medsovetМедицинский СоветMeditsinskiy sovet = Medical Council2079-701X2658-5790REMEDIUM GROUP Ltd.10.21518/2079-701X-2019-12-48-53medsovet-3132Research ArticleНЕВРОЛОГИЯNEUROLOGYНарушения сна у жителей мегаполисаSleep disorders in metropolitan residentsЦареваЕ. В.TsarevaE. V.

Царева Елена Вячеславовна - руководитель сомнологической службы «Унисон», руководитель секции «Стресс и сон» Международного общества по изучению и эффективному контролю стресса и связанных с ним расстройств «Стресс под контролем», невролог-сомнолог.

123596, Москва, ул. Горбунова, д. 2, стр. 3, офис 812; тел./факс: +7(495)212-09-03

Tsareva Elena Vyacheslavovna - CEO Unison Sleep Service, Chief of Section Stress&Sleep of the International Society Stress Under Control, MD, Neurologist, Sleep Medicine Specialist.

123596, Moscow, Gorbunova St., 2, Bldg. 3, Office 812

tsareva.ev@unisongroup.ruСомнологическая служба «Унисон»РоссияUnison Sleep ServiceRussian Federation2019290820190124853Copyright © Царева Е.В., 20192019Царева Е.В.Tsareva E.V.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.med-sovet.pro/jour/article/view/3132

Каждый второй горожанин сталкивается с нарушениями сна. Последствия снижения качества сна имеют серьезное медицинское и социально-экономическое значение. Популяционные исследования выделяют основные причины нарушений сна для жителей мегаполисов: стресс, нарушение гигиены сна и соматические заболевания. Влияние стресса на сон отмечают 75% опрошенных. Наиболее часто встречается бессонница, наряду с обструктивным апноэ во сне и синдромом беспокойных ног. Тактика лечения бессонницы строится на существующих стандартах ведения пациентов с инсомнией. Основные методы коррекции хронической бессонницы - когнитивно-поведенческая терапия, медикаментозное лечение коротко действующими препаратами или их сочетание. Препараты, рекомендованные для фармакотерапии хронической бессонницы: Z-гипнотики, бензодиазепины, препараты мелатонина и агонисты мелатониновых рецепторов, блокаторы гистаминовых Н1-рецепторов, антидепрессанты, антипсихотики, растительные и противоэпилептические препараты. Большая часть из них представлена в таблетированной форме. Случаи постепенной отмены гипнотика, увеличения периода полувыведения препарата, а также отказа от медикаментозного лечения из опасения отсутствия контроля побочных эффектов требуют индивидуального подбора дозировки гипнотиков. Жидкая форма доксиламина из группы Н1-гистаминовых рецепторов в виде капель -Валокардин®-Доксиламин (Krewel Meuselbach GmbH, Германия) дает возможность удобного дозирования при потенцировании эффекта за счет сочетания с этанолом и мятным маслом.

Every second patient has sleep disorder. Outcomes of decreased quality of sleep lead to serious medical and socioeconomic value. Population studies identify the main causes of sleep problems: stress, poor sleep hygiene, somatic disorders. The effect of stress on sleep is noted by 75% of responders. The most frequently sleep disorders are insomnia, obstructive sleep apnea and restless legs. Treatment of insomnia based on current standards for the management of patients with insomnia. The main methods for the treatment of chronic insomnia are cognitive behavioral therapy, short-term hypnotic pharmacotherapy or a combination of both. Z-hypnotics, benzodiazepine receptors agonists, melatonine and melatonine receptors agonists, antihistamines, antidepressants, neuroleptics, herbal and antiepileptic drugs are recommended for the treatment of chronic insomnia. Most of them are in tablet form. Cases of gradual cancellation of hypnotics, an increase in half-life of the drug and refusal of hypnotic drug for fear of lack of hypnotic side effects control, require individual selection of the dosage. Liquid form (in drops) of doxilamine from antihistamines group -Valocardine®-Doxilamine (Krewel Meuselbach GmbH, Germany) enables convenient dosing with addition potentiation of the effect due to combination with ethanol and mint oil.

