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

摂食障害と過眠

著者： 都留あゆみ¹ 松井健太郎¹²

所属機関： ¹国立精神・神経医療研究センター病院臨床検査部 ²東京女子医科大学精神医学講座

ページ範囲：P.1373 - P.1380

抄録　摂食障害は神経性やせ症，神経性過食症，過食性障害に分類される。神経性やせ症がやせ願望を背景とした極端な体重減少を主症状とする一方，神経性過食症，過食性障害はいずれも持続的なむちゃ食いを主症状とし，不適切な代償行動の有無(神経性過食症では嘔吐や下剤の使用などの排出行動がみられる)で鑑別される。摂食障害は，いずれの病型であっても睡眠障害が生じやすいことが示されてきた一方，摂食障害患者の過眠症状について評価した研究は少ない。神経性やせ症で体重の減少に伴って生じる茫洋とした様子は飢餓反応によるものと考えられる。逆に過食性障害による体重の増加は閉塞性睡眠時無呼吸による二次的な日中の眠気を生じうる。本稿では，摂食障害患者に生じる睡眠の問題や睡眠構築の変化，概日リズムとの関連について概説するとともに，摂食障害で特異的に生じうる日中の眠気について考察する。

参考文献

1)髙橋三郎，大野裕(監訳)：DSM-5精神疾患の診断・統計マニュアル．医学書院，2014

2)Asaad Abdou T, Esawy HI, Abdel Razek Mohamed G, et al：Sleep profile in anorexia and bulimia nervosa female patients. Sleep Med 48：113-116, 2018

3)Kim KR, Jung YC, Shin MY, et al：Sleep disturbance in women with eating disorder：prevalence and clinical characteristics. Psychiatry Res 176：88-90, 2010

4)Bat-Pitault F, Da Silva C, Charvin I, et al：Sleep disturbances in anorexia nervosa subtypes in adolescence. Eat Weight Disord 26：1845-1852, 2021

5)Levy AB, Dixon KN, Schmidt H：Sleep architecture in anorexia nervosa and bulimia. Biol Psychiatry 23：99-101, 1988

6)Nobili L, Baglietto MG, Beelke M, et al：Impairment of the production of delta sleep in anorectic adolescents. Sleep 27：1553-1559, 2004

7)Lacey JH, Crisp AH, Kalucy RS, et al：Study of EEG sleep characteristics in patients with anorexia nervosa before and after restoration of matched population mean weight consequent on ingestion of a “normal” diet. Postgrad Med J 52：45-49, 1976

8)El Ghoch M, Calugi S, Bernabè J, et al：Sleep Patterns Before and After Weight Restoration in Females with Anorexia Nervosa：A Longitudinal Controlled Study. Eur Eat Disord Rev 24：425-429, 2016

9)Menculini G, Brufani F, Del Bello V, et al：Circadian rhythms disruptions and eating disorders：clinical impact and possible psychopathological correlates. Psychiatr Danub 31：497-502, 2019

10)Sauchelli S, Jiménez-Murcia S, Sánchez I, et al：Orexin and sleep quality in anorexia nervosa：Clinical relevance and influence on treatment outcome. Psychoneuroendocrinology 65：102-108, 2016

11)Kennedy SH, Garfinkel PE, Parienti V, et al：Changes in melatonin levels but not cortisol levels are associated with depression in patients with eating disorders. Arch Gen Psychiatry 46：73-78, 1989

12)Kennedy SH：Melatonin disturbances in anorexia nervosa and bulimia nervosa. Int J Eat Disord 16：257-265, 1994

13)Simor P, Zavecz Z, Pálosi V, et al：The influence of sleep complaints on the association between chronotype and negative emotionality in young adults. Chronobiol Int 32：1-10, 2015

14)Latzer Y, Tzischinsky O, Epstein R：Sleep-wake monitoring in women suffering from anorexia nervosa. Eat Disord 9：159-166, 2001

15)Tzischinsky O, Latzer Y：Sleep-wake cycles in obese adolescents with and without binge eating episodes. Eur Eat Disord Rev 14：111-117, 2006

16)日本摂食障害学会(監修)：摂食障害治療ガイドライン．医学書院，2012

17)田村奈穂：摂食障害における身体合併症．臨床栄養 127：907-911, 2015

18)National Collaborating Centre for Mental Health：Eating Disorders：Core Interventions in the Treatment and Management of Anorexia Nervosa, Bulimia Nervosa and Related Eating Disorders. British Psychological Society(UK), 2004

19)Treasure J, Claudino AM, Zucker N：Eating disorders. Lancet 375：583-593, 2010

20)Touyz S, Le Grange D, Lacey H, et al：Treating severe and enduring anorexia nervosa：a randomized controlled trial. Psychol Med 43：2501-2511, 2013

21)Le Grange D, Fitzsimmons-Craft EE, Crosby RD, et al：Predictors and moderators of outcome for severe and enduring anorexia nervosa. Behav Res Ther 56：91-98, 2014

22)Hay PJ, Claudino AM, Touyz S, et al：Individual psychological therapy in the outpatient treatment of adults with anorexia nervosa. Cochrane Database Syst Rev 2015：Cd003909, 2015

23)Kessler RC, Berglund PA, Chiu WT, et al：The prevalence and correlates of binge eating disorder in the World Health Organization World Mental Health Surveys. Biol Psychiatry 73：904-914, 2013

24)Gottlieb DJ, Punjabi NM：Diagnosis and Management of Obstructive Sleep Apnea：A Review. JAMA 323：1389-1400, 2020

25)George CF：Reduction in motor vehicle collisions following treatment of sleep apnoea with nasal CPAP. Thorax 56：508-512, 2001

26)Connor J, Whitlock G, Norton R, et al：The role of driver sleepiness in car crashes：a systematic review of epidemiological studies. Accid Anal Prev 33：31-41, 2001

27)Young T, Palta M, Dempsey J, et al：The occurrence of sleep-disordered breathing among middle-aged adults. N Engl J Med 328：1230-1235, 1993

28)Lydecker JA, Grilo CM：Comparing men and women with binge-eating disorder and co-morbid obesity. Int J Eat Disord 51：411-417, 2018

29)Tzischinsky O, Latzer Y, Epstein R, et al：Sleep-wake cycles in women with binge eating disorder. Int J Eat Disord 27：43-48, 2000

30)Patel SR, White DP, Malhotra A, et al：Continuous positive airway pressure therapy for treating sleepiness in a diverse population with obstructive sleep apnea：results of a meta-analysis. Arch Intern Med 163：565-571, 2003

31)Ferguson KA, Cartwright R, Rogers R, et al：Oral appliances for snoring and obstructive sleep apnea：a review. Sleep 29：244-262, 2006

32)Wilfley DE, Welch RR, Stein RI, et al：A randomized comparison of group cognitive-behavioral therapy and group interpersonal psychotherapy for the treatment of overweight individuals with binge-eating disorder. Arch Gen Psychiatry 59：713-721, 2002

33)Hilbert A, Bishop ME, Stein RI, et al：Long-term efficacy of psychological treatments for binge eating disorder. Br J Psychiatry 200：232-237, 2012

34)McElroy SL, Shapira NA, Arnold LM, et al：Topiramate in the long-term treatment of binge-eating disorder associated with obesity. J Clin Psychiatry 65：1463-1469, 2004

35)Claudino AM, de Oliveira IR, Appolinario JC, et al：Double-blind, randomized, placebo-controlled trial of topiramate plus cognitive-behavior therapy in binge-eating disorder. J Clin Psychiatry 68：1324-1332, 2007

36)McElroy SL, Hudson JI, Capece JA, et al：Topiramate for the treatment of binge eating disorder associated with obesity：a placebo-controlled study. Biol Psychiatry 61：1039-1048, 2007

37)Brownley KA, Berkman ND, Peat CM, et al：Binge-Eating Disorder in Adults：A Systematic Review and Meta-analysis. Ann Intern Med 165：409-420, 2016

38)高石久：Lisdexamfetamineの依存・乱用リスクを巡る国内外の知見．臨床精神薬理 22：993-1000, 2019