医学常识双语浏览：失眠.docx

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1、医学常识双语浏览：失眠医学常识双语浏览：失眠下面学习啦我为大家带来医学常识双语浏览：失眠，欢迎大家学习!Insomniaismorethanjustbeingunabletofallasleep.Itisasubjectiveconditionofinsufficientornonrestorativesleepdespiteanadequateopportunitytosleep.TheInstituteofMedicineandmostcurrentstudiesplacetheprevalenceofinsomniaat30%to40%inthegeneraladultpopulatio

2、n.Althoughtheneedforsleepdoesnotnecessarilydecreasewithage,theincidenceofsleepdisturbancesappearstoincreasewithage,particularlyamongwomen.Actually,theelderlyaremorepronetosleepmaintenanceproblems,whereasyoungerpeopletendtohavetroublefallingasleep.失眠并不仅仅是无法入睡。失眠是在有足够睡眠时机时睡眠仍不充分或睡后精神无法恢复的一种主观病症。美国医学研究

3、院和现有的多数研究都以为，失眠在普通成人中的流行率为30%至40%。固然睡眠需要未必随年龄增长而减少，但睡眠障碍的发生率似乎是随年龄而增加的，十分是妇女。事实上，老年人更容易在睡眠维持方面出问题，而年轻人则往往是难以入睡。I.Approach.I.诊断思路：Insomniarepresentsasymptomofanunderlyingproblemandisnotinitselfadiseaseentity.Sleepandalertnessareregulatedbyacomplexinteractionbetweenthebodysinternalbiologicclocks,there

4、ticularactivatingsystem,andvariousinfluencessuchaslightoranxietythatcaninterferewiththenormalsleepcycles.Theapproachtodiagnosisshouldrecognizethepotentialforvariouscausesandusehistoryandspecialstudiestodeterminethecauseoftheinsomnia.失眠是某种潜在疾病的一种症状，失眠本身并不是一种病质。睡眠和觉悟是诸多复杂因素互相作用的结果，如人体内生物种、脑干网状激活体系统及其他

5、各种能够影响正常睡眠周期的因素，如灯光、焦虑等。诊断时应该认清各种因素的影响力，并根据病史及其他特殊检查确定失眠原因。A.Typesofinsomnia.A.失眠类型。Althoughmorethanoneclassificationsystemforinsomniaexists,aconsensusseemstosupportdividinginsomniaintotransient(lastingafewdays),short-term(lastingweeks),andlong-termorchronic(lastingmanyweekstomonthsoryears).TheAssoc

6、iationforthePsychophysiologicalStudyofSleephasclassifiedinsomniaas:失眠分类方法不止一种，但公认的是将失眠分为暂时性(持续数天)、短期性(持续数周)和长期性或慢性(持续数周、月或年)这几种。睡眠社会心理生理研究协会将失眠分为下面几种：1.Psychophysiologic,whichcoversthetransientandshort-termproblemsassociatedwithsituationalfactorssuchasconcernaboutanillfamilymember.1.社会心理性失眠。该类失眠包括暂时

7、性和短期性失眠，通常与环境因素有关，如对生病家属的担忧。2.Psychiatric,especiallydepression,whichhasaveryhighconcordancewithinsomnia,andwhichalsocoversotheraffectivedisordersandpsychosis.2.精神病性失眠。尤其是抑郁症引发的失眠，抑郁症与失眠有很高的关联性。其他因素包括情感障碍、精神错乱等。3.Drugsandalcohol,especiallychronicalcoholism,andtheuseofcentralnervoussystemstimulantssuc

8、hascaffeine,nicotine,orotherdrugs.3.药物与酒精性失眠。十分是慢性酒精中毒和服用一些中枢神经系统兴奋剂，如咖啡因、尼古丁或其他药物。4.Sleep-relatedmovementssyndromes.Thesesyndromescompriseaspecialcategoryrelatedtobehavioralormotorproblems.Periodiclimbmovementsandrestlesslegsyndromearethemostfrequentdiagnoses.4.睡眠相关运动综合症。这些综合症包括与行为或运动相关的一些特殊疾病，其中以周

9、期性肢体运动和下肢不适综合症为最常见。5.Sleep-inducedrespiratoryproblems(e.g.,obstructivesleepapnea).Withthiscondition,thepatientsusuallyhavenotroublefallingasleepinitially,buthavemultiplearousalsandawakeningsduringthenight.5.睡眠诱发的呼吸系统疾病(如阻塞性睡眠呼吸暂停)。患有这类疾病的病人通常无入睡困难，但在夜间醒来次数多。6.Medicalandenvironmentalcausessuchasrepea

10、tedrapideyemovement(REM)interruptionsfromoutsidenoise.6.医源及环境性失眠。如外界噪声屡次打断快速眼球运动睡眠相。7.Unknowncauses-thepatientmayjustbeashortsleeper.7.原因不明性失眠。也许病人本来就睡眠少。B.Specialconcerns.B.十分注意问题。Potentially,themostseriousproblemassociatedwithinsomniaisrelatedtoobstructivesleepapnea.Ifleftuntreated,itisassociatedw

11、ithoxygendesaturation,hypercapnia,andhypopnea,whichcanleadtosignificantcardiovascularproblems(e.g.,systemicandpulmonaryhypertension,corpulmonale,andrightventricularfailure).与失眠相关的最严重的潜在问题是阻塞性睡眠呼吸暂时。如不治疗，会并发血氧饱和度下降、高碳酿血症和呼吸减慢，进而导致严重的心血管疾病(如系统性和肺动脉高压、肺心病和右心室衰竭)。II.History病史：A.Characteristicsofinsomnia

12、.A.失眠的特点：Insomniacannotbediagnosedbytheamountoftimeapersonsleeps.Rather,itisdistinguishedbythedaytimeconsequencesofunsatisfactorysleep.Apertinenthistoryforinsomniawouldinclude:不能根据病人睡眠时间长短来诊断失眠。应根据睡眠缺乏能否影响生活加以鉴别。与失眠相关的病史包括：1.Ahistoryofrestlessness,irritability,daytimesomnolence,andimpairedworkorsoci

13、alfunctioning,whichcanleadtosituationalstress.Thismaybeatransientproblem,butitcanleadtodifficultieswithinitiationofsleepandearlyawakenings.1.不安、易怒、昼间困乏及工作与社会职能障碍，均可导致环境压力。问题可能是暂时性的，但会造成入睡困难和早醒。2.Useofcaffeineorotherstimulants,especiallyover-the-countermedications(e.g.,decongestants)thatmaycontaineph

14、edrineorphenylpropanolamine.Lateeveningexercisecanalsobeastimulant.Alcoholmayhelpinducesleep,butitinterfereswithREMsleepandleadstononrestorativesleepandearlyawakenings.2.服用咖啡因或其他兴奋剂，十分是含有麻黄碱或盐酸基丙醇胺的非处方药(如碱充血剂)。晚间锻炼也有兴奋作用。酒精有助入睡，但干扰快速眼球运动睡眠相，导致早醒和睡后精神未恢复。3.Affectchanges,sadness,hopelessness,andvegeta

15、tivesignssuchasweightlossshouldsuggestdepression,themostcommonpsychiatricdisorderassociatedwithinsomnia(Chapter3.3).Thisisespeciallytrueiftheinsomniapersistsforweeks.Anxietydisorderscausedifficultywithgettingtosleep,whereaspatientswithdepressionmayfallasleepmorereadilybuthaveearlyawakening.3.情感变化、悲戚

16、、无助和营养机能变化引发的一些体征，如体重减轻，可提示抑郁症，它是最常见的失眠相关精神病。假如失眠持续数周，其诊断就更确凿无疑。焦虑症导致入睡困难，抑郁症病人则容易入睡，也易早醒。4.Medicalproblemssuchaspepticulcerdiseaseandheartfailurehavebeenimplicatedininsomnia(Chapters7.5and9.6).Ahistoryoffrequentnocturnalurinationscanalsodisruptsleepandmayindicatebenignprostatehyperplasiaorotherpros

17、tateproblems.Hyperthyroidismcancauseirritabilityandinsomnia,ascanthyroidreplacementtherapyforhypothyroidism.Otherproblemssuchasasthma,angina,backpain,andsinusitiscanalsocausesleepdisorders.4.内科疾病。如消化性溃疡病和心力衰竭，都跟失眠有牵连。夜间尿频中断睡眠，多见于良性前列腺增生或其他前列腺疾病。甲状腺功能亢进可导致易怒和失眠，用甲状腺素替代疗法治疗甲状腺功能减退症时也会出现上述现象。其他疾病如哮喘、心绞

18、痛、背痛和鼻窦炎等可以引起睡眠障碍。5.Loudsnoring,daytimesomnolence,forgetfulness,difficultyconcentrating,andahistoryfromthebedpartnerofperiodsofdiscontinuationofbreathingduringsleepof10secondsormoreshouldsuggestamorethoroughevaluationforobstructivesleepapnea.Daytimenapping,associatedfindingsofgastrointestinalrefluxd

19、isease,andhypertensionarealsosuggestiveassociationsforsleepapnea.5.严重打鼾、白天困乏、健忘、注意力难以集中、及睡伴对其睡眠呼吸中断10秒种或以上的描绘等，这些现象都提示应进行更彻底的检查，以确定其能否有阻塞性睡眠呼吸暂停。昼间瞌睡、胃肠反流疾病相关检查结果和高血压等也提示与睡眠呼吸暂停有关。6.Thebedpartnerisalsoagoodpersontoaskaboutlegmovementsduringsleep.Thiscouldbesuggestiveofaperiodiclimbmovementdisorder.A

20、similarsyndrome,restlesslegs,isassociatedwithahistoryofunpleasantsensationsinthelegsandapersistentdesiretomovethem.Bothconditionscauseadelayinsleeponsetandnocturnalawakenings.6.睡伴也是病人睡眠时腿部运动的良好询问对象，提供情况对周期性肢体运动障碍有提示作用。类似的还有不安腿综合症，它通常伴有腿部不适感，并使患者想要不断地移动两腿。这两种疾病都导致入睡推延和夜间觉悟。7.Sleepphasedisturbancescau

21、sedbyjetlagorshiftworkcanbecharacterizedbyearlyawakeningorbyawakeninglaterintheday.7.时差或倒班引起睡眠相混乱，其特征是早醒或白天晚醒。III.Physicalexamination.III.体格检查：Thephysicalexaminationforinsomniaismoreasearchforotherunderlyingdiseasestatesthanforanyspecificsignsforinsomnia,althoughhypertension,obesity,andthicknecksugg

22、estconsiderationofsleepapnea.固然高血压、肥胖症、短颈都可考虑有睡眠呼吸暂停，但失眠患者的体格检查更多的是检查其有否其他潜在疾病，而非检查失眠的特殊体征。IV.Testing.IV.实验室检查：Thediagnosisofunexplainedinsomniamayinvolvetestinginasleeplaboratoryusingpolysomnography.Thisprovidestheopportunitytomonitorsuchparametersastheelectroencephalogram(EEG),breathing,oxygensatu

23、ration,andbodymovementsduringsleep.Polysomnographycandeterminethedisturbancesinchronobiologicrhythmsandlossofnormalsleep-awakepatternsassociatedwithcircadianrhythmdisorders.TheEEGresultsfromthesleeplaboratorywilldemonstrateapatientsabilitytoprogressthroughthefivecyclesofnormalsleepandwhereintheproce

24、ssanydisturbancesmaybelocated.Forinstance,ashortREMsleeplatencyperiodfrominitiationofsleeptoactualREMsleep,alongwithincreasedREMsleep,andreducedtotalsleeptimewithfrequentawakeningsareallassociatedwithdepression.原因不明性失眠的诊断，应采用睡眠实验室多相睡眠描记仪进行检查，其监测参数包括：脑电波、呼吸、血氧饱和度及睡眠时的躯体运动等。多相睡眠描记仪可确诊时间生物节律紊乱和昼夜生理节律异常

25、导致的正常睡眠觉悟方式的丧失。睡眠实验室获得的脑电波可证实病人能否经历五个正常睡眠周期和异常出现的位置。如，初入睡至实际快速眼球运动睡眠之间快速眼球运动睡眠期的缩短，快速眼球运动睡眠延长、频繁觉悟导致总睡眠时间减少等，都与抑郁症有关。V.Diagnosticassessment.诊断评价：Thekeytodiagnosinginsomniaandothersleepdisordersishistoryandsleeplaboratorymonitoring.Short-termproblemsrelatedtodifficultywithinitiatingsleepmaybesituatio

26、nalorenvironmental.Long-termproblemswithsleep_,lastingweekstomonths,maybemorepsychophysiologicsuchaswithchronicanxietyordepression.Athoroughhistoryofpersonalorjob-relatedissues,caffeine,alcoholandotherdruguse,relatedmedicalproblems,abnormallegandbodymovementsatnight,problemswithdaytimenappingandsomn

27、olenceaswellasnighttimesnoring,andapneaspellswillalldirectthepractitionertothecauseofmostproblems.Agoodsleepstudyoftenconfirmsthediagnosisandleadstospecificinterventions.诊断失眠及其他睡眠障碍的关键是病史和睡眠实验室监测。与入睡困难相关的短期失眠一般是由环境因素引起的。持续数周甚至数月的长期睡眠问题更多的是由心理生理因素引起，如长期患有焦虑症或抑郁症。具体的病史检查，包括个人及工作情况问题，咖啡因、酒精及其他药物服用史，相关内科疾病，夜间腿部及躯体异常运动，昼间瞌睡，夜间打鼾及呼吸暂停时间等情况，都能够引导医生找到多数失眠的原因。对睡眠情况进行认真检查通常能够确诊失眠，进而采取特定的治疗措施。医学常识双语浏览：失眠下面学习啦我为大家带来医学常识双语浏览：失眠，欢迎大家学习!Insomniaismorethanjustbeingunabletofallasleep.Itisasubjectiveconditionofinsufficientornonrestorativesleepdespiteanadequateopportunity推荐度：