睡眠障碍的循证治疗

目的评价不同治疗方案对睡眠障碍的疗效及不良反应，为睡眠障碍提供有循证证据的最佳治疗方案。方法以sleep disorder（睡眠障碍）、insomnia（失眠）、restless legs syndrome or RLS（不宁腿综合征）、obstructive sleep apnea or OSA（阻塞性睡眠呼吸暂停）、narcolepsy（发作性睡病）、REM behaviour disorder or RBD（快速眼动睡眠期行为障碍）、treatment or therapv（治疗）等英文词汇作为榆索词，分别检索2006-2013年Cochrane图书馆、美国国家图书馆医学在线（MEDLINE）、ScieneeDireet等数据库，获得临床指南、系统评价、随机对照临床试验、回顾性病例分析研究、病例观察研究及综述等文献，采用Jadad量表进行质量评价。结果经筛选共计纳入与睡眠障碍治疗有关的临床指南6篇、系统评价12篇、随机对照临床试验5篇、回顾性病例分析2篇、病例观察1篇、综述14篇；其中33篇为高质量文献、7篇为低质量文献。经对各项临床试验治疗原则及不同治疗方法疗效和安全性评价显示：（1）失眠为最常见的睡眠障碍，以药物治疗和改善认知行为为主要治疗方法，两种治疗方法各有优缺点，联合治疗为最佳方案。（2）原发性不宁腿综合征的一线治疗药物为多巴胺受体激动药和抗惊厥药，继发性患者主要为病因治疗。（3）阻塞性睡眠呼吸暂停综合征治疗包括经鼻持续气道正压通气、口腔矫正器、手术治疗，其中经鼻持续气道正压通气为一线治疗方法。（4）发作性睡病的药物治疗包括莫达非尼、羟丁酸钠及抗抑郁药，应根据临床分型选择不同药物。（5）快速眼动睡眠期行为障碍的治疗包括一般治疗如避免诱因、保证睡眠环境安全等，药物治疗主要有苯二氮革类及褪黑素。结论借助循证医学评价方法可为不同类型睡眠障碍的治疗提供最佳临床证据。

Evidence-based evaluation of therapeutic measures for sleep disorders

Objective To evaluate the therapeutic efficacy and side effects of various treatment for sleep disorders in order to provide the best therapeutic regimen for the evidence-based treatment of sleep disorders. Methods Sleep disorder, insomnia, restless legs syndrome or RLS, obstructive sleep apnea or OSA, narcolepsy, REM behaviour disorder or RBD, treatment or therapy were used as retrieval words. Cochrane Library, MEDLINE, ScienceDirect were used for retrieval, and manual searching was also used. Related clinical guidelines, systematic reviews, randomized controlled clinical trials, retrospective case analysis, case- observation studies and reviews were collected and evaluated by Jadad Scale. Results Forty related articles were selected as following： 6 clinical guidelines, 12 systematic reviews, 5 randomized controlled trials, 2 retrospective case analysis, 1 case-observation study and 14 reviews. Thirty-three were of high quality, while 7 were of tow quality with score. According to the evaluation of therapeutic efficacy and side effects of various therapies, it is suggested as following： 1） insomnia is the most common in sleep disorders; the treatment methods of insomnia mainly include drug therapy and cognitive behavioral treatment （CBT）; the two kinds of therapy have their own advantages and disadvantages, and the combination therapy of drugs and CBT is the best treatment plan. 2） The first-line treatment of primary RLS is dopamine agonists and anti- seizure drugs; however, the treatment of secondary RLS is mainly etiologic treatment. 3） The main treatments of OSAS are nasal continuous positive airway pressure（nCPAP）, oral orthotics and surgery, and nCPAP is the first- line treatments. 4） The medication of narcolepsy is mainly modafinil, hydroxy butyric acid sodium and antidepressants, and the specific choosing should accord to clinical classifications. 5） The main treatments of RBD include general treatments such as avoiding triggers, insuring the safety of sleep environment, and drug therapy such as benzodiazepines and melatonin. Conclusion Evidence- based medicine can provide the best clinical evidence on sleep disorders＂ treatment.