzheimer’s disease, with insomnia potentially contributing to disease progression, making the condition even more paramount to address. The objective of this review was to provide the clinician with an overview of treatment strategies that may have value in the treatment of disturbed sleep in Alzheimer’s disease. Nonpharmacological approaches to treatment should be exhausted foremost; however, pharmacotherapy may be needed in certain clinical scenarios, which can be a challenge for clinicians given the paucity of evidence and guidelines for treatment in the subpopulation of Alzheimer’s disease. Agents such as sedating antidepressants, melatonin, and site-specific γ-aminobutyric acid agonists are often employed based on historical usage but are not necessarily supported by high-quality trials. Newer agents such as dual orexin receptor antagonists have demonstrated some promise but still need further evaluation.
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影响因子：
168.9
作者：
Ballard, Clive;Gauthier, Serge;Jones, Emma
通讯作者：
Jones, Emma
影响因子：
5.6
作者：
Boeve, Bradley F;Silber, Michael H;Ferman, Tanis J
通讯作者：
Ferman, Tanis J
影响因子：
6
作者：
Bietry, Fabienne A.;Pfeil, Alena M.;Meier, Christoph R.
通讯作者：
Meier, Christoph R.
DOI：
10.1093/gerona/50a.6.m303
发表时间：
1995-11-01
影响因子：
5.1
作者：
BLIWISE, DL;HUGHES, M;KUTNER, N
通讯作者：
KUTNER, N
影响因子：
7.2
作者：
Camargos, Einstein F.;Louzada, Luciana L.;Nobrega, Otavio T.
通讯作者：
Nobrega, Otavio T.