2006AASM失眠症心理及行为治疗实践参数.pdf
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1、SLEEP,Vol.29,No.11,200614151.0 INTRODUCTIONINSOMNIA IS A COMMON CONDITION,REPORTED TO OCCUR IN ONE THIRD OF THE ADULT POPULATION.1 CHRONIC INSOMNIA IS ASSOCIATED WITH A reduced quality of life,impaired daytime functioning,increased loss of time from work and higher health costs.Chronic insomnia is a
2、lso associated with an increased risk of depression and chronic use of hypnotic medication.2-4 The diagnosis of insomnia is based on subjective complaints of difficulty falling asleep or staying asleep,or non-restorative sleep associated with marked distress or significant daytime im-pairment.5,6 In
3、somnia-related complaints may include reports of daytime fatigue,problems with memory and concentration and mood disturbance.Insomnia can be a primary disorder,as in pri-mary insomnia(e.g.psychophysiological insomnia,paradoxical insomnia,idiopathic insomnia,physiological insomnia-unspeci-fied,etc.),
4、or(what we term here as)secondary insomnia,where insomnia is a symptom of or associated with other conditions in-cluding medical or psychiatric illness,substance abuse disorder or another sleep disorder.5-7 It is often difficult to distinguish the cause of insomnia in patients with concurrent medica
5、l disorders.However,insomnia,whether primary or secondary to a comor-bid illness,merits attention.Indicators of the severity of insomnia Practice Parameters for the Psychological and Behavioral Treatment of Insomnia:An Update.An American Academy of Sleep Medicine ReportAn American Academy of Sleep M
6、edicine ReportStandards of Practice Committee of the American Academy of Sleep Medicine1Timothy Morgenthaler,MD;2Milton Kramer,MD;3Cathy Alessi,MD;4Leah Friedman,MA,PhD;5Brian Boehlecke,MD;6Terry Brown,DO;7Jack Coleman,MD;8Vishesh Kapur,MD;9Teofilo Lee-Chiong,MD;10Judith Owens,MD;11Jeffrey Pancer,DD
7、S;12Todd Swick,MD1Mayo Clinic,Rochester,MN;2New York Medical Center,New York,NY,3VA Greater Los Angeles Healthcare System-Sepulveda and University of California,Los Angeles,CA;4Stanford University School of Medicine,Stanford,CA;5University of North Carolina,Chapel Hill,NC;6St.Joseph Memorial Hospita
8、l,Murphysboro,IL;7Murfreesboro Medical Center,Murfreesboro,TN;8University of Washington,Seattle,WA;9National Jewish Medical and Research Center,Denver,CO;10 Rhode Island Hospital,Providence,RI;11Toronto,Canada;12Houston Sleep Center,Houston,TXPractice Parameter PaperMorgenthaler et alPRACTICE PARAME
9、TERAbstract:Insomnia is highly prevalent,has associated daytime conse-quences which impair job performance and quality of life,and is asso-ciated with increased risk of comorbidities including depression.These practice parameters provide recommendations regarding behavioral and psychological treatme
10、nt approaches,which are often effective in primary and secondary insomnia.These recommendations replace or modify those published in the 1999 practice parameter paper produced by the American Sleep Disorders Association.A Task Force of content experts was appointed by the American Academy of Sleep M
11、edicine to perform a comprehensive review of the scientific literature since 1999 and to grade the evidence regarding non-pharmacological treatments of insomnia.Recommendations were developed based on this review using evidence-based methods.These recommendations were developed by the Stan-dards of
12、Practice Committee and reviewed and approved by the Board of Directors of the American Academy of Sleep Medicine.Psychological and behavioral interventions are effective in the treatment of both chronic primary insomnia(Standard)and secondary insomnia(Guideline).Stimu-lus control therapy,relaxation
13、training,and cognitive behavior therapy are individually effective therapies in the treatment of chronic insomnia(Standard)and sleep restriction therapy,multicomponent therapy(without cognitive therapy),biofeedback and paradoxical intention are individually effective therapies in the treatment of ch
14、ronic insomnia(Guideline).There was insufficient evidence to recommend sleep hygiene education,imag-ery training and cognitive therapy as single therapies or when added to other specific approaches.Psychological and behavioral interventions are effective in the treatment of insomnia in older adults
15、and in the treatment of insomnia among chronic hypnotic users(Standard).Keywords:Practice guidelines,practice parameters,insomnia primary,insomnia secondary,treatment,behavioral,psychological,non-pharma-cological,stimulus control therapy,relaxation training,sleep restriction,cognitive behavior thera
16、py,multicomponent therapy,paradoxical inten-tion,sleep hygiene education.Citation:Morgenthaler T;Kramer M;Alessi C et al.Practice parameters for the psychological and behavioral treatment of insomnia:an update.An American Academy of Sleep Medicine report.SLEEP 2006;29(11):1415-1419.Disclosure Statem
17、entThis was not an industry supported study.Dr.Morgenthaler has received research support from Itamar Medical,LTD.and ResMed,Inc.Dr.Alessi is a consultant for Prescription Solutions,Inc.Dr.Coleman is on the medical advisory board of Influent Medical;and is a consultant and speaker/instructor for Acc
18、larent.Dr.Kapur has received research support from the Washington Technology Center and Pro-tech Services,Inc.;and has received research equipment from Respironics.Dr.Owens has received research support from Cephalon,Lilly,and Sepracor;is a consultant for Lilly,Cephalon,and Shire;and is a speaker fo
19、r Johnson&Johnson,Cephalon,and Lilly.Dr.Swick has received research support from Sanofi-Aventis,Takeda Pharmaceuticals,Merck,Jazz Pharmaceuticals,Pfizer,Somaxon,Astellas-Pharmaceuticals,and Cephalon;and is a member of the speakers bureau for GlaxoSmith-Kline,Jazz Pharmaceuticals,Sepracor,Cephalon,an
20、d Boehringer Ingel-heim.Drs.Kramer,Friedman,Boehlecke,Brown,Lee-Chiong,and Pancer have indicated no financial conflicts of interest.Submitted for publication April 20,2006Accepted for publication April 30,2006Adress correspondence to:Timothy I.Morgenthaler,MD,Mayo Sleep Disor-ders Center,Mayo Clinic
21、,200 First Street SW,Rochester,MN,55905;Tel:(507)284-3764;Fax(507)266-4372;Email:morganthaler.timothymayo.eduSLEEP,Vol.29,No.11,20061416include intensity,frequency and duration of the sleep difficulty.Insomnia is said to be persistent if it lasts from 1 to 6 months,and chronic if it lasts more than
22、six months.The present paper replaces the previous practice parameters8 for the non-pharmacologic treatment of chronic insomnia.These updated recommendations are based on the accompanying re-view paper2 prepared by a taskforce appointed by the Standards of Practice Committee(SPC)of the American Acad
23、emy of Sleep Medicine(AASM).2.0 METHODS A task force of content experts was appointed by the AASM in January,2004 to review and grade evidence in the peer-reviewed scientific literature regarding the behavioral and psychological treatment of insomnia,including both primary and secondary in-somnia.Re
24、commendations are based on evidence from studies evaluated in this literature review.The Board of Directors of the AASM approved these recom-mendations.All members of the AASM SPC and Board of Direc-tors completed detailed conflict-of-interest statements and were found to have no conflicts of intere
25、st with regard to this subject.These practice parameters define principles of practice that should meet the needs of most patients in most situations.These guidelines should not,however,be considered inclusive of all proper methods of care or exclusive of other methods of care rea-sonably expected t
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