背景:非快速眼动(NREM)误视通常是良性和短暂的,不需要正式治疗。然而,失眠症也可以是慢性的,扰乱睡眠质量,并对患者或其他人造成重大伤害风险。已经描述了许多行为策略来管理NREM睡眠,但是没有发表全面的评论。进行了系统评价,以总结行为和心理干预的范围及其功效。
方法:我们对文献进行了系统的搜索,以确定NREM失眠症的行为和心理治疗的所有报告(混乱性唤醒,性失眠,梦游,睡眠恐怖,与睡眠有关的进食障碍,失眠症重叠障碍)。这项审查是根据PRISMA指南进行的。该方案在PROSPERO(CRD42021230360)注册。搜索是在以下数据库中进行的(最初是2021年3月10日,更新于2023年2月24日):Ovid(MEDLINE),Cochrane图书馆数据库(Wiley),CINAHL(EBSCO),PsycINFO(EBSCO),和WebofScience(Clarivate)。鉴于缺乏标准化的量化结果衡量标准,使用了叙事综合方法。偏见风险评估使用乔安娜·布里格斯研究所的工具。
结果:共包括72种四种语言的出版物,其中大多数是病例报告(68%)或病例系列(21%)。儿童被列入32份出版物,成人被列入44份出版物。最常见的治疗是催眠(33出版物),其次是各种类型的心理治疗(31),睡眠卫生(19),教育/保证(15),松弛(10),预定的觉醒(9),睡眠延长/计划小睡(9),正念(5)研究设计和不一致的结果测量限制了特定治疗的证据,但是一些证据支持多组分CBT,睡眠卫生,预定的觉醒,和催眠。
结论:这篇综述强调了广泛的行为和心理干预措施来管理NREM失眠症。这些治疗效果的证据受到大多数研究的回顾性和不受控制的性质以及不经常使用经过验证的定量结果测量的限制。已经单独研究了行为和心理治疗以及各种组合,和最近的出版物表明,倾向于倾向于多成分认知行为疗法,这些疗法旨在专门针对NREM失眠症的启动和诱发因素。
Non-rapid eye movement (NREM) parasomnias are often benign and transient, requiring no formal treatment. However, parasomnias can also be chronic, disrupt sleep quality, and pose a significant risk of harm to the patient or others. Numerous behavioral strategies have been described for the management of NREM parasomnias, but there have been no published comprehensive reviews. This systematic review was conducted to summarize the range of behavioral and psychological interventions and their efficacy.
We conducted a systematic search of the literature to identify all reports of behavioral and psychological treatments for NREM parasomnias (confusional arousals,
sexsomnia, sleepwalking, sleep terrors, sleep-related eating disorder, parasomnia overlap disorder). This review was conducted in line with PRISMA guidelines. The protocol was registered with PROSPERO (CRD42021230360). The search was conducted in the following databases (initially on March 10, 2021 and updated February 24, 2023): Ovid (MEDLINE), Cochrane Library databases (Wiley), CINAHL (EBSCO), PsycINFO (EBSCO), and Web of Science (Clarivate). Given a lack of standardized quantitative outcome measures, a narrative synthesis approach was used. Risk of bias assessment used tools from Joanna Briggs Institute.
A total of 72 publications in four languages were included, most of which were case reports (68%) or case series (21%). Children were included in 32 publications and adults in 44. The most common treatment was hypnosis (33 publications) followed by various types of psychotherapy (31), sleep hygiene (19), education/reassurance (15), relaxation (10), scheduled awakenings (9), sleep extension/scheduled naps (9), and mindfulness (5). Study designs and inconsistent outcome measures limited the evidence for specific treatments, but some evidence supports multicomponent CBT, sleep hygiene, scheduled awakenings, and hypnosis.
This review highlights the wide breadth of behavioral and psychological interventions for managing NREM parasomnias. Evidence for the efficacy of these treatments is limited by the retrospective and uncontrolled nature of most research as well as the infrequent use of validated quantitative outcome measures. Behavioral and psychological treatments have been studied alone and in various combinations, and recent publications suggest a trend toward preference for multicomponent cognitive behavioral therapies designed to specifically target priming and precipitating factors of NREM parasomnias.