Assessment and treatment of insomnia in adult patients with alcohol use disorders
Assessment and treatment of insomnia in adult patients with alcohol use disorders
复制标题
DOI：
10.1016/j.alcohol.2014.12.003
复制
发表时间：
2015-06-01
期刊：
影响因子：
2.3
通讯作者：
Brower, Kirk J.
中科院分区：
文献类型：
--
作者：
Brower, Kirk J.
由于酒精依赖患者的发病率、持续性以及与复发和自杀想法的相关性，以及随机对照研究证明行为疗法和非成瘾药物的疗效，酒精依赖患者的成瘾已日益成为治疗的目标。这篇文章的重点是评估和治疗酒精依赖成年人在清醒4周或更长时间后仍然存在的失眠。在各种治疗方案中进行选择，需要对失眠及其多因素原因进行全面评估。除了长期大量饮酒及其对睡眠调节系统的影响外，影响因素还包括病前失眠;同时发生的医学，精神和其他睡眠障碍;使用其他物质和药物;压力;环境因素;以及睡眠卫生不足。该评估利用病史、评定量表和睡眠日记以及身体、精神状态和实验室检查来排除这些因素。多导睡眠图是指当另一个睡眠障碍是可疑的，如睡眠呼吸暂停或周期性肢体运动障碍，或当失眠是抗拒治疗。清醒仍然是失眠的必要的一线治疗方法，大多数患者都会有一些改善。如果需要针对失眠症的治疗，那么简短的行为疗法是治疗的选择，因为它们已经显示出长期的益处，而不会恶化饮酒的结果。药物作用更快，但通常只有在服用时才有效。褪黑激素激动剂;镇静抗抑郁药、抗惊厥药和抗精神病药;和苯二氮卓类受体激动剂各有其益处和风险，必须权衡和监测以优化结果。一些预防复发的药物也可能具有促进睡眠的活性。虽然人们认为治疗失眠有助于防止复发，但这一点尚未得到证实。因此，失眠和酒精依赖最好被认为是共同发生的疾病，每一种都需要自己的治疗。(C)2015 Elsevier Inc. All rights reserved.
Insomnia in patients with alcohol dependence has increasingly become a target of treatment due to its prevalence, persistence, and associations with relapse and suicidal thoughts, as well as randomized controlled studies demonstrating efficacy with behavior therapies and non-addictive medications. This article focuses on assessing and treating insomnia that persists despite 4 or more weeks of sobriety in alcohol-dependent adults. Selecting among the various options for treatment follows a comprehensive assessment of insomnia and its multifactorial causes. In addition to chronic, heavy alcohol consumption and its effects on sleep regulatory systems, contributing factors include premorbid insomnia; co-occurring medical, psychiatric, and other sleep disorders; use of other substances and medications; stress; environmental factors; and inadequate sleep hygiene. The assessment makes use of history, rating scales, and sleep diaries as well as physical, mental status, and laboratory examinations to rule out these factors. Polysomnography is indicated when another sleep disorder is suspected, such as sleep apnea or periodic limb movement disorder, or when insomnia is resistant to treatment. Sobriety remains a necessary, first-line treatment for insomnia, and most patients will have some improvement. If insomnia-specific treatment is needed, then brief behavioral therapies are the treatment of choice, because they have shown long-lasting benefit without worsening of drinking outcomes. Medications work faster, but they generally work only as long as they are taken. Melatonin agonists; sedating antidepressants, anticonvulsants, and antipsychotics; and benzodiazepine receptor agonists each have their benefits and risks, which must be weighed and monitored to optimize outcomes. Some relapse prevention medications may also have sleep-promoting activity. Although it is assumed that treatment for insomnia will help prevent relapse, this has not been firmly established. Therefore, insomnia and alcohol dependence might be best thought of as co-occurring disorders, each of which requires its own treatment. (C) 2015 Elsevier Inc. All rights reserved.