Pharmacological Treatment of Chronic Insomnia
Pharmacological Treatment of Chronic Insomnia
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慢性失眠的药物治疗
DOI：
10.2165/00023210-199504030-00003
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发表时间：
1995
期刊：
影响因子：
6
通讯作者：
D. Monti
中科院分区：
文献类型：
--
作者：
J. Monti;D. Monti
摘要失眠被定义为无法获得最佳功能和健康所需的睡眠量或质量。长期或慢性失眠通常被认为是持续至少21至30个晚上；然而，它通常会持续数月或数年。女性比男性更常见，并且随着年龄的增长变得更加明显。慢性失眠与精神障碍、心理生理状况、睡眠卫生不良、神经系统疾病和药物依赖有关。最常见的诊断是与精神疾病相关的慢性失眠，其次是心理生理状况。在慢性心理生理性失眠、特发性失眠和与广泛性焦虑相关的失眠中，需要使用非药物策略和促进睡眠的药物（例如安眠药）。对于与重度抑郁症相关的慢性失眠患者，诱导急性镇静的抗抑郁药（例如阿米替林、多虑平、曲唑酮）是首选的主要药物治疗。必要时可加用催眠药。目前使用的催眠药有苯二氮卓类衍生物、环吡咯酮佐匹克隆、咪唑并吡啶唑吡坦等。半衰期短的安眠药在早晨醒来和白天功能方面表现出最佳的疗效和不良反应。对于慢性失眠患者，安眠药可以缩短入睡潜伏期，减少夜间觉醒次数并减少清醒时间。总睡眠时间的增加与更多的非快速眼动 (NREM) 睡眠有关。苯二氮卓类药物、佐匹克隆和唑吡坦在诱导和维持睡眠的有效性方面几乎没有差异。然而，与苯二氮卓类药物和佐匹克隆相比，唑吡坦不会抑制慢波睡眠。睡眠实验室和临床研究往往表明，苯二氮卓类药物只有在慢性失眠患者服用相对较短的时间时才有效。此外，短效和中效苯二氮卓类药物和佐匹克隆会导致失眠反弹，并且在突然停止服用苯二氮卓类药物后会出现戒断综合征，表明存在心理和身体依赖性。相比之下，没有观察到与唑吡坦给药相关的耐受性或反弹性失眠的证据。
SummaryInsomnia is defined as the inability to get the amount or quality of sleep necessary for optimal functioning and well being. Long term or chronic insomnia has been conventionally considered to be that lasting for at least 21 to 30 nights; however, it usually persists for months or years. It is more frequent in women than in men, and becomes more pronounced with age.Chronic insomnia is associated with mental disorders, psychophysiological conditions, inadequate sleep hygiene, neurological disorders and drug dependency. The most prevalent diagnosis is chronic insomnia associated with psychiatric disorders, followed in precedence by psychophysiological conditions.In chronic psychophysiological insomnia, idiopathic insomnia and insomnia associated with generalised anxiety, nonpharmacological strategies and sleeppromoting medication (e.g. hypnotics) are indicated. In patients with chronic insomnia associated with major depressive disorders, antidepressants that induce acute sedation (e.g. amitriptyline, doxepin, trazodone) represent the primary drug treatments of choice. When necessary, hypnotics can be added.Currently used hypnotics include benzodiazepine derivatives, the cyclopyrrolone zopiclone and the imidazopyridine zolpidem. Hypnotics with a short halflife show the best profile of efficacy versus adverse effects with regard to morning awakening and daytime functioning. In patients with chronic insomnia, hypnotics reduce sleep-onset latency, decrease the number of nocturnal awakenings and reduce the time spent awake. The increase in total sleep time is related to greater amounts of non-rapid eye movement (NREM) sleep.Few differences exist between benzodiazepines, zopiclone and zolpidem in terms of effectiveness in inducing and maintaining sleep. However, in contrast to the benzodiazepines and zopiclone, zolpidem does not suppress slow-wave sleep. Sleep laboratory and clinical studies tend to indicate that benzodiazepines are only effective when administered for relatively short periods of time in patients with chronic insomnia. Furthermore, a rebound insomnia has been described for short- and intermediate-acting benzodiazepines and zopiclone, and a withdrawal syndrome, denoting the presence of psychological and physical dependence, follows the abrupt cessation ofbenzodiazepine administration. In contrast, no evidence of tolerance or rebound insomnia has been observed in relation to zolpidem administration.
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三种苯二氮卓类催眠药动态差异的药代动力学决定因素。
影响因子：
--
作者：
Greenblatt,DJ;Harmatz,JS;Engelhardt,N;Shader,RI
通讯作者：
Shader,RI
苯二氮卓动力学：对治疗学和药物老年学的影响。
影响因子：
5.9
作者：
Greenblatt,DJ;Divoll,M;Abernethy,DR;Ochs,HR;Shader,RI
通讯作者：
Shader,RI
氟西泮、三唑仑和安慰剂的催眠效果比较：一项长期同时进行的夜间和白天研究。
影响因子：
2.9
作者：
Mitler,MM;Seidel,WF;vandenHoed,J;Greenblatt,DJ;Dement,WC
通讯作者：
Dement,WC
深入了解 GABA-苯二氮卓受体的结构和功能：离子通道和精神病学。
DOI：
10.1176/ajp.148.2.162
发表时间：
1991
期刊：
The American journal of psychiatry
影响因子：
--
作者：
Zorumski,CF;Isenberg,KE
通讯作者：
Isenberg,KE