Effective Treatment of Night Terrors and Sleepwalking with Ramelteon
Effective Treatment of Night Terrors and Sleepwalking with Ramelteon
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Ramelteon 有效治疗夜惊和梦游
DOI：
10.1089/cap.2016.0088
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发表时间：
2016
期刊：
影响因子：
--
通讯作者：
Honda H
中科院分区：
文献类型：
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作者：
Sasayama D;Washizuka S;Honda H
夜惊和梦游是典型的异态睡眠，发生在慢波非快速眼动睡眠阶段。这些症状通常会随着年龄的增长而消退，因此大多数儿童不需要治疗。然而，必须保护患有这些疾病的儿童在发作期间免受伤害。在严重病例中，通常使用低剂量苯二氮卓类药物进行夜间镇静（Remulla and Guilleminault 2004）。然而，儿童应谨慎使用苯二氮卓类药物，因为它们可能产生耐受性和依赖性。在这里，我们报告一个男孩的夜惊和梦游是有效的治疗与ramelteon。一名11岁的注意力缺陷多动障碍（ADHD）男孩因睡眠困难被转介到我们的儿童精神科门诊。他的过去的历史显示，他是一个活跃的孩子，总是运行和爬上的东西。他的夜惊和梦游始于7岁，当时他因意外从塔上摔下受伤住院后开始出现睡眠困难。他被诊断患有ADHD，并在8岁时开始接受托莫西汀治疗。他的母亲虐待和忽视他，酗酒，在他9岁时去世。在他母亲去世后，梦游发作最频繁，每周超过一次。虽然梦游症的发作频率逐渐降低，但仍每月发生一次，因此需要在夜间采取保护措施以免受伤。在他第一次访问时，一直照顾他的祖母报告说，他每天晚上都受到惊吓，难以入睡。入睡后一两个小时，他常常又哭又叫，第二天就不记得了。梦游症也每月发生一次以上，在此期间，他会走出卧室。Ramelteon的起始剂量为4 mg/天。他的入睡困难在几天内消失，因此，在给药10天后停用ramelteon。令人惊讶的是，他的夜惊和梦游也迅速消退沿着入睡困难的改善。随访10个月后，无失眠复发或异眠发作。这份报告是第一次提出雷美替恩，一种褪黑激素受体激动剂，在儿童夜惊和梦游的可能疗效。异态睡眠的改善为他提供了安全感，这可能导致了一个良性循环，最大限度地减少了对睡眠的恐惧，并保持了良好的睡眠习惯。两份轶事报告显示了褪黑激素治疗夜惊和梦游的疗效（Jan et al. 2004; Ozcan and Donmez 2014）。尽管这些异态睡眠的病理生理学尚不清楚，但已知在慢波睡眠期间睡眠剥夺和强迫唤醒会诱发易感个体的梦游（Pilon等人，2008）。在本例中，由于雷美替恩治疗而改善的睡眠剥夺可能纠正了慢波睡眠失调，导致异睡状态改善。确切的机制仍有待阐明，但ramelteon可能是苯二氮卓类药物治疗儿童夜惊和梦游的替代品。
Night terrors and sleepwalking are parasomnias that typ-ically occur during the slow-wave nonrapid eye movement sleep stage. The symptoms often subside with age, and therefore, no treatment is required for most children. However, children with these disorders must be protected from sustaining injuries during the episodes. In severe cases, low doses of benzodiazepines are commonly administered for night sedation (Remulla and Guilleminault 2004). However, benzodiazepines should be used with caution in children because of their potential for tolerance and dependency. Here, we report a boy whose night terrors and sleepwalking were effectively treated with ramelteon. An 11-year-old boy with attention-deficit/hyperactivity disorder (ADHD) was referred to our child psychiatry outpatient clinic because of sleeping difficulties. His past history revealed that he was an active child, always running and climbing on things. His night terrors and sleepwalking began at age 7, when his sleeping difficulties began after being hospitalized because of an injury from an accidental fall from a tower. He was diagnosed with ADHD and was started on atomoxetine at the age of 8. His mother, who had abused and neglected him, was alcohol dependent and died when he was 9 years old. Sleepwalking episodes were most frequent, more than once a week, after the death of his mother. Although the episodes gradually became less frequent, sleepwalking continued to occur once a month, necessitating protection from injury at night. On his first visit, his grandmother, who has been taking care of him, reported that he was frightened every night and suffered difficulty falling asleep. An hour or two after falling asleep, he often cried and screamed, which he did not remember the next day. Episodes of sleepwalking also occurred more than once a month, during which he would walk out of his bedroom. Ramelteon was started at a dose of 4 mg/day. His trouble falling asleep disappeared within a few days, and therefore, ramelteon was discontinued after 10 days of administration. Surprisingly, his night terrors and sleepwalking also subsided promptly along with the improvement of difficulty falling asleep. No recurrence of insomnia or episodes of parasomnias have occurred after 10 months of follow-up. This report is the first to suggest the possible efficacy of ramelteon, a melatonin receptor agonist, in childhood night terrors and sleepwalking. Improvement of parasomnias provided him a sense of security, which may have led to a virtuous cycle of minimizing the fear of sleep and maintaining good sleeping habits. Two anecdotal reports have shown the efficacy of melatonin therapy in night terrors and sleepwalking (Jan et al. 2004; Ozcan and Donmez 2014). Although the pathophysiology of these parasomnias remains unclear, sleep deprivation and forced arousals during slow-wave sleep are known to induce sleepwalking in predisposed individuals (Pilon et al. 2008). In the present case, improved sleep deprivation because of ramelteon treatment may have corrected the slow-wave sleep dysregulation, resulting in improved parasomnias. The precise mechanism remains to be elucidated, but ramelteon may be an alternative to benzodiazepines in treating children with night terrors and sleepwalking.