精神医学64巻10号

2022年10月発行

特集 精神・神経疾患に併存する過眠の背景病態と治療マネジメント

統合失調症に関連した眠気について

著者： 水木慧¹ 小鳥居望²

所属機関： ¹久留米大学医学部神経精神医学講座 ²小鳥居諫早病院

ページ範囲：P.1365 - P.1371

文献概要

抄録　統合失調症と睡眠の関連は100年以上前から指摘されており，近年では統合失調症患者における紡錘波の減衰という疾患特異性のある終夜睡眠ポリグラフィ(PSG)の異常所見に関するさまざまな知見が集積されている。一方で，不眠とは表裏一体の関係にある眠気に焦点を当てた研究は少ない。統合失調症そのものの病態は過覚醒に親和性があるが，抗精神病薬による過鎮静や，統合失調症に合併しやすい睡眠覚醒リズム障害や睡眠時無呼吸症候群などの併存は二次的に日中の眠気を引き起こす。こうした眠気は社会参加への大きな阻害要因となるため，睡眠衛生指導や薬物調整などの対策を講じていくことが重要である。

参考文献

1)Harvey PD, Siu CO, Loebel AD：Change in daytime sleepiness and cognitive function in a 6-month, double-blind study of lurasidone and quetiapine XR in patients with schizophrenia. Schizophr Res Cogn 5：7-12, 2016

2)Kamath J, Virdi S, Winokur A：Sleep Disturbances in Schizophrenia. Psychiar Clin North Am 38：777-792, 2015

3)Chan MS, Chung KF, Yeung WF, et al：Sleep in schizophrenia. A systematic review and meta-analysis of polysomnographic findings in case-control studies. Sleep Med Rev 32：69-84, 2017

4)Caldwell DF, Domirto EF：Electroencephalographic and eye movement patterns during sleep in chronic schizophrenic patients. Electroencephalogr Clin Neurophysiol 22：414-420, 1967

5)Steen RG, Mull C, McClure R, et al：Brain volume in first-episode schizophrenia. systematic review and meta-analysis of magnetic resonance imaging studies. Br J Psychiatry 188：510-518, 2006

6)Kasai K, Shenton ME, Salisbury DF, et al：Progressive decrease of left Heschl gyrus and planum temporale gray matter volume in first-episode schizophrenia. a longitudinal magnetic resonance imaging study. Arch Gen Psychiatry 60：766-775, 2003

7)Ferrarelli F, Huber R, Peterson MJ, et al：Reduced sleep spindle activity in schizophrenia patients. Am J Psychiatry 164：483-492, 2007

8)Manoach DS, Demanuele C, Wamsley EJ, et al：Sleep spindle deficits in antipsychotic-naive early course schizophrenia and in non-psychotic first-degree relatives. Front Hum Neurosci 8：762, 2014

9)Sharma P, Dikshit R, Shah N, et al：Excessive Daytime Sleepiness in Schizophrenia：A Naturalistic Clinical Study. J Clin Diag Res 10：6-8, 2016

10)Johns MW：Sensitivity and specificity of the multiple sleep latency test(MSLT), the maintenance of wakefulness test and the epworth sleepiness scale：failure of the MSLT as a gold standard. J Sleep Res 9：5-11, 2000

11)Geisler P, Tracik F, Crönlein T, et al：The influence of age and sex on sleep latency in the MSLT-30-a normative study. Sleep 29：687-692, 2006

12)Kluge M, Himmerich H, Wehmeier PM, et al：Sleep propensity at daytime as assessed by Multiple Sleep Latency Tests(MSLT)in patients with schizophrenia increases with clozapine and olanzapine. Shizophr Res 135：123-127, 2012

13)Tandon R, Lenderking WR, Weiss C, et al：The impact on functioning of second-generation antipsychotic medication side effects for patients with schizophrenia：a worldwide, cross-sectional, web-based survey. Ann Gen Psychiatry 19：42, 2020

14)Okruszek L, Jernajczyk W, Wierzbicka A, et al. Daytime sleepiness and EEG abnormalities in patients treated with second generation antipsychotic agents. Pharmacological Reports 66：1077-1082, 2014

15)小鳥居望：Risperidone oral solutionの睡眠障害に対する即時効果．未治療の統合失調症を対象としたPSGによる検討．臨床精神薬理 10：799-810, 2007

16)Sharpley AL, Vassallo CM, Cowen PJ：Olanzapine increases slow-wave sleep：evidence for blockade of central 5-HT(2C)receptors in vivo. Biol Psychiatry 47：468-470, 2000

17)Gomez-Revuelta M, Pelayo-Teran JM, Juncal-Ruiz M, et al：Antipsychotic Treatment Effectiveness in First Episode of Psychosis：PAFIP 3-Year Follow-Up Randomized Clinical Trials Comparing Haloperidol, Olanzapine, Risperidone, Aripiprazole, Quetiapine, and Ziprasidone. Int J Neuropsychopharmacol 23：217-229, 2020

18)Wulff K, Dijk DJ, Middleton B, et al：Sleep and circadian rhythm disruption in schizophrenia. Br J Psychiatry 200：308-316, 2012

19)Monteleone P, Natale M, La Rocca A, et al：Decreased nocturnal secretion of melatonin in drug-free schizophrenics：no change after subchronic treatment with antipsychotics. Neuropsychobiology 36：159-163, 1997

20)Poon YPY, Kan CW, Yeung WF, et al：Delayed sleep-wake phase disorder and delayed sleep-wake phase in schizophrenia：Clinical and functional correlates. Schizophr Res 202：412-413, 2018

21)Stubbs B, Vancampfort D, Veronese N, et al：The prevalence and predictors of obstructive sleep apnea in major depressive disorder, bipolar disorder and schizophrenia：A systematic review and meta-analysis. J Affect Disord 197：259-267, 2016

22)Chiner E, Arriero JM, Signes-Costa J, et al：Acute psychosis after CPAP treatment in a schizophrenic patient with sleep apnoea-hypopnoea syndrome. Eur Respir J 7：313-315, 2001

23)Scoriels L, Jones PB, Sahakian BJ：Modafinil effects on cognition and emotion in schizophrenia and its neurochemical modulation in the brain. Neuropharmacology 64：168-184, 2013

24)Andrade C, Kisely S, Monteiro I, et al：Antipsychotic augmentation with modafinil or armodafinil for negative symptoms of schizophrenia：systematic review and meta-analysis of randomized controlled trials. J Psychiatr Res 60：14-21, 2015