References

nnp

Neurology, Neuropsychiatry, Psychosomatics

Неврология, нейропсихиатрия, психосоматика

2074-27112310-1342

"IMA-Press", LLC

10.14412/2074-2711-2016-4-45-50

nnp-671

Research Article

CLINICAL OBSERVATONS

КЛИНИЧЕСКОЕ НАБЛЮДЕНИЕ

HYPERSOMNIA AND CIRCADIAN DISTURBANCES IN PARKINSON’S DISEASE

ГИПЕРСОМНИЯ И ЦИРКАДНЫЕ НАРУШЕНИЯ ПРИ БОЛЕЗНИ ПАРКИНСОНА

Нодель

М. Р.

Nodel

M. R.

Марина Романовна Нодель - кафедра нервных болезней и нейрохирургии.

119021, Москва, ул. Россолимо, 11, nodell_m@yahoo.com

Marina Romanovna Nodel - Department of Nervous System Diseases and Neurosurgery.

11, Rossolimo St., Moscow 119021, nodell_m@yahoo.com

nodell_m@yahoo.com

Первый Московский государственный медицинский университет имени И.М. СеченоваРоссияI.M. Sechenov First Moscow State Medical UniversityRussian Federation

2016

16122016

844550

2016

Нодель М.Р.

Nodel M.R.

Данная работа распространяется под лицензией Creative Commons Attribution 4.0.

This work is licensed under a Creative Commons Attribution 4.0 License.

https://nnp.ima-press.net/nnp/article/view/671

Excessive daytime sleepiness (hypersomnia) is one of the clinically important, but inadequately studied symptoms of Parkinson’s disease (PD). It manifests as constant excessive sleepiness during the day and/or short unexpected (unintentional) naps. Hypersomnia negatively affects quality of life in patients; it is potentially dangerous in the situations requiring greater attention. The paper presents current approaches to diagnosing hypersomnia in PD. It discusses the multifactorial nature of its pathophysiology in patients with PD. The present-day ideas about the relationship of hypersomnia to degeneration of the brain structures involved in the regulation of sleep and wakefulness, to nocturnal sleep disorders and dopaminergic therapy are described. The paper gives the results of experimental and clinical studies confirming the role of circadian mechanisms in the manifestation of insomnia and hypersomnia in PD patients. It describes a clinical case of a patient with moderate motor and cognitive impairments, in whom hypersomnia is a leading factor in deteriorating daily life. The possible role of circadian disturbances in the development of hypersomnia and related mild manifestations of insomnia and parasomnia is discussed. A clinically significant effect in treating sleep and wakefulness disorders has been achieved in the prolonged use of melatonin and cognitive-behavioral therapy.

Повышенная дневная сонливость (гиперсомния) является одним из клинически значимых, но недостаточно изученных симптомов болезни Паркинсона (БП). Она проявляется постоянной повышенной сонливостью в течение дня и/или короткими неожиданными (непреднамеренными) засыпаниями. Гиперсомния негативно влияет на качество жизни пациентов, потенциально опасна в ситуациях, требующих повышенного внимания. Приведены современные подходы к диагностике гиперсомнии при БП. Обсуждается многофакторность ее патофизиологии у пациентов с БП. Описываются современные представления о связи гиперсомнии с дегенерацией структур мозга, участвующих в регуляции сна и бодрствования, нарушениями ночного сна, дофаминергической терапией. Приведены результаты экспериментальных и клинических исследований, подтверждающих роль циркадных механизмов в проявлении инсомнии и гиперсомнии у больных БП. Представлено клиническое наблюдение пациента с умеренно выраженными двигательными, когнитивными нарушениями, у которого ведущим фактором ухудшения повседневной жизни являлась гиперсомния. Обсуждается возможная роль циркадных нарушений в развитии гиперсомнии, а также сопутствующих мягких проявлений инсомнии и парасомнии. Клинически значимый эффект в отношении нарушений сна и бодрствования достигнут на фоне применения пролонгированного препарата мелатонина, когнитивно-поведенческой теарапии.

болезнь Паркинсонагиперсомнияциркадные нарушениямелатонин

Parkinson’s diseasehypersomniacircadian disturbancesmelatonin

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The authors declare that there are no conflicts of interest present.