Treatment of central disorders of hypersomnolence: an American Academy of Sleep Medicine clinical practice guideline.
Treatment of central disorders of hypersomnolence: an American Academy of Sleep Medicine clinical practice guideline.
复制标题
DOI：
10.5664/jcsm.9328
复制
发表时间：
2021-09-01
期刊：
影响因子：
--
通讯作者：
Watson, Nathaniel F
中科院分区：
文献类型：
--
作者：
Maski, Kiran;Trotti, Lynn Marie;Watson, Nathaniel F
简介：本指南制定了治疗成人和儿童中枢性嗜睡症的临床实践建议。方法：美国睡眠医学会委托睡眠医学专家组成的工作组根据文献的系统回顾和使用 GRADE 流程对证据的评估，制定建议并为每项建议分配优势。该工作组总结了相关文献和证据质量、利弊平衡、患者价值观和偏好以及支持建议的资源使用注意事项。 AASM 董事会批准了最终建议。建议：以下建议旨在指导临床医生选择针对成人和儿童中枢性嗜睡症的具体治疗方法。每个推荐声明都被分配了一个强度（“强”或“有条件”）。 “强烈”建议（即“我们建议”）是临床医生在大多数情况下应遵循的建议。 “有条件”建议（即“我们建议”）是要求临床医生利用临床知识和经验并充分考虑患者个体的价值观和偏好来确定最佳行动方案的建议。在每种疾病下，强烈建议按字母顺序列出，然后是有条件建议按字母顺序列出。关于因医疗状况而导致嗜睡的成人患者的部分是根据 ICSD-3 中确定的临床和病理亚型进行分类的。所有建议声明中的干预措施均与不治疗进行比较。 成人发作性睡病患者：1：我们建议临床医生使用莫达非尼治疗成人发作性睡病。 （强）.2：我们建议临床医生使用pitolisant 治疗成人发作性睡病。 （强）.3：我们建议临床医生使用羟丁酸钠治疗成人发作性睡病。 （强）.4：我们建议临床医生使用 solriamfetol 治疗成人发作性睡病。 （强）.5：我们建议临床医生使用阿莫达非尼治疗成人发作性睡病。 （有条件）6：我们建议临床医生使用右旋苯丙胺治疗成人发作性睡病。 （有条件）7：我们建议临床医生使用哌醋甲酯治疗成人发作性睡病。 （有条件）。特发性嗜睡症成人患者：8：我们建议临床医生使用莫达非尼治疗成人特发性嗜睡症。 （强）.9：我们建议临床医生使用克拉霉素治疗成人特发性嗜睡症。 （有条件）10：我们建议临床医生使用哌醋甲酯治疗成人特发性嗜睡症。 （有条件）11：我们建议临床医生使用pitolisant治疗成人特发性睡眠过多。 （有条件）12：我们建议临床医生使用羟丁酸钠治疗成人特发性嗜睡症。 （有条件）。成人克莱恩-莱文综合征患者：13：我们建议临床医生使用锂来治疗成人克莱恩-莱文综合征。 （视情况而定）。因医疗状况而导致嗜睡的成人患者：继发于 α-突触核蛋白病的嗜睡：14：我们建议临床医生使用阿莫达非尼治疗成人路易体痴呆继发的嗜睡。 （有条件）15：我们建议临床医生使用莫达非尼治疗成人帕金森病继发的嗜睡症。 （有条件）16：我们建议临床医生使用羟丁酸钠治疗成人帕金森病继发的睡眠过多。 （有条件）。创伤后嗜睡：17：我们建议临床医生使用阿莫达非尼治疗成人创伤性脑损伤继发的嗜睡。 （有条件）18：我们建议临床医生使用莫达非尼治疗成人创伤性脑损伤继发的嗜睡症。 （有条件）。患有与原发性中枢神经系统嗜睡相关的遗传性疾病的成人患者：19：我们建议临床医生使用莫达非尼治疗成人强直性肌营养不良继发的嗜睡症。 （有条件）。继发于脑肿瘤、感染或其他中枢神经系统病变的嗜睡症成人患者：20：我们建议临床医生使用莫达非尼治疗成人多发性硬化症继发的嗜睡症。 （有条件）。患有发作性睡病的儿科患者：21：我们建议临床医生使用莫达非尼治疗儿科患者的发作性睡病。 （有条件）22：我们建议临床医生使用羟丁酸钠治疗儿科患者的发作性睡病。 （有条件）。引用：Maski K、Trotti LM、Kotagal S 等人。中枢性嗜睡症的治疗：美国睡眠医学会临床实践指南。 J 临床睡眠医学杂志。 2021；17(9):1881-1893。
INTRODUCTION: This guideline establishes clinical practice recommendations for the treatment of central disorders of hypersomnolence in adults and children.METHODS: The American Academy of Sleep Medicine commissioned a task force of experts in sleep medicine to develop recommendations and assign strengths to each recommendation, based on a systematic review of the literature and an assessment of the evidence using the GRADE process. The task force provided a summary of the relevant literature and the quality of evidence, the balance of benefits and harms, patient values and preferences, and resource use considerations that support the recommendations. The AASM Board of Directors approved the final recommendations.RECOMMENDATIONS: The following recommendations are intended to guide clinicians in choosing a specific treatment for central disorders of hypersomnolence in adults and children. Each recommendation statement is assigned a strength ("strong" or "conditional"). A "strong" recommendation (ie, "We recommend") is one that clinicians should follow under most circumstances. A "conditional" recommendation (ie, "We suggest") is one that requires that the clinician use clinical knowledge and experience and strongly consider the individual patient's values and preferences to determine the best course of action. Under each disorder, strong recommendations are listed in alphabetical order followed by the conditional recommendations in alphabetical order. The section on adult patients with hypersomnia because of medical conditions is categorized based on the