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Idiopathic hypersomnia

机译：特发性失眠

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Idiopathic hypersomnia continues to evolve from the concept of "sleep drunkenness" introduced by Bedrich Roth in Prague in 1956 and the description of idiopathic hypersomnia with two forms, polysymptomatic and monosymptomatic, by the same Bedrich Roth in 1976. The diagnostic criteria of idiopathic hypersomnia have varied with the successive revisions of the International classifications of sleep disorders, including the recent 3rd edition. No epidemiological studies have been conducted so far. Disease onset occurs most often during adolescence or young adulthood. A familial background is often present but rigorous studies are still lacking. The key manifestation is hypersomnolence. It is often accompanied by sleep of long duration and debilitating sleep inertia. Polysomnography (PSG) followed by a multiple sleep latency test (MSLT) is mandatory, as well as a 24 h PSG or a 2-wk actigraphy in association with a sleep log to ensure a total 24-h sleep time longer than or equal to 660 minutes, when the mean sleep latency on the MSLT is longer than 8 min. Yet, MSLT is neither sensitive nor specific and the polysomnographic diagnostic criteria require continuous readjustment and biologic markers are still lacking. Idiopathic hypersomnia is most often a chronic condition though spontaneous remission may occur. The condition is disabling, sometimes even more so than narcolepsy type 1 or 2. Based on neurochemical, genetic and immunological analyses as well as on exploration of the homeostatic and circadian processes of sleep, various pathophysiological hypotheses have been proposed. Differential diagnosis involves a number of diseases and it is not yet clear whether idiopathic hypersomnia and narcolepsy type 2 are not the same condition. Until now, the treatment of idiopathic hypersomnia has mirrored that of the sleepiness of narcolepsy type 1 or 2. The first randomized, double-blind, placebo-controlled trials of modafinil have just been published, as well as a double-blind, placebo-controlled trial of clarithromycine, a negative allosteric modulator of the gamma-aminobutyric acid-A receptor. (C) 2015 Elsevier Ltd. All rights reserved.
机译：自1956年Bedrich Roth在布拉格提出“睡眠醉酒”的概念，到1976年由同一位Bedrich Roth提出对多发症状和单症状的两种形式的特发性失眠的描述，特发性失眠继续发展。特发性失眠的诊断标准有随着国际上对睡眠障碍分类的不断修订，包括最近的第三版，修订版本也有所不同。到目前为止，尚未进行任何流行病学研究。疾病发作最常见于青春期或成年期。通常存在家族背景，但仍缺乏严格的研究。关键表现是过睡。它通常伴有长时间的睡眠并削弱睡眠惯性。必须进行多导睡眠监测（PSG），然后进行多次睡眠潜伏期测试（MSLT），以及进行24小时PSG或2周活动检查和睡眠记录，以确保24小时总睡眠时间大于或等于660分钟，此时MSLT的平均睡眠延迟时间超过8分钟。然而，MSLT既不灵敏也不特异，多导睡眠图诊断标准需要不断调整，并且仍缺乏生物学标记。尽管可能会自发缓解，特发性失眠通常是一种慢性疾病。该病是致残的，有时甚至比1型或2型发作性睡病更严重。基于神经化学，遗传和免疫学分析以及对睡眠的稳态和昼夜节律过程的探索，提出了各种病理生理学假设。鉴别诊断涉及多种疾病，目前尚不清楚特发性失眠与2型发作性睡病是否处于不同的状况。到目前为止，特发性失眠症的治疗方法已经反映出1型或2型发作性睡病的嗜睡情况。莫达非尼的第一个随机，双盲，安慰剂对照试验已经发表，以及双盲，安慰剂-安慰剂治疗也是如此。 clarithromycine的对照试验，clarithromycine是γ-氨基丁酸-A受体的负变构调节剂。 （C）2015 Elsevier Ltd.保留所有权利。

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