medsovetМедицинский СоветMeditsinskiy sovet = Medical Council2079-701X2658-5790REMEDIUM GROUP Ltd.10.21518/2079-701X-2020-19-70-77medsovet-5921Research ArticleНЕРВНО-ПСИХИЧЕСКИЕ РАССТРОЙСТВАNEUROPSYCHIATRIC DISORDERSЭволюция инсомнии: переход из кратковременной в хроническуюEvolution of insomnia: transition from acute to chronic disorderhttps://orcid.org/0000-0002-5051-2106ПчелинаП. В.PchelinaP. V.

Пчелина Полина Валерьевна - кандидат медицинских наук, врач-невролог, отделение медицины сна.

Polina V. Pchelina - Cand. of Sci. (Med.), Neurologist, Sleep medicine department.

11, Bldg. 1, Rossolimo St., Moscow, 119435

polbox@mail.ruhttps://orcid.org/0000-0001-6215-0918ПолуэктовМ. Г.PoluektovM. G.

Полуэктов Михаил Гурьевич - кандидат медицинских наук, доцент, заведующий отделением медицины сна.

Mikhail G. Poluektov - Cand. of Sci. (Med.), Associate Professor, Head of the Sleep medicine department.

polouekt@mail.ruУниверситетская клиническая больница №3, Федеральное государственное автономное образовательное учреждение высшего образования «Первый Московский государственный медицинский университет имени И.М. Сеченова» Министерства здравоохранения Российской Федерации (Сеченовский Университет)РоссияUniversity Rospital №3, Federal State Autonomous Educational Institution of Higher Education “Sechenov First Moscow State Medical University” of the Ministry of Health of the Russian Federation (Sechenov University)Russian Federation2020101220200197077Copyright © Пчелина П.В., Полуэктов М.Г., 20202020Пчелина П.В., Полуэктов М.Г.Pchelina P.V., Poluektov M.G.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.med-sovet.pro/jour/article/view/5921

Описание и пути коррекции острой инсомнии встречаются редко в связи с расхождением в определении этого состояния в различных классификациях и затруднением диагностики (чаще пациенты не обращаются к врачам, а лечатся сами или ждут естественной нормализации сна). В настоящей статье проанализировано место острой инсомнии в существующих моделях патогенеза инсомнии, систематизированы факторы, влияющие на развитие инсомнии, а также приведены данные экспериментальных исследований, подтверждающих это влияние. Вероятно, острая инсомния является неспецифической гиперреакцией организма на дистресс, которая склонна к самоизлечению, но такие факторы, как неэффективные копинг-стратегии, дисфункциональное мышление, нарушение правил гигиены сна, предрасполагают к ее переходу в хроническую форму. Это подтверждается эпидемиологическими исследованиями: годовая заболеваемость острой инсомнией среди взрослого населения составляет около 30%, среди которых 16-19% случаев представлены эпизодом острой инсомнии, развившимся впервые в жизни, а переход острой инсомнии в хроническую происходит в 7,4% случаев.

Понимание гетерогенности острой инсомнии, а также механизмов и предикторов хронизации будет способствовать персонализации лечебного подхода. При острой инсомнии чаще всего назначается короткий курс снотворных препаратов - агонистов ГАМК-рецепторов, антагонистов гистаминовых рецепторов, растительных препаратов, а когнитивно-поведенческая терапия инсомнии традиционно применяется при хроническом течении. Выявление особенностей поведения и мышления пациентов, предрасполагающих к хронизации заболевания, позволяет рекомендовать когнитивно-поведенческую терапию инсомнии уже на ранних стадиях инсомнии, при первом обращении пациента с острой инсомнией.

Due to the divergence of the acute insomnia conceptualization and difficulties in diagnostics, this phenomenon attracts comparatively little attention in the medical literature. Patients don’t seek medical attention and prefer self-treatment or wait for selfrecovery. This paper aims to review the literature concerning understanding the position of chronic insomnia in existing human models, systematization of aspects, related to insomnia development, and evidence of this relation. Apparently, acute insomnia is a non-specific hyperreaction to distress which tends to self-recovery. Ineffective coping strategies, dysfunctional thinking, and violation of sleep hygiene rules predispose transition from acute to chronic form. This is evidenced by epidemiological data: 1-year prevalence of acute insomnia in adults is about 30% among which 16-19% of cases are diagnosed for the first time and 7,4% become chronic.

Understanding of acute insomnia heterogeneity, as well as pathogenesis and predictors of chronization, reveals the perspectives for personalized treatment and prophylaxis. Acute insomnia is routinely managed with short-term prescription of GABAA receptor agonists, antihistamines, phytotherapy, while cognitive-behavioral therapy is commonly used for the chronic form of insomnia. Identification of behavioral and cognitive predictors of insomnia chronization enables management of insomnia with cognitive-behavioral therapy even in the early stages.

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