[Sleep disturbances in Alzheimer's disease and other dementias].

Marie-Françoise Vecchierini
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引用次数: 39

Abstract

Sleep in dementias has been mainly studied in Alzheimer disease (AD). Sleep disturbances are found in 25 to 35% of subjects with AD. Subjective and objective disturbances are described. Long nocturnal awakenings disrupt sleep; total sleep time and sleep efficiency are reduced. Slow wave sleep is decreased and sometimes disappears. REM sleep percentage is also reduced and at a later stage of the disease, REM latency is increased. Sleep fragmentation can be associated with excessive daytime napping and sleepiness, and with other behavioral symptoms such as the sundowning syndrome and nocturnal agitation. Sleep abnormalities closely parallel the level of severity of dementia. The rest/activity ratio and the sleep-wake rhythms are more and more disturbed; the phase delay of the temperature rhythm is associated with the severity of the sundowning syndrome. Sleep disturbances and behavioral symptoms are the main reasons to institutionalize the patient. Sleep disturbances are related to multiple factors. Pathophysiological changes resulting of the disease itself, such as damage to the cholinergic pathways and to the circadian pacemaker in the suprachiasmatic nucleus, contribute to sleep changes in AD. Associated medical and psychiatric illness and their different treatments as well as environmental factors also induced sleep disturbances. Sleep-disordered breathing is a highly prevalent condition in AD patients and restless leg syndrome may account for nocturnal agitation. In Parkinson and in Lewy body dementias, sleep disturbances are more severe than in DA and REM sleep behavior disorder can precede by several years these diseases. Sleep attacks and sleepiness are very frequent in Parkinson disease. Specific etiologies should drive specific treatment. Several non pharmacologic treatments are usually associated to treat sleep disturbances in AD: information, increased daytime physical, social activities to minimize daytime naps and exposure to bright light. Some studies found advantages to associate melatonin in the evening.

[阿尔茨海默病和其他痴呆症的睡眠障碍]。
睡眠与痴呆的关系主要研究于阿尔茨海默病(AD)。25 - 35%的阿尔茨海默病患者存在睡眠障碍。描述了主观干扰和客观干扰。夜间长时间醒来会扰乱睡眠;总睡眠时间和睡眠效率都会降低。慢波睡眠减少,有时消失。快速眼动睡眠的比例也会减少,在疾病的后期,快速眼动潜伏期会增加。睡眠分裂可能与白天过度打盹和困倦有关,也可能与其他行为症状有关,如日落综合症和夜间躁动。睡眠异常与痴呆症的严重程度密切相关。休息/活动比和睡眠-觉醒节律越来越紊乱;温度节律的相位延迟与日落综合征的严重程度有关。睡眠障碍和行为症状是将患者送院的主要原因。睡眠障碍与多种因素有关。疾病本身引起的病理生理变化,如对视交叉上核胆碱能通路和昼夜节律起搏器的损害,有助于AD患者的睡眠变化。相关的医学和精神疾病及其不同的治疗方法以及环境因素也会引起睡眠障碍。睡眠呼吸障碍在阿尔茨海默病患者中非常普遍,不宁腿综合征可能是夜间躁动的原因。在帕金森氏症和路易体痴呆中,睡眠障碍比DA和快速眼动睡眠行为障碍更严重,这些疾病可在数年前发生。睡眠发作和困倦在帕金森氏症中非常常见。具体的病因需要具体的治疗。一些非药物治疗通常与治疗阿尔茨海默氏症的睡眠障碍有关:信息,增加白天的身体活动,减少白天小睡和暴露在强光下。一些研究发现,晚上服用褪黑素有好处。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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