Insomnia disorder
Insomnia disorder
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DOI：
10.1038/nrdp.2015.26
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发表时间：
2015-09-03
影响因子：
81.5
通讯作者：
Spiegelhalder, Kai
中科院分区：
文献类型：
--
作者：
Morin, Charles M.;Drake, Christopher L.;Spiegelhalder, Kai
强迫症以情境性、复发性或慢性的方式影响很大一部分人口，是医疗实践中最常见的主诉之一。该障碍的主要特征是对睡眠持续时间或质量不满意，难以开始或维持睡眠，沿着大量的痛苦和日间功能的损害。它可以作为主诉出现，或者更经常地与其他医学或精神疾病（如疼痛和抑郁症）共同发生。持续性失眠与不良的长期健康结果有关，包括生活质量下降以及身体和心理疾病。尽管失眠症的患病率和负担很高，但其病因和病理生理学仍知之甚少。在过去的十年中，分类和诊断范式的重要变化已经促使人们从纯粹的基于失眠的概念化转变为将失眠本身视为一种疾病。这些变化已经被治疗的关键进展所取代，一般的药理学和心理干预越来越多地被具有睡眠特异性和失眠特异性治疗靶点的方法所取代。心理和药物治疗有效地减少了入睡所需的时间和入睡后清醒的时间，并使总睡眠时间适度增加;这些结果与日间功能的改善相关。尽管取得了这些进展，但仍存在一些挑战，包括需要提高我们对失眠机制的认识，并开发更具成本效益，高效和可获得的治疗方法。
Insomnia disorder affects a large proportion of the population on a situational, recurrent or chronic basis and is among the most common complaints in medical practice. The disorder is predominantly characterized by dissatisfaction with sleep duration or quality and difficulties initiating or maintaining sleep, along with substantial distress and impairments of daytime functioning. It can present as the chief complaint or, more often, co-occurs with other medical or psychiatric disorders, such as pain and depression. Persistent insomnia has been linked with adverse long-term health outcomes, including diminished quality of life and physical and psychological morbidity. Despite its high prevalence and burden, the aetiology and pathophysiology of insomnia is poorly understood. In the past decade, important changes in classification and diagnostic paradigms have instigated a move from a purely symptom-based conceptualization to the recognition of insomnia as a disorder in its own right. These changes have been paralleled by key advances in therapy, with generic pharmacological and psychological interventions being increasingly replaced by approaches that have sleep-specific and insomnia-specific therapeutic targets. Psychological and pharmacological therapies effectively reduce the time it takes to fall asleep and the time spent awake after sleep onset, and produce a modest increase in total sleep time; these are outcomes that correlate with improvements in daytime functioning. Despite this progress, several challenges remain, including the need to improve our knowledge of the mechanisms that underlie insomnia and to develop more cost-effective, efficient and accessible therapies.