小结
定义
病史和体格检查
关键诊断因素
- 存在的危险因素
- 事件中认知紊乱（意识模糊性觉醒、睡惊症、睡行症）
- 激烈活动或暴力行为（意识模糊性觉醒、睡行症、睡惊症和快速动眼睡眠行为障碍 [Rapid eye movement sleep behaviour disorder, RBD]）
- 多次出现无法活动的状态（复发性孤立性睡眠麻痹）
- 事件中的自主神经过度兴奋（睡惊症）
- 遗忘症
- 发作期间常规的体格检查
其他诊断因素
- 行为举止和面部表情异常（意识模糊性觉醒、睡行症、睡惊症）
- 受伤证据
危险因素
- 非快速眼动（non-rapid eye movement, NREM）异态睡眠家族史（意识模糊性觉醒、睡行症、睡惊症）
- HLA 基因 DQB1*05 和 *04 等位基因的存在（睡行症）
- 药物或酒精
- 精神障碍史
- 发热
- 急性睡眠剥夺或不规律的睡眠-觉醒节律障碍
- 情绪应激和创伤性生活事件
- 被迫觉醒
- 未经治疗的合并睡眠障碍
- 月经前状态（青春期女童）
诊断性检查
首要检查
- 临床检查
- 多导睡眠描记（快速动眼睡眠行为障碍）
需考虑的检查
- 多导睡眠描记（意识模糊性觉醒）
- 多导睡眠描记（睡行症）
- 多导睡眠描记（睡惊症）
- 多导睡眠描记（梦魇障碍）
- 多导睡眠描记（其他异态睡眠障碍）
- 利用扩展脑电图（electroencephalogram, EEG）视频记录进行的多导睡眠描记
- 尿液药物筛查
治疗流程
意识模糊性觉醒
睡行症
睡惊症
梦魇
复发性孤立性睡眠麻痹
快速动眼睡眠行为障碍
撰稿人
作者
Shalini Paruthi, MD
Co-Medical Director, Sleep Medicine and Research Center
St. Luke's Hospital
Adjunct Associate Professor
Department of Pediatrics
Saint Louis University School of Medicine
St Louis
MO
利益声明
SP receives royalties from UpToDate for writing two topics: diagnosis and management of pediatric obstructive sleep apnea. SP is a board member of the Restless Legs Syndrome Foundation.
鸣谢
Dr Shalini Paruthi would like to gratefully acknowledge Dr Raman Malhotra and Dr Alon Y. Avidan, previous contributors to this topic.
利益声明
AYA has been paid honorarium speaking fees by the American Academy of Sleep Medicine, the American Academy of Neurology, the American College of Chest Physicians, Sepracor Inc, Cephalon Inc, and Pfizer Pharmaceuticals.
同行评议者
Paul Gringras, MB, ChB, MSc, MRCPCH
Consultant in Paediatric Neurodisability
Evelina Children's Hospital
St Thomas' Hospital
London
UK
利益声明
PG is lead applicant on the ongoing MENDS trial, which is concerned with the use of melatonin in children with neurodevelopmental disorders and impaired sleep.
Paul Montgomery, MSc, DipSW, DPhil
Reader in Psycho-Social Intervention
Centre for Evidence Based Intervention
Barnett House
University of Oxford
Oxford
UK
利益声明
PM has received funding greater than 6 figures USD from the Swedish Board of Health and Welfare, Martek Biosciences, Danish Social Research Institute, UK Department of Health, UK Health Technology Assessment Programme. PM declares that he has no competing interests.
Lynn A. D'Andrea, MD
Associate Professor of Pediatrics
Chief
Division of Pulmonary and Sleep Medicine
Department of Pediatrics
Medical College of Wisconsin
Medical Director
Pulmonary Clinic
Children's Hospital of Wisconsin
Milwaukee
WI
利益声明
LAD declares that she has no competing interests.
鉴别诊断
- 癫痫（夜间）
- 发作性睡病
- 周期性肢体运动障碍 (PLMD)
更多 鉴别诊断指南
- 关于失眠、异态睡眠障碍和昼夜睡眠节律障碍循证治疗的共识声明：更新版
- 针对儿童多导睡眠描记和多次睡眠潜伏期试验的非呼吸系适应证的实践参数
更多 指南
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