clinical and pathological subtypes identified in ICSD-3. The interventions in all the recommendation statements were compared to no treatment.Adult patients with narcolepsy:1: We recommend that clinicians use modafinil for the treatment of narcolepsy in adults. (STRONG).2: We recommend that clinicians use pitolisant for the treatment of narcolepsy in adults. (STRONG).3: We recommend that clinicians use sodium oxybate for the treatment of narcolepsy in adults. (STRONG).4: We recommend that clinicians use solriamfetol for the treatment of narcolepsy in adults. (STRONG).5: We suggest that clinicians use armodafinil for the treatment of narcolepsy in adults. (CONDITIONAL).6: We suggest that clinicians use dextroamphetamine for the treatment of narcolepsy in adults. (CONDITIONAL).7: We suggest that clinicians use methylphenidate for the treatment of narcolepsy in adults. (CONDITIONAL).Adult patients with idiopathic hypersomnia:8: We recommend that clinicians use modafinil for the treatment of idiopathic hypersomnia in adults. (STRONG).9: We suggest that clinicians use clarithromycin for the treatment of idiopathic hypersomnia in adults. (CONDITIONAL).10: We suggest that clinicians use methylphenidate for the treatment of idiopathic hypersomnia in adults. (CONDITIONAL).11: We suggest that clinicians use pitolisant for the treatment of idiopathic hypersomnia in adults. (CONDITIONAL).12: We suggest that clinicians use sodium oxybate for the treatment of idiopathic hypersomnia in adults. (CONDITIONAL).Adult patients with Kleine-Levin syndrome:13: We suggest that clinicians use lithium for the treatment of Kleine-Levin syndrome in adults. (CONDITIONAL).Adult patients with hypersomnia due to medical conditions:Hypersomnia secondary to alpha-synucleinopathies:14: We suggest that clinicians use armodafinil for the treatment of hypersomnia secondary to dementia with Lewy bodies in adults. (CONDITIONAL).15: We suggest that clinicians use modafinil for the treatment of hypersomnia secondary to Parkinson's disease in adults. (CONDITIONAL).16: We suggest that clinicians use sodium oxybate for the treatment of hypersomnia secondary to Parkinson's disease in adults. (CONDITIONAL).Posttraumatic hypersomnia:17: We suggest that clinicians use armodafinil for the treatment of hypersomnia secondary to traumatic brain injury in adults. (CONDITIONAL).18: We suggest that clinicians use modafinil for the treatment of hypersomnia secondary to traumatic brain injury in adults. (CONDITIONAL).Adult patients with genetic disorders associated with primary central nervous system somnolence:19: We suggest that clinicians use modafinil for the treatment of hypersomnia secondary to myotonic dystrophy in adults. (CONDITIONAL).Adult patients with hypersomnia secondary to brain tumors, infections, or other central nervous system lesions:20: We suggest that clinicians use modafinil for the treatment of hypersomnia secondary to multiple sclerosis in adults. (CONDITIONAL).Pediatric patients with narcolepsy:21: We suggest that clinicians use modafinil for the treatment of narcolepsy in pediatric patients. (CONDITIONAL).22: We suggest that clinicians use sodium oxybate for the treatment of narcolepsy in pediatric patients. (CONDITIONAL).CITATION: Maski K, Trotti LM, Kotagal S, et al. Treatment of central disorders of hypersomnolence: an American Academy of Sleep Medicine clinical practice guideline. J Clin Sleep Med. 2021;17(9):1881-1893.