家庭肠外营养(HPN)的输注通常在夜间循环,与睡眠发作相吻合。已知HPN的成年消费者经历睡眠不良,这归因于入睡后频繁的觉醒和长时间的觉醒。因此,大多数消费者不符合睡眠时间和质量或白天午睡的建议。导致睡眠问题的主要潜在病理生理学是夜尿症;然而,其他因素也存在,包括医疗设备造成的中断(即,泵警报),合并症条件,血糖异常,和药物使用。早期指导睡眠是必要的,因为睡眠在身体健康和福祉中的核心作用,包括减轻并发症,如感染风险,肠胃问题,疼痛敏感性,和疲劳。临床医生应定期询问患者的睡眠情况,并解决已知会干扰睡眠的因素。缓解睡眠问题的非药理学机会包括健康睡眠实践教育(即,睡眠卫生);输液时间表的变化,卷,rates,和设备;以及,可能,行为干预,尚未在该人群中进行检查。解决共病条件,比如情绪障碍,营养缺乏也可能有所帮助。还需要HPN递送中的药物干预和技术进步。对这一人群的睡眠研究被认为是当务之急,但目前仍然有限。
Infusions of home parenteral nutrition (HPN) are often cycled at night coinciding with
sleep episodes. Adult consumers of HPN are known to experience poor
sleep attributed to frequent awakenings and long durations of wakefulness after falling a
sleep. Consequently, most consumers do not meet recommendations for sleep duration and quality or daytime napping. The primary underlying pathophysiology resulting in sleep problems is nocturia; however, other factors also exist, including disruptions caused by medical equipment (ie, pump alarms), comorbid conditions, dysglycemia, and medication use. Early guidance on
sleep is imperative because of the central role of
sleep in physical health and wellbeing, including mitigating complications, such as infection risk, gastrointestinal problems, pain sensitivity, and fatigue. Clinicians should routinely inquire about the sleep of their patients and address factors known to perturb
sleep. Nonpharmacologic opportunities to mitigate
sleep problems include education on healthy
sleep practices (ie, sleep hygiene); changes in infusion schedules, volumes, rates, and equipment; and, possibly, behavioral interventions, which have yet to be examined in this population. Addressing comorbid conditions, such as mood disorders, and nutrition deficiencies may also help. Pharmacologic interventions and technological advancement in HPN delivery are also needed. Research on sleep in this population is considered a priority, yet it remains limited at this time.