【医脉通】2019+BAP共识声明:失眠异态睡眠以及昼夜节律睡眠障碍的治疗.pdf
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1、https:/doi.org/10.1177/0269881119855343Journal of Psychopharmacology 1 25 The Author(s)2019Article reuse guidelines: Association for Psychopharmacology consensus statement on evidence-based treatment of insomnia,parasomnias and circadian rhythm disorders:An updateSue Wilson1,Kirstie Anderson2,David
2、Baldwin3,Derk-Jan Dijk4,Audrey Espie5,Colin Espie6,Paul Gringras7,Andrew Krystal8,David Nutt1,Hugh Selsick9 and Ann Sharpley10AbstractThis British Association for Psychopharmacology guideline replaces the original version published in 2010,and contains updated information and recommendations.A conse
3、nsus meeting was held in London in October 2017 attended by recognised experts and advocates in the field.They were asked to provide a review of the literature and identification of the standard of evidence in their area,with an emphasis on meta-analyses,systematic reviews and randomised controlled
4、trials where available,plus updates on current clinical practice.Each presentation was followed by discussion,aiming to reach consensus where the evidence and/or clinical experience was considered adequate,or otherwise to flag the area as a direction for future research.A draft of the proceedings wa
5、s circulated to all speakers for comments,which were incorporated into the final statement.KeywordsSleep disorders,insomnia,circadian rhythm disorders,parasomnias,guidelines,evidence-based treatment855343JOP0010.1177/0269881119855343Journal of PsychopharmacologyWilson et al.research-article2019BAP G
6、uidelinesTable of ContentsIntroduction 2Method 2Insomnia 2 Scope of the guidelines 2 Table 1 Levels of evidence 3 Epidemiology of insomnia 3 Table 2 Insomnia:diagnostic criteria 4 Diagnosis of insomnia 4 Figure 1 Diagnosis of insomnia 5 Comorbidity 5 Costs and consequences of insomnia 5 Figure 2 The
7、 ideal sleeping pill 6 Recommendation 6 Psychological treatment of insomnia 7 Underpinning principles cognitive behavioural therapy 7 Recommendation 7 Drug treatments for insomnia 7 Underpinning principles-pharmacology 8 Underpinning principles pharmacokinetics 8 Figure 3 treatment of insomnia 9 Tol
8、erance,dependence and withdrawal 9 Pharmacological treatment of insomnia 10 Recommendations 10 Long-term use of sleeping medications 10 Recommendation 11 Using drugs for depression to treat insomnia 11 Recommendations 12 Drugs for psychosis for treatment of insomnia 12 Recommendations 13 Antihistami
9、nes(H1 antagonists)13 Recommendations 13Circadian rhythm disorders 13 Diagnosis of circadian rhythm disorders 14 Treating circadian rhythm disorders 14 Recommendations 14Parasomnias 15 Diagnosis of parasomnias 15 Treatment of parasomnias 15Special populations 16 Sleep disorders in women:effects of m
10、enopause and pregnancy 16 Menopause 16 Recommendations 16 Pregnancy 16 Recommendations 16 Treatment of insomnia in older adults 17 Recommendation 17 Sleep problems in children 17 Recommendations 18 Sleep disturbance in adults with intellectual disability 18 Assessment 18 Treatment considerations 18
11、Recommendations 19References 19Appendix 1 25 2 Journal of Psychopharmacology 00(0)IntroductionSleep disorders are common in the general population,and even more so in clinical practice,yet are relatively poorly understood by doctors and other health care practitioners.These British Association for P
12、sychopharmacology(BAP)guidelines address this problem by providing an accessible yet up-to-date and evi-dence-based outline of the major issues,especially those relating to reliable diagnosis and appropriate treatment.We limited our-selves to discussion of sleep problems that are not regarded as bei
13、ng secondary to sleep disordered breathing;National Institute of Clinical Excellence(NICE)guidelines for this are summarised on the NICE website and an updated guideline will be available in 2020;a comprehensive toolkit is available at the British Sleep Society website,http:/www.sleepsociety.org.uk.
14、We also did not consider certain sleep disorders for which sets of guidelines already exist,such as narcolepsy(Billiard et al.,2006)and rest-less legs syndrome(Picchietti et al.,2015).Thus,the main scope of this document is to address insomnia,circadian rhythm disor-ders(CRDs)and the more common par
15、asomnias which are likely to present to primary care physicians and psychiatrists.The BAP is an association of psychiatrists,psychopharma-cologists and preclinical scientists who are interested in the broad field of drugs and the brain.BAP is the largest national organisa-tion of its kind worldwide,
16、and publishes the Journal of Psychopharmacology.The association started publishing con-sensus statements more than two decades ago,and the first BAP guidelines on depression were considered a landmark publication when they appeared in 1993(Montgomery et al.,1993).There are now guidelines for the tre
17、atment and management of most of the disorders encountered in psychiatry;all guidelines are avail-able to download from the BAP website(http:/www.bap.org.uk).MethodThis British Association for Psychopharmacology guideline replaces the original version published in 2010,(Wilson et al 2010)and contain
18、s updated information and recommendations.A consensus meeting was held in London in October 2017,attended by recognised experts and advocates in the field.They were asked to provide a review of the literature and identification of the standard of evidence in their area,with an emphasis on meta-analy
19、ses,systematic reviews and randomised controlled trials(RCTs)where available,plus updates on current clinical practice.Each presentation was followed by discussion,aiming to reach consensus where the evidence and/or clinical experience was considered adequate,or otherwise to flag the area as a direc
20、tion for future research.The previous consensus statement was then updated with the new evidence and references.Categories of evidence for causal relationships,observational relationships and strength of recommendations are given in Table 1 and are taken from(Shekelle et al.,1999).The strength of re
21、commendation reflects not only the quality of the evidence,but also the importance of the area under study.For example,it is possible to have methodologically sound(category I)evidence about an area of practice that is clinically irrelevant,or has such a small effect that it is of little practical i
22、mportance and therefore attracts a lower strength of recommendation.However,more commonly,it has been necessary to extrapolate from the available evidence leading to weaker levels of recommendation(B,C or D)based upon category I evidence statements.The costs of the meeting were defrayed by BAP.All s
23、peakers completed conflict of interest statements that are held at the BAP office according to BAP policy.InsomniaScope of the guidelinesOur intention is to provide an updated statement to guide clini-cians who manage patients in primary or secondary medical care.There have been three sets of guidel
24、ines for the treatment of insomnia since the previous BAP consensus(Qaseem et al.,2016;Riemann et al.,2017;Sateia et al.,2017).The first set of guidelines concerns adults with insomnia and includes insomnia comorbid with other disorders such as depression;the second set addresses primary insomnia wi
25、thout comorbidity;the third set covers all adults with chronic insomnia disorder.These sets were discussed by the expert group and where appropriate some ele-ments were incorporated in the present consensus.Since the publication of the 2010 BAP guideline,there has been an important shift in thinking
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