нарушения снагородское населениебессонницаинсомниягипнотикиsleep disordersadultscitizensinsomniahypnoticsReferencesWittmann M., Dinich J., Merrow M., Roenneberg T., Social jetLag: misalignment of biological and social time, Chronobiol Int. 2006;23(1-2):497-509.Wittmann M., Dinich J., Merrow M., Roenneberg T., Social jetLag: misalignment of biological and social time, Chronobiol Int. 2006;23(1-2):497-509.Фонд общественного мнения. Всероссийский репрезентативный опрос населения. 2017.Public Opinion Foundation. All-Russian representative survey of the population. 2017 (In Russ).Lee H., Xie L., Yu M., Kang H., Feng T., Deane R. et al, The Effect of Body Posture on Brain Glymphatic Transport. J Neurosci. 2015;35(31): 11034-11044.Lee H., Xie L., Yu M., Kang H., Feng T., Deane R. et al, The Effect of Body Posture on Brain Glymphatic Transport. J Neurosci. 2015;35(31): 11034-11044.Пигарев Н.И. Висцеральная теория сна. Журнал высшей нервной деятельности. 63(1), 2013;1:86-104.N. I. Pigarev, Visceral Theory of Sleep. Zhurnal Vysshei Nervnoi Deyatelnosti, vol. 63, 2013;1:86-104. (In Russ).Mahabala C., Kamath P., Bhaskaran U., Pai N.D., Pai A.U. Antihypertensive therapy: nocturnal dippers and nondippers. Do we treat them differently? Vascular Health and Risk Management. 2013;9:125-133.Mahabala C., Kamath P., Bhaskaran U., Pai N.D., Pai A.U. Antihypertensive therapy: nocturnal dippers and nondippers. Do we treat them differently? Vascular Health and Risk Management. 2013;9:125-133.Van Cauter E., Copinschi G. Interrelationships between growth hormone and sleep. Growth Horm IGF Res. 2000 Apr;10 Suppl B:S57-62.Van Cauter E., Copinschi G. Interrelationships between growth hormone and sleep. Growth Horm IGF Res. 2000 Apr;10 Suppl B:S57-62.Westermann J., Lange T., Textor J., Born J. System Consolidation During Sleep - A Common Principle Underlying Psychological and Immunological Memory Formation. Trends Neurosci. 2015;38(10):585-597.Westermann J., Lange T., Textor J., Born J. System Consolidation During Sleep - A Common Principle Underlying Psychological and Immunological Memory Formation. Trends Neurosci. 2015;38(10):585-597.Williamson A.M., Feyer A.M. Moderate sleep deprivation produces impairments in cognitive and motor performance equivalent to legally prescribed levels of alcohol intoxication. Occup Environ Med. 2000 Oct; 57(10):649-55.Williamson A.M., Feyer A.M. Moderate sleep deprivation produces impairments in cognitive and motor performance equivalent to legally prescribed levels of alcohol intoxication. Occup Environ Med. 2000 Oct; 57(10):649-55.Федеральный закон от 3 апреля 2018 г. № 62-ФЗ «О внесении изменения в статью 12.8 Кодекса Российской Федерации об административных правонарушениях».Федеральный закон от 3 апреля 2018 г. № 62-ФЗ «О внесении изменения в статью 12.8 Federal Law No. 62-FZ «On Amending Article 12.8 of the Administrative Offenses Code of the Russian Federation» of April 3, 2018 (In Russ).Crash and causality statistics, NSW Centre for Road Safety, 2017.Crash and causality statistics, NSW Centre for Road Safety, 2017.Kario K. Nocturnal Hypertension. Hypertension. 2018;71:997-1009.Kario K. Nocturnal Hypertension. Hypertension. 