Фармакологические принципы терапии инсомнии

Фармакотерапия инсомнии является неотъемлемой частью лечения этого клинического синдрома. Спектр препаратов, используемых при нарушениях сна, весьма обширен, причем не все они относятся к «истинным» снотворным средствам, а нередко являются представителями различных классов психотропных средств. Современные снотворные препараты при соблюдении необходимых правил позволяют получить необходимое снотворное действие, не сопровождающееся негативными изменениями структуры сна и качества последующего бодрствования. Результаты отечественных и зарубежных исследований, рекомендации ведущих профессиональных сообществ (Российского общества сомнологов  – 2016; European Sleep Research Society – 2017; American Academy of Sleep Medicine – 2017; American College of Physicians – 2016) позволяют утверждать, что нормализация сна при инсомнии, в т. ч. с использованием фармакотерапии, нейтрализует ее негативное воздействие, повышает адаптивные возможности человека и способствует предотвращению развития хронических нарушений сна с их серьезными неблагоприятными последствиями.

1. Lichstein KL, Taylor DJ, McCrae CS, Petrov ME. Insomnia: epidemiology and risk factors. Principles and Practice of Sleep Medicine. 6th ed. Philadelphia: Elsevier, 2016: 761-768.

2. 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, 2016, 2: 41-51.

3. American Academy of Sleep Medicine. International classification of sleep disorders, 3 ed.: Diagnostic and coding manual. Westchester, Ill.: American Academy of Sleep Medicine, 2014.

4. Riemann D, Nissen C, Palagini L et al. The neurobiology, investigation, and treatment of chronic insomnia. The Lancet Neurology, 2015, 14(5): 547-558.

5. Riemann D, Baglioni C, Bassetti C et al. Euro-pean guideline for the diagnosis and treatment of insomnia. J Sleep Res, 2017, 26(6): 675-700.

6. Dean GE, Weiss C, Morris JL, Chasens ER. Impaired sleep: A multifaceted geriatric syndrome. Nurs Clin N Am, 2017, 52(3): 387-404.

7. Mendelson WB, Roth T, Cassella J et al. The treatment of chronic insomnia: drug indications, chronic use and liability: summary of a 2001 new clinical drug evaluation unit meeting symposium. Sleep Med Rev, 2004, 8(1): 7-17.

8. Левин Я.И., Ковров Г.В. Некоторые современные подходы к терапии инсомнии. Лечащий врач, 2003, 4: 18-24.

9. Möhler H, Fritschy J M, Rudolph U. A new benzodiazepine pharmacology. Journal of Pharmacology and Experimental Therapeutics, 2002, 300(1): 2-8.

10. Holbrook AM, Crowther R, Lotter A et al. Meta-analysis of benzodiazepine use in the treatment of insomnia. CMAJ, 2000, 162(2): 225-233.

11. Longo LP, Johnson B. Addiction: part I. Benzodiazepines - side effects, abuse risk, and alternatives. Am Fam Physician, 2000, 61(7): 2121-2128.

12. Brasure M, MacDonald R, Fuchs E et al. Management of insomnia disorder. comparative effectiveness review No. 159.(Prepared by the Minnesota Evidence-based Practice Center under Contract No. 290-2012-00016-I). AHRQ Publication No. 15 (16)-EHC027-EF. Rockville, MD: Agency for Healthcare Research and Quality, 2016.

13. Walsh JK, Krystal AD, Amato DA et al. Nightly treatment of primary insomnia with eszopi-clone for six months: effect on sleep, quality of life, and work limitations. Sleep, 2007, 30(8): 959-968.

14. Krystal A, Walsh J, Laska E et al. Sustained efficacy of eszopiclone over 6 months of nightly treatment: results of a randomized, double-blind, placebo-controlled study in adults with chronic insomnia. Sleep, 2003, 26(7): 793-799.

15. Elie R, Ruther E, Farr I et al. Sleep latency is shortened during 4 weeks of treatment with zaleplon, a novel nonbenzodiazepine hypnotic. J Clin Psychiatry, 1999, 60(8): 536-544.

16. Fry J, Scharf M, Mangano R et al. Zaleplon improves sleep without producing rebound effects in outpatients with insomnia. Int Clin Psychopharmacol, 2000, 15(3): 141-152.

17. Randall S, Roehrs TA, Roth T. Efficacy of eight months of nightly zolpidem: a prospective placebo-controlled study. Sleep, 2012, 35(11): 1551-1557.

18. Roth T, Krystal A, Steinberg FJ et al. Novel sub-lingual low-dose zolpidem tablet reduces latency to sleep onset following spontaneous middle-of-the-night awakening in insomnia in a randomized, double-blind, placebocontrolled, outpatient study. Sleep, 2013, 36(2): 189-196.

19. Krystal AD, Erman M, Zammit GK et al. Longterm efficacy and safety of zolpidem extended-release 12.5 mg, administered 3 to 7 nights per week for 24 weeks, in patients with chronic primary insomnia: a 6-month, randomized, double-blind, placebo-controlled, parallel-group, multicenter study. Sleep, 2008, 31(1): 79-90.

20. Ancoli-Israel S, Krystal AD, McCall WV et al. A 12-week, randomized, double-blind, placebo-controlled study evaluating the effect of eszopiclone 2 mg on sleep/wake function in older adults with primary and comorbid insomnia. Sleep, 2010, 33(2): 225-234.

21. Leppik I, Roth-Schechter G, Gray G et al. Double blind, placebo controlled comparison of zolpidem, triazolam, and temazepam in elderly pati ents with insomnia. Drug Dev Res, 1997, 40: 230-238.

22. Pillai V, Roth T, Roehrs T et al. Effectiveness of benzodiazepine receptor agonists in the treatment of insomnia: an examination of response and remission rates. Sleep, 2017, 40(2): zsw044.

23. Wilson SJ, Nutt DJ, Alford C et al. British Association for Psychopharmacology consensus statement on evidence-based treatment of insomnia, parasomnias and circadian rhythm disorders. J Psychopharmacol, 2010, 24(11): 1577-1601.

24. Charles AC, Winkelman JW, Richardson GS. Sleep disorders. Harrison’s internal medicine. 17th ed. New York: McGraw-Hill Publishing, 2005: 153-161.

25. Mason M, Cates CJ, Smith I. Effects of opioid, hypnotic and sedating medications on sleep-disordered breathing in adults with obstructive sleep apnoea. Cochrane Database Syst Rev, 2015, 7: CD011090.

26. Brzezinski A, Vangel MG, Wurtman RJ et al. Effects of exogenous melatonin on sleep: a meta-analysis. Sleep medicine reviews, 2005, 9(1): 41-50.

27. Spadoni G, Bedini A, Lucarini S, Mor M et al. Pharmacokinetic and pharmacodynamic evaluation of ramelteon: an insomnia therapy. Expert Opin Drug Metab Toxicol, 2015, 11(7): 1145-1156.

28. Miyamoto M. Pharmacology of ramelteon, a selective MT1/MT2 receptor agonist: a novel therapeutic drug for sleep disorders. CNS Neurosci Ther, 2009, 15(1): 32-51.

29. Roth T, Stubbs C, Walsh JK. Ramelteon (TAK-375), a selective MT1/MT2 receptor agonist, reduces latency to persistent sleep in a model of transient insomnia related to a novel sleep environment. Sleep, 2005, 28(3): 303-307.

30. Mayer G, Wang-Weigand S, Roth-Schechter B et al. Efficacy and safety of 6-month nightly ramelteon administration in adults with chronic primary insomnia. Sleep, 2009, 32(3): 351-360.

31. Kato K, Hirai K, Nishiyama J et al. Neurochemical properties of ramelteon (TAK-375), as selective MT1/MT2 receptor agonist. Neuropharmacology, 2005, 48(2): 301-310.

32. Walsh JK. Drugs used to treat insomnia in 2002: regulatory based rather than evidence based medicine. Sleep, 2004, 27(8): 1441-1442.

33. Mendelson WB. A review of the evidence for efficacy and safety of trazodone in insomnia. J Clin Psychiatry, 2005, 66(4): 469-476.

34. McCleery J, Cohen DA, Sharpley AL. Pharmacotherapies for sleep disturbances in Alzheimer’s disease. Cochrane Database Syst Rev, 2014, 3, CD009178.

35. Smales ET, Edwards BA, Deyoung PN et al. Trazodone effects on obstructive sleep apnea and non-REM arousal threshold. Ann Am Thorac Soc, 2015, 12(5): 758-764.

36. Zisapel N. Drugs for insomnia. Expert Opin Emerg Drugs, 2012, 17(3): 299-317.

37. Yeung WF, Chung KF, Yung KP, Ng TH. Doxepin for insomnia: a systematic review of rand-omