Update on treatment for idiopathic hypersomnia
Update on treatment for idiopathic hypersomnia
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DOI：
10.1080/13543784.2018.1417385
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发表时间：
2018-01-01
影响因子：
6.1
通讯作者：
Dauvilliers, Yves
中科院分区：
文献类型：
--
作者：
Evangelista, Elisa;Lopez, Regis;Dauvilliers, Yves
简介：特发性嗜睡（IH）是一种特征不明显的孤儿中枢性嗜睡障碍，可导致白天过度嗜睡（EDS）、夜间睡眠延长和睡眠惯性，通常需要长期对症的兴奋剂药物治疗。迄今为止，全球范围内尚无药物获得治疗IH患者的授权。涵盖领域：作者回顾了1997年至2017年从已发表文献（Medline/PubMed/Web of Science）和Clinicaltrial.gov数据库中获得的IH药物治疗数据。大多数IH治疗的数据来自观察性研究和病例系列，只有三个精心设计的临床试验availed.Expert意见：在最近的两个随机，双盲，安慰剂对照试验，莫达非尼改善EDS在IH。大多数标记为发作性睡病的其他促醒剂在IH患者的病例系列中具有相似的疗效。在两项回顾性研究中，Pitolisant和羟丁酸钠显示出有希望的结果。γ-氨基丁酸-A受体拮抗剂对客观EDS的疗效需要澄清。所有这些药物都是标签外使用，用于IH中EDS的管理。IH需要特定的临床仪器和客观测试，以更好地评估EDS的严重程度和对药物的反应性，以及延长的睡眠和睡眠惯性，以优化IH患者的整体管理。
Introduction: Idiopathic hypersomnia (IH) is a poorly characterized orphan central disorder of hyper-somnolence responsible for excessive daytime sleepiness (EDS), prolonged nighttime sleep and sleep inertia that often require long-term symptomatic stimulant medication. To date, no drug has currently the authorization for the treatment of IH patients worldwide.Areas covered: The authors reviewed data on pharmacological treatment of IH obtained from published literature (Medline/PubMed/Web of Science) and Clinicaltrial.gov database from 1997 to 2017. Most of data on treatment of IH derived from observational studies and case series with only three well-designed clinical trials available.Expert opinion: In two recent randomized, double-blind, placebo-controlled trials, modafinil improves EDS in IH. Most of other wakefulness-promoting agents labeled for narcolepsy have similar efficacy in cases series of IH patients. Pitolisant and sodium oxybate show promising results in two retrospective studies. The efficacy of gamma-aminobutyric acid-A receptor antagonists on objective EDS needs to be clarified. All these medications are used off-label for the management of EDS in IH. Specific clinical instruments and objective tests are required in IH to better evaluate the severity of EDS and responsiveness to medications, but also prolonged sleep and sleep inertia, to optimize the whole management of IH patients.