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1、Consensusondrugtreatment,definitionanddiagnosisforinsomnia.失眠的定义、诊断及药物治疗共识E・Estivill,A.Bove,D.Garcia-Borreguero,J.Gibert,J.Paniagua,G.Pin,F・J・Puertas,R.CilvetiandmembersoftheConsensusGroupUnidaddeTrastornosdeSueno,InstitutoUniversitarioDexeus,Barcelona,Spa
2、in・Thirty-fourexpertsandaliteraturesupervisorgottogetherinordertoreachaconsensus1regardingthedefinition,diagnosisandpharmacologicaltreatmentofinsomnia.Insomniaisasubjectiveperceptionofdissatisfactionwiththeamountand/orqualityofsleep.Itincludesdifficultyini
3、nitiatingormaintainingsleeporearlyawakeningwithinabilitytofallasleepagain.Itisassociatedwithcomplaintsofnon-restorativesleepanddysfunctionofdiurnalalertness,energy,cognitivefunction,behaviouroremotionalstate,withadecreaseinqualityoflife.Thediagnosisisbased
4、onclinicalandsleephistory,physicalexaminationandadditionaltests,althoughpolysomnographyisnotroutinelyindicated.Therapyshouldincludetreatmentoftheunderlyingcauses,cognitiveandbehaviouralmeasuresanddrugtreatment.Hypnotictherapycanbeprescribedfromtheonsetofin
5、somniaandnon-benzodiazepineselectiveagonistsoftheGABA-Areceptorcomplexarethedrugsoffirstchoice.Itisrecommendedthathypnotictreatmentbemaintainedincaseswherewithdrawalimpairsthepatientsqualityoflifeandwhenallothertherapeuticmeasureshavefailed.Experiencesugge
6、ststhatintermittenttreatmentisbetterthancontinuoustherapy.Theavailabledatadonotconfirmsafetyofhypnoticsinpregnancy,lactationandchildhoodinsomnia.Benzodiazepinesarenotindicatedindecompensatedchronicpulmonarydiseasebutnosignificantadverseeffectsonrespiratory
7、functionhavebeenreportedwithzolpidemandzopicloneinstablemildtomoderatechronicobstructivepulmonarydiseaseandintreatedobstructivesleepapnoeasyndrome.Dataforzaleplonareinconclusive.Ifthepatientrecoverssubjectivecontroloverthesleepprocess,gradualdiscontinuatio
8、nofhypnotictreatmentcanbeconsidered.(ClinDrugInvest2003;23(6):351-385)由34名专家和1名文献顾问组成的专家组，共同讨论制定出有关失眠的定义、诊断及其药物治疗的“共识”(consensus)。失眠是个体对睡眠时间和/或质量不满足的一种主观体验，包括入睡困难、睡眠维持障碍，或早醒并无法再次入睡。常见主诉为醒后疲乏、白天警觉性降低、无精打采,以及认知
