Circadian Rhythm Sleep-Wake Phase Disorders复制标题

昼夜节律睡眠-觉醒期紊乱

Delayed and advanced sleep-wake phase disorders (DSWPD and ASWPD) appeared in the literature approximately 40 years ago as delayed sleep phase syndrome and advanced sleep phase syndrome. They have traditionally been viewed as a misalign- ment of the endogenous circadian timekeeping system with the desired sleep-wake schedule. However, with consideration of the 2-process model of sleep-wake regula- tion, these disorders clearly involve the sleep homeostatic system as well. For example, those with DSWPD encounter insufficient sleep duration if enforced to a more “traditional” sleep schedule, hence homeostatic sleep pressure builds incrementally and relentlessly across the work or school week. At more recent international conferences and in some publications, there is evolving consideration that these circadian rhythm sleep-wake disorders may not be entirely distinct from the traditional insomnia disorders. What follows is foundational as well as state-of- the-art information on the diagnostic and treatment considerations for these circadian rhythm sleep-wake disorders, with subsequent future challenges in sleep and circadian medicine.Diagnostic criteria for circadian rhythm disorders are provided in both the International Classification for Sleep Disorders (ICSD) and the Diagnostic and Statistical Manual of Mental Disorders (DSM). Both the ICSD-37 and the DSM-58 have 3 major criteria that must be met for any Circadian Rhythm Sleep Disorder. These major criteria include (1) sleep disruption that can be attributed to disruption of the circadian system or a misalignment between an individual’s endogenous rhythm and the sleep-wake schedule needed for work and social activities, which is (2) associated with daytime sleepiness and/or insomnia and (3) causes clinically significant impairment or distress in at least 1 domain of functioning (eg, social, occupational).

译文