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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
文献概要
抄録 日中の眠気(過眠)を訴える患者の中に，自閉スペクトラム症(autism spectrum disorder：ASD)の併存がみられることがしばしばあり，就学や就業において支障をきたす。ASDでは睡眠障害を生じる頻度が非常に高く，日中眠気は種々の形の睡眠障害に伴って生じ得る。特に多くみられるのが概日リズムの乱れや睡眠不足であり，これにはASDの行動特性に関連した睡眠衛生の問題や，社会参加場面でのストレス・疲労・動機づけの問題も加わる。生物学的には，メラトニンや時計遺伝子を含めた概日リズム機構，報酬系を含めたドーパミン系がASDと睡眠障害の双方に共通して病態に関与する可能性が考えられ，睡眠制御機構全体との関連も視野に入れての解明が望まれる。マネジメントとしては，睡眠の問題の適切な評価，ASDの特性を踏まえた睡眠衛生および社会適応の指導，概日リズムもしくはドパミン系に作用する薬物療法などが鍵となる。
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