小结
定义
病史和体格检查
关键诊断因素
- 存在的危险因素
- 同眠者的陈诉
- 入睡延迟
- 多次或长时间觉醒
其他诊断因素
- 功能受损
- 事故
- 睡眠时间缩短
- 日间小睡
- 甲状腺毒症
- 慢性疼痛
- 不宁腿综合征
- 扁桃体或舌增大
- 小颌畸形和颌后缩畸形
- 咽腔狭窄
危险因素
- 女性
- 高龄
- 慢性疾病
- 慢性疼痛（如髋关节损伤）
- 精神疾病
- 酒精或物质滥用
- 兴奋剂使用
- 睡眠卫生不佳
- 外伤性脑损伤
- 药物治疗
- 近期跨时区旅行
- 夜班工作
- 甲状腺失调
- 参与精英运动
- 久坐行为
诊断性检查
首要检查
- 匹兹堡睡眠质量指数 (PSQI)
- 失眠严重程度指数 (ISI)
- 斯坦福嗜睡量表 (SSS)
- Epworth 嗜睡量表
- 雅典失眠量表（Athens Insomnia Scale, AIS）
需考虑的检查
- 多导睡眠图 (PSG)
- 活动记录仪检查
- 睡眠日记
- 促甲状腺素 (TSH)
治疗流程
急性失眠症
慢性失眠症
撰稿人
作者
John W. Winkelman, MD, PhD
Chief, Sleep Disorders Clinical Research Program
Department of Psychiatry
Massachusetts General Hospital
Professor of Psychiatry
Harvard Medical School
Boston
MA
利益声明
JWW has received honoraria for consulting to Avadel, CVS, Eisai, and Merck, and research grants from Merck and the RLS Foundation.
鸣谢
Dr John W. Winkelman would like to gratefully acknowledge Dr Teofilo Lee-Chiong and Dr Vipin Malik, previous contributors to this topic.
利益声明
TLC is the Chief Medical Liaison for Philips, a company that makes devices to treat sleep apnoea. VM received research funding from Philips Respironics for a study on COPD-OSA overlap.
同行评议者
Karl Doghramji, MD
Director
Sleep Disorders Center
Thomas Jefferson University Hospital
Philadelphia
PA
利益声明
KD is a speaker for Sanofi-Aventis, King Pharmaceuticals, Takeda Pharmaceuticals, Sepracor, and Pfizer; a consultant for Sanofi-Aventis, Takeda Pharmaceuticals, Sepracor, Pfizer, and Neurocrine Biosciences; and has stock in Merck.
Chiadi U. Onyike, MD, MHS
Assistant Professor
Geriatric Psychiatry and Neuropsychiatry
The Johns Hopkins Hospital
Baltimore
MD
利益声明
CUO declares that he has no competing interests.
Roy Goldberg, MD
Medical Director
Kings Harbor Multicare Center
Bronx
NY
利益声明
RG declares that he has no competing interests.
Craig Sawchuk, MD
Affiliate Assistant Professor
Department of Psychiatry and Behavioral Sciences
University of Washington Medical Center
Seattle
WA
利益声明
CS declares that he has no competing interests.
David Cunnington, MD
Director
Melbourne Sleep Disorders Centre
Melbourne
Victoria
Australia
利益声明
DC has received consulting fees from Sanofi-Aventis and Lundbeck, and honoraria for speaking from Sanofi-Aventis.
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