精神医学65巻11号

2023年11月発行

特集 精神疾患回復の時間経過を見通す

睡眠障害の回復過程を考える

著者： 井上雄一¹

所属機関： ¹東京医科大学睡眠学講座

ページ範囲：P.1546 - P.1554

抄録
　睡眠障害は，治療によって回復した後にも，疾患の病態に応じたケアを行うことが，治療成績を安定させる上で肝要である。特に不眠症については，非機能的認知の変化につれてレジリエンスが変化していくことが回復のカギを握るし，中枢性過眠症では症状の抑制のみならず，周囲からのサポートが重要である。睡眠覚醒相後退障害では，その好発時期においては睡眠衛生を保ち再発予防の治療を長期間行うことが求められる。また，パラソムニアでは，服薬中止後も睡眠不足，飲酒，発熱などの危険因子に注意すべきであるし，閉塞性睡眠時無呼吸では体重管理が予後管理の上で最重要課題となる。治療終結の判断が拙速にならないように十分配慮すべきであろう。

参考文献

1）Ohayon MM：Epidemiology of insomnia：What we know and what we still need to learn. Sleep Med Rev 6：97-111, 2002

2）Morin CM, Bélanger L, LeBlanc M, et al：The natural history of insomnia：A population-based 3-year longitudinal study. Arch Intern Med 169：447-453, 2009

3）Nakajima S, Okajima I, Inoue Y, et al：Validation of the Japanese version of the Ford Insomnia Response to Stress Test and the association of sleep reactivity with trait anxiety and insomnia. Sleep Med 15：196-202, 2014

4）Fortier-Brochu E, Morin CM：Cognitive impairment in individuals with insomnia：Clinical significance and correlates. Sleep 37：1787-1798, 2014

5）Wilt TJ, MacDonald R, Brasure M, et al：Pharmacologic treatment of insomnia disorder：An evidence report for a clinical practice guideline by the American College of Physicians. Ann Intern Med 165：103-112, 2016

6）Cheng P, Kalmbach DA, Hsieh HF, et al：Improved resilience following digital cognitive behavioral therapy for insomnia protects against insomnia and depression one year later. Psychol Med 53：3826-3836, 2023

7）Okajima I, Nakajima S, Inoue Y, et al：Association among changes in sleep-related beliefs, sleep reactivity, and improvement of insomnia following cognitive behavioral therapy. Sleep Med 29：96-97, 2017

8）Tomishima S, Komada Y, Inoue Y, et al：Prevalence and factors associated with the risk of delayed sleep-wake phase disorder in Japanese youth. Front Psychiatry 13：878042, 2022

9）Asaoka S, Komada Y, Inoue Y, et al：Effect of delayed sleep phase during university life on the daytime functioning in work life after graduation. Sleep Med 15：1155-1158, 2014

10）Ito A, Ando K, Hayakawa T, et al：Long-term course of adult patients with delayed sleep phase syndrome. Jpn J Psychiatry Neurol 47：563-567, 1993

11）Futenma K, Takaesu Y, Inoue Y, et al：Delayed sleep-wake phase disorder and its related sleep behaviors in the young generation. Front Psychiatry 14：1174719, 2023

12）Takaesu Y, Inoue Y, Ono K, et al：Circadian rhythm sleep-wake disorders predict shorter time to relapse of mood episodes in euthymic patients with bipolar disorder：A Prospective 48-Week Study. J Clin Psychiatry 79：17m11565, 2018

13）Um YH, Kim TW, Jeong JH, et al：A longitudinal follow-up study on multiple sleep latency test and body mass index of patients with narcolepsy type 1 in Korea. J Clin Sleep Med 13：1441-1444, 2017

14）Trotti LM：Twice is nice?：Test-retest reliability of the multiple sleep latency test in the central disorders of hypersomnolence. J Clin Sleep Med 16：17-18, 2020

15）Li SB, de Lecea L：The hypocretin（orexin）system：From a neural circuitry perspective. Neuropharmacology 167：107993, 2020

16）Ozaki A, Inoue Y, Hayashida K, et al：Quality of life in patients with narcolepsy with cataplexy, narcolepsy without cataplexy, and idiopathic hypersomnia without long sleep time：Comparison between patients on psychostimulants, drug-naïve patients and the general Japanese population. Sleep Med 13：200-206, 2012

17）日本睡眠学会認定委員会　睡眠障害診療ガイド・ワーキンググループ（監）：睡眠障害診療ガイド．文光堂，p 32，2011

18）Gupta MA, Simpson FC：Obstructive sleep apnea and psychiatric disorders：a systematic review. J Clin Sleep Med 11：165-175, 2015

19）Inonue Y：Weight loss from lifestyle interventions and severity of sleep apnoea：A systematic review and meta-analysis. Sleep Med 15：1173, 2014

20）Kagimura T, Nomura T, Inoue Y, et al：Prospective survey on the natural course of restless legs syndrome over two years in a closed cohort. Sleep Med 12：821-826, 2011

21）Inoue Y, Kuroda K, Hirata K, et al：Predictors of health-related quality of life in sufferers with restless legs syndrome：A multi-national study. J Neurol Sci 294：62-66, 2010

22）Trenkwalder C, Allen R, Högl B, et al：Restless legs syndrome associated with major diseases：A systematic review and new concept. Neurology 86：1336-1343, 2016

23）Inoue Y, Kuroda K, Hirata K, et al：Long-term open-label study of parmipexde in patiens with primary restless legs syndrome. J Neurol Sci 294：62-66, 2010

24）Mitterling T, Heidbreder A, Stefani A, et al：Natural course of restless legs syndrome/Willis-Ekbom disease：Long-term observation of a large clinical cohort. Sleep Med 16：1252-1258, 2015

25）Takahashi M, Nishida S, Inoue Y, et al：Restless legs syndrome augmentation among Japanese patients receiving pramipexole therapy：Rate and risk factors in a retrospective study. PloS one 12：e0173535, 2017

26）Trenkwalder C, Högl B, Benes H, et al：Augmentation in restless legs syndrome is associated with low ferritin. Sleep Med 9：572-574, 2008

27）Sato M, Matsui K, Inoue Y, et al：The prevalence and associated factors of seasonal exacerbation of subjective symptoms in Japanese patients with restless legs syndrome. Sleep Med 101：238-243, 2023

28）Augustine A：Nonrapid eye movement parasomnias. J Clin Neurophysiol 40：224-229, 2023

29）Inoue Y：Sleep-related eating disorder and its associated conditions. Psychiatry Clin Neurosci 69：309-320, 2015

30）Sumi Y, Ubara A, Kadotani H, et al：Minor hallucinations in isolated rapid eye movement sleep behavior disorder indicative of early phenoconversion：A preliminary study. Acta Neurol Scand 145：348-359, 2022