2018;71:997-1009.Chobanian A.V., Bakris G.L., Black H.R., Cushman W.C., Green LA., Izzo J.L. Jr., Jones D.W., Materson BJ., Oparil S., Wright J.T. Jr., Roccella EJ. National Heart, Lung, and Blood Institute Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure; National High Blood Pressure Education Program Coordinating Committee., The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure: the JNC 7 report. JAMA, 2003;289:2560 -2572.Chobanian A.V., Bakris G.L., Black H.R., Cushman W.C., Green LA., Izzo J.L. Jr., Jones D.W., Materson BJ., Oparil S., Wright J.T. Jr., Roccella EJ. National Heart, Lung, and Blood Institute Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure; National High Blood Pressure Education Program Coordinating Committee., The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure: the JNC 7 report. JAMA, 2003;289:2560 -2572.Logan A.G., Perlikowski S.M., Mente A., Tisler A., Tkacova R., Niroumand M. et al. High prevalence of unrecognized sleep apnoea in drug-resistant hypertension. J. Hypertens, 2001;19:2271-2277.Logan A.G., Perlikowski S.M., Mente A., Tisler A., Tkacova R., Niroumand M. et al. High prevalence of unrecognized sleep apnoea in drug-resistant hypertension. J. Hypertens, 2001;19:2271-2277.Курлыкина Н.В., Певзнер А.В., Литвин А.Ю., Галицин П.В., Чазова И.Е., Соколов С.Ф., Голицын С.П. Возможности лечения больных с длительными ночными асистолиями и синдромом обструктивного апноэ сна созданием постоянного положительного давления воздуха в верхних дыхательных путях. Кардиология, 2009; 49(6):36-42.Kurlykina N.V., Pevzner A.V. Litvin A.Yu., Galitsyn P.V., Chazova I.E., Sokolov S.F., Golitsyn S.P. Prospects for the treatment of patients with prolonged nocturnal asystoles and obstructive sleep apnea by creating a constant positive air pressure in the upper respiratory tract. Kardiologia, vol. 49 2009;6:36-42. (In Russ).Gami A.S., Hodge D.O., Herges R.M., Olson E.D., Nykodym J., Kara T., Somers V.K. Obstructive sleep apnea, obesity, and the risk of incident atrial fibrillation. J.Am. Coll. Cardiol, 2007;49:565-571.Gami A.S., Hodge D.O., Herges R.M., Olson E.D., Nykodym J., Kara T., Somers V.K. Obstructive sleep apnea, obesity, and the risk of incident atrial fibrillation. J.Am. Coll. Cardiol, 2007;49:565-571.Garrigue S., Pepin J.L., Defaye P. et al. High Prevalence of Sleep Apnea Syndrome in Patients With Long-Term Pacing. Circulation. 2007;115:1703-1709.Garrigue S., Pepin J.L., Defaye P. et al. High Prevalence of Sleep Apnea Syndrome in Patients With Long-Term Pacing. Circulation. 2007;115:1703-1709.Gronfier C., Luthringer R., Follenius M.A. A quantitative evaluation of the relationship between growth hormone secretion and delta wave electroencephalographic activity during normal sleep and after enrichment in delta waves. Sleep. 1996;19.Gronfier C., Luthringer R., Follenius M.A. A quantitative evaluation of the relationship between growth hormone secretion and delta wave electroencephalographic activity during normal sleep and after enrichment in delta waves. Sleep. 1996;19.Margel D. et al. OSA is associated with erectile dysfunction. Urology, 2004;63 (3):545-9.Margel D. et al. OSA is associated with erectile dysfunction. Urology, 2004;63 (3):545-9.Martin S.A., Appleton S.L., Adams RJ., Taylor A.W., Catcheside P.G., Vakulin A. et al. Nocturia, Other Lower Urinary Tract Symptoms and Sleep Dysfunction in a Community-Dwelling Cohort of Men. Urology. 2016 Nov;97:219-226.Martin S.A., Appleton S.L., Adams RJ., Taylor A.W., Catcheside P.G., Vakulin A. et al. Nocturia, Other Lower Urinary Tract Symptoms and Sleep Dysfunction in a Community-Dwelling Cohort of Men. Urology. 2016 Nov;97:219-226.Ding C., Lim L.L., Xu L., Kong A.P.S., Sleep and Obesity. J Obes Metab Syndr. 2018 Mar 30;27(1):4-24.Ding C., Lim L.L., Xu L., Kong A.P.S., Sleep and Obesity. J Obes Metab Syndr. 2018 Mar 30;27(1):4-24.Calhoun D.A., Sleep disorders and hypertension risk. J Hum Hypertens. 2017 Jun;31(6):371-372.Calhoun D.A., Sleep disorders and hypertension risk. J Hum Hypertens. 2017 Jun;31(6):371-372.Hein M., Lanquart J.P., Loas G., Hubain P., Linkowski P. Prevalence and risk factors of type 2 diabetes in insomnia sufferers: a study on 1311 individuals referred for sleep examinations. Sleep Med. 2018 Jun;46:37-45.Hein M., Lanquart J.P., Loas G., Hubain P., Linkowski P. Prevalence and risk factors of type 2 diabetes in insomnia sufferers: a study on 1311 individuals referred for sleep examinations. Sleep Med. 2018 Jun;46:37-45.Wisconsin Sleep Cohort Study. Sleep 2008;31(8):1071-1078.Wisconsin Sleep Cohort Study. Sleep 2008;31(8):1071-1078.Lee-Chiong T., Aloia M., Sleep: a Global Perspective (Phillips). 2015.Lee-Chiong T., Aloia M., Sleep: a Global Perspective (Phillips). 2015.Инициативный всероссийский опрос Национального аналитического центра финансовых исследований, 2017.Initiative All-Russian Survey of the National Analytical Center for Financial Research, 2017. (In Russ).Всероссийский опрос «Сон: представления и практики». Фонд общественного мнения. 2018.All-Russian poll «Sleep: understanding and practices». Public Opinion Foundation. 2018. (In Russ).Stress & Anxiety Disorders Survey. ADAA. Dialogues Clin Neurosci. 2008 Sep;10(3):329-336.Stress & Anxiety Disorders Survey. ADAA. Dialogues Clin Neurosci. 2008 Sep;10(3):329-336.American Academy of Sleep Medicine. International classification of sleep disorders (ICSD)(3rd ed.). 2014.American Academy of Sleep Medicine. International classification of sleep disorders (ICSD)(3rd ed.). 2014.Классификация нарушений сна, русифицированная и адаптированная версия. Рассмотрена и принята Российской ассоциацией сомнологов в 2017 году.Classification of sleep disorders, russified and adapted version. Considered and adopted by the Russian Association of Somnologists in 2017. (In Russ).Adams RJ., Appleton S.L., Taylor A.W., Gill T.K., Lang C., McEvoy R.D., Sleep health of Australian adults in 2016: results of the 2016 Sleep Health Foundation national survey. Sleep Health. 2017 Feb;3(1):35-42.Adams RJ., Appleton S.L., Taylor A.W., Gill T.K., Lang C., McEvoy R.D., Sleep health of Australian adults in 2016: results of the 2016 Sleep Health Foundation national survey. Sleep Health. 2017 Feb;3(1):35-42.Benjafield A., Valentine K., Ayas N., Eastwood PR., Heinzer R.C., Ip M.S. et al, Global Prevalence of Obstructive Sleep Apnea in Adults: Estimation Using Currently Available Data, в ATS Conference. 2018.Benjafield A., Valentine K., Ayas N., Eastwood PR., Heinzer R.C., Ip M.S. et al, Global Prevalence of Obstructive Sleep Apnea in Adults: Estimation Using Currently Available Data, в ATS Conference. 2018.Полуэктов М.Г., Бузунов Р.В., Авербух В.М. и др. Проект клинических рекомендаций по диагностике и лечению хронической инсомнии у взрослых. Consilium Medicum. Неврология и Ревматология (Прил.). 2016; 2:41-51.Poluektov M.G., Buzunov R.V., Averbukh V.M. et al. Draft clinical guidelines for the diagnosis and treatment of chronic insomnia in adults. Consilium Medicum. Nevrologia i Revmatologia (Pril.). 2016;2:41-51. (In Russ).Wilson S.J., Nutt D.J., Alford C., Argyropoulos S.V., Baldwin D.S., Bateson A.N. et al. British Association for Psychopharmacology consensus statement on evidence-based treatment of insomnia, parasomnias and circadian rhythm disorders. J Psychopharmacol. 2010; 24(11):1577-601.Wilson S.J., Nutt D.J., Alford C., Argyropoulos S.V., Baldwin D.S., Bateson A.N. et al. British Association for Psychopharmacology consensus statement on evidence-based treatment of insomnia, parasomnias and circadian rhythm disorders. J Psychopharmacol. 2010; 24(11):1577-601.Kolla B.P., Lovely J.K., Mansukhani M.P., Morgenthaler T.I. Zolpidem is independently associated with increased risk of inpatient falls. J Hosp Med. 2013;8(1):1-6.Kolla B.P., Lovely J.K., Mansukhani M.P., Morgenthaler T.I. Zolpidem is independently associated with increased risk of inpatient falls. J Hosp Med. 2013;8(1):1-6.Management of Chronic Insomnia Disorder in Adults (Guidline). The American College of Physicians. 2016.Management of Chronic Insomnia Disorder in Adults (Guidline). The American College of Physicians. 2016.Trauer J.M., Qian M.Y., Doyle J.S., Rajaratnam S.M., Cunnington D., Cognitive behavioral therapy for chronic insomnia: a systematic review and meta-analysis. Ann. Intern. Med., 2015;163:191-204.Trauer J.M., Qian M.Y., Doyle J.S., Rajaratnam S.M., Cunnington D., Cognitive behavioral therapy for chronic insomnia: a systematic review and meta-analysis. Ann. Intern. Med., 2015;163:191-204.Riemann D., Baglioni C., Bassetti C., Bjorvatn B., Groselj L.D., Jason G.E. et al, European guidline for the diagnosis and treatment of insomnia. J Sleep Res. 2017 Dec; 26(6):675-700.Riemann D., Baglioni C., Bassetti C., Bjorvatn B., Groselj L.D., Jason G.E. et al, European guidline for the diagnosis and treatment of insomnia. J Sleep Res. 2017 Dec; 26(6):675-700.Vanhuffel H., Rey M., Lambert I., Da Fonseca D., Bat-Pitault F. Contribution of mindfulness meditation in cognitive behavioral therapy for insomnia. Encephale. 2018 Apr;44(2):134-140.Vanhuffel H., Rey M., Lambert I., Da Fonseca D., Bat-Pitault F. Contribution of mindfulness meditation in cognitive behavioral therapy for insomnia. Encephale. 2018 Apr;44(2):134-140.Регистр лекарственных средств России. Глава 2.7. Взаимодействия лекарств.Drug registry of Russia. Chapter 2.7. Drug Interactions. (In Russ)/Choi D.W., Chun S.Y., Lee S.A., Han K.T., Park E.C. Association between Sleep Duration and Perceived Stress: Salaried Worker in Circumstances of High Workload. Int J Environ Res Public Health. 2018 Apr; 15(4):796.Choi D.W., Chun S.Y., Lee S.A., Han K.T., Park E.C. Association between Sleep Duration and Perceived Stress: Salaried Worker in Circumstances of High Workload. Int J Environ Res Public Health. 2018 Apr; 15(4):796.

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