Update sleep medicine 2010

作者：Mayer G^*; Javidi S

来源：Nervenheilkunde, 2011, 30(9): 683-+.

• Polysomnography
• polygraphy
• cardiovascular and metabolic risk factors
• hyperaraousal model
• genome-wide analysis
• narcolepsy
• REM sleep behaviour disorder

Diagnosis of sleep disorders can be performed according to the evidence based guideline "nonrestorative sleep/sleep disorders" of the German Sleep Society. PSG scoring is performed according to a new system since 2007. Frontal and occipital derivations allow scoring of graphoelements that characterize sleep stages at their maximal representation. Deep sleep stages are reduced to one stage N3. Indication for ambulatory polygraphy for diagnosis of sleep related breathing disorders is optimized by introducing a "pretest probability". PSG is indicated if it is high and polygraphy displays only little apneas, and when alveolar hypoventilation is probable. Sleep related breathing disorders and short sleep are associated with high cardiovascular, metabolic and mortality risk. If insomnia is a risk factor itself is unclear. However, many proofs for the hyperarousal model of insomnia have been discovered. New therapeutic options for insomnia are given by the introduction of melatonin agonists. Genome-wide analysis has found several associations with gene loci that support the autoimmune hypothesis of narcolepsy. Post mortem investigations displayed a minor loss of hypocretinergic cells in humans. The allele DQB1*0602 is almost always associated with a low CSF hypocretin, and. therefore does not require a diagnostic lumbar puncture. REM sleep behaviour disorder has become an established predictor for neurodegenerative diseases. The diagnostic procedures comprise specific questionnaires, olfactory tests, transcranial ultrasound of basal ganglia, cerebral imaging and muscle tone analysis of REM sleep.

• 出版日期2011