失眠和其他睡眠障碍治疗共识

XMLTemplate(2010)[18.8.2010–9:55am][1–25]K:/JOP/JOP379307.3d(JOP)[PREPRINTERstage]OriginalPaperBritishAssociationforPsychopharmacologyconsensusstatementonevidence-basedtreatmentofinsomnia,parasomniasandcircadianrhythmdisordersSJWilson1,DJNutt2,CAlford3,SVArgyropoulos4,DSBaldwin5,ANBateson6,TCBritton7,CCrowe8,D-JDijk9,CAEspie10,PGringras11,GHajak12,CIdzikowski13,ADKrystal14,JRNash15,HSelsick16,ALSharpley17andAGWade18AbstractSleepdisordersarecommoninthegeneralpopulationandevenmoresoinclinicalpractice,yetarerelativelypoorlyunderstoodbydoctorsandotherhealthcarepractitioners.TheseBritishAssociationforPsychopharmacologyguidelinesaredesignedtoaddressthisproblembyprovidinganaccessibleup-to-dateandevidence-basedoutlineofthemajorissues,especiallythoserelatingtoreliablediagnosisandappropriatetreatment.AconsensusmeetingwasheldinLondoninMay2009.ThoseinvitedtoattendincludedBAPmembers,representativeclinicianswithastronginterestinsleepdisordersandrecognizedexpertsandadvocatesinthefield,includingarepresentativefrommainlandEuropeandtheUSA.Presenterswereaskedtoprovideareviewoftheliteratureandidentificationofthestandardofevidenceintheirarea,withanemphasisonmeta-analyses,systematicreviewsandrandomizedcontrolledtrialswhereavailable,plusupdatesoncurrentclinicalpractice.Eachpresentationwasfollowedbydiscussion,aimedtoreachconsensuswheretheevidenceand/orclinicalexperiencewasconsideredadequateorotherwisetoflagtheareaasadirectionforfutureresearch.Adraftoftheproceedingswasthencirculatedtoallparticipantsforcomment.Keysubsequentpublicationswereaddedbythewriterandspeakersatdraftstage.Allcommentswereincorporatedasfaraspossibleinthefinaldocument,whichrepresentstheviewsofallparticipantsalthoughtheauthorstakefinalresponsibilityforthedocument.KeywordsSleep,insomnia,parasomnia,circadianrhythmdisorder,consensus,treatmentIntroductionSleepdisordersarecommoninthegeneralpopulationandevenmoresoinclinicalpractice,yetarerelativelypoorlyunder-stoodbydoctorsandotherhealthcarepractitioners.TheseBritishAssociationforPsychopharmacology(BAP)guidelinesaredesignedtoaddressthisproblembyprovidinganaccessibleyetup-to-dateandevidence-basedoutlineofthemajorissues,especiallythoserelatingtoreliablediagnosisandappropriatetreatment.Welimitedourselvestodiscussionofsleepproblemsthatarenotregardedasbeingsecondarytorespiratoryprob-lems(e.g.sleepapnoea–seeNICEGuidanceTA139),asthesefalloutsidetheremitoftheBAP.Wealsodidnotconsidercertainneuropsychiatricdisordersforwhichrecentsetsofguidelinesalreadyexist,suchasnarcolepsy(Billiardetal.,2006)andrestlesslegs(Vignatellietal.,2006)andalsoreferinterestedreaderstotheBritishSleepSocietywebsite’sCollege,London,UK.5ClinicalNeuroscienceDivision,UniversityofSouthamptonUK.6InstituteofMembraneandSystemsBiology,FacultyofBiologicalSciences,UniversityofLeedsUK.7King’sCollegeHospital,London,UK.8MaterPrivateHospital,Dublin,Eire.9SurreySleepResearchCentre,UniversityofSurrey,UK.10UniversityofGlasgowSleepCentre,SacklerInstituteofPsychologicalResearch,UniversityofGlasgow,UK.11King’sCollegeLondon,andPaediatricSleepDisorderUnit,EvelinaChildren’sHospital,London,UK.12SleepDisorderandResearchCentre,UniversityofRegensburg,Germany.13EdinburghSleepCentre,SAAS,Edinburgh,UK.14DukeSleepDisordersLaboratory,DukeUniversitySchoolofMedicine,Durham,NC,USA.15BetsiCadwaladrUniversityHealthBoard,Mold,Flintshire,UK.16UniversityCollegeLondonHospitals,UK.17UniversityDepartmentofPsychiatry,WarnefordHospital,Oxford,UK.18CPSClinicalResearchCentre,Glasgow,Scotland,UK.Correspondingauthor:SueWilson,PsychopharmacologyUnit,DorothyHodgkinBuilding,Whitsonst,Bristol,BS311TD,UKEmail:[e-mail]ology0(0)1–25!TheAuthor(s)2010Reprintsandpermissions:sagepub.co.uk/journalsPermissions.navDOI:10.1177/0269881110379307jop.sagepub.comXMLTemplate(2010)[18.8.2010–9:55am][1–25]K:/JOP/JOP379307.3d(JOP)[PREPRINTERstage]TheBAPisanassociationofpsychiatrists,psychopharma-cologistsandpreclinicalscientistswhoareinterestedinthebroadfieldofdrugsandthebrain.BAPisthelargestnationalorganizationofitskindworldwide,andpublishestheJournalofPsychopharmacology.TheAssociationstartedpublishingconsensusstatementsmorethanadecadeago,andthefirstBAPguidelinesondepressionwereconsideredalandmarkpublicationwhentheyappearedin1993(Montgomery,1993).Thatdocument,updatedin2000andin2008(Andersonetal.,2000;Andersonetal.,2008),hasbecomethestandardofcareinmanycountriesasitisconsideredanaccessibleconsensustoguidepractisingpsychiatrists.Additionalguidelineshavecoveredmanagementofbipolardisorder(Goodwin,2003;Goodwin,2009)drugtreatmentsforaddiction(Lingford-Hughesetal.,2004),anxietydisorders(Baldwinetal.,2005),oldagepsycho