对于失眠的新兴和即将到来的治疗方法
1Inje University College of Medicine, Busan, Korea.
Translational and clinical pharmacology
|April 8, 2024
概括
新的失眠治疗方法,如双素受体对抗剂 (DORAs),为二类药物提供了更安全的替代品. 不眠症的认知行为疗法 (CBT-I) 和数字疗法也显示出改善睡眠管理的前景.
科学领域:
- 药理学和睡眠医学 药理学和睡眠医学
- 睡眠调节的神经科学 睡眠调节的神经科学
背景情况:
- 对于失眠的二二胺受体激动剂 (BZDs) 携带滥用和依赖的风险.
- 为了解决这些局限性,正在开发新的药理和非药理干预措施.
研究的目的:
- 审查双素受体对抗剂 (DORAs) 和选择性素-2受体对抗剂 (2-SORAs) 的作用机制,药理动力学,疗效和安全性.
- 讨论对失眠的认知行为治疗 (CBT-I) 和数字治疗在失眠管理中的作用.
主要方法:
- 对药理学药物 (DORA,2-SORA) 和非药理学干预措施 (CBT-I,数字疗法) 的文献综述.
- 对药物机制,临床试验数据和真实世界的安全信息的分析.
主要成果:
- DORAs (suvorexant, daridorexant, lemborexant) 提供了一种新的机制,通过阻断唤醒促进的素,诱导自然睡眠而不发生阶段变化或认知障碍.
- 选择性素-2受体对抗剂 (2-SORA) 正在临床开发中.
- 治疗失眠的认知行为疗法 (CBT-I),包括像Somryst®这样的数字格式,显示出有效性,但面临着可扩展性的挑战.
结论:
- DORA和2-SORA代表了对失眠有前途的药理学替代品,重点是改善安全性.
- 数字CBT-I提供可访问的非药物选择,尽管存在局限性.
- 未来的失眠治疗强调了药理和非药理方法的安全性,有效性和可访问性.
相关概念视频
01:19Management of Insomnia
244
The sleep cycle, an integral part of human health, consists of several stages with distinct characteristics and functions. It begins with a transition from wakefulness to sleep, known as the light sleep phase, followed by the restorative deep sleep phase, essential for physical recovery and growth. The cycle concludes with the Rapid Eye Movement (REM) phase, characterized by high brain activity and vivid dreaming. Insomnia, a prevalent sleep disorder, involves difficulty falling asleep, staying...
244
01:17Sedatives and Hypnotics Drugs: Miscellaneous Agents
171
Sedatives and hypnotics encompass a wide range of substances, each with its unique mechanism of action, uses, and potential adverse effects.
Melatonin congeners like ramelteon (Rozerem) and tasimelteon (Hetlioz) selectively bind to melatonin receptors (MT1 and MT2) and thus mimic the actions of melatonin, a hormone that regulates sleep-wake cycles. Tasimelteon is primarily used for non-24-hour sleep-wake disorder, common in blind patients. They are also used to treat conditions like insomnia...
Melatonin congeners like ramelteon (Rozerem) and tasimelteon (Hetlioz) selectively bind to melatonin receptors (MT1 and MT2) and thus mimic the actions of melatonin, a hormone that regulates sleep-wake cycles. Tasimelteon is primarily used for non-24-hour sleep-wake disorder, common in blind patients. They are also used to treat conditions like insomnia...
171
01:27Insomnia
84
Insomnia is a prevalent sleep disorder characterized by difficulty falling asleep, frequent awakenings during the night, and waking up too early without being able to return to sleep. People with insomnia often experience these disruptions at least three nights a week for at least one month. Chronic insomnia, which lasts for at least three months, can lead to increased anxiety, which in turn can worsen sleep difficulties, creating a cycle of sleeplessness and stress.
Multiple factors contribute...
Multiple factors contribute...
84
01:23Sedatives and Hypnotics: Overview
355
Sedatives are drugs that alleviate anxiety, while hypnotics induce sleep. Both classes of medication suppress neuronal activity, leading to a calming effect for sedatives and facilitating sleep for hypnotics.
Sedative-hypnotics are categorized into barbiturates, benzodiazepines (BZDs), and non-benzodiazepines or Z-drugs. These drugs work by suppressing central nervous system activity, and this suppression is dose-dependent. Older sedative medications, like barbiturates, follow a linear curve in...
Sedative-hypnotics are categorized into barbiturates, benzodiazepines (BZDs), and non-benzodiazepines or Z-drugs. These drugs work by suppressing central nervous system activity, and this suppression is dose-dependent. Older sedative medications, like barbiturates, follow a linear curve in...
355
01:23Antidepressant Drugs: MAOIs and Other Agents
227
Atypical antidepressants, including bupropion (Wellbutrin), mirtazapine (Remeron), nefazodone (Serzone), trazodone (Desyrel), and vilazodone (Viibryd), offer unique mechanisms of action. Bupropion weakly inhibits dopamine and norepinephrine reuptake, aiding depression treatment and smoking cessation, with a low risk of sexual dysfunction. Mirtazapine enhances serotonin and norepinephrine neurotransmission, leading to sedation, increased appetite, and weight gain. As a result, it helps treat...
227
01:14CNS Depressants: Barbiturates and Benzodiazepines
258
CNS depressants include drugs from the category of barbiturates and benzodiazepines. They are valuable medications for managing anxiety disorders and insomnia. Barbiturates, once used to induce and maintain sleep, have been replaced mainly by benzodiazepines due to barbiturate's toxicity, tolerance, and overdose risks. They interact with GABAA receptors, leading to sedation at low doses and potentially coma and death at higher doses. Phenobarbital, a long-acting barbiturate, possesses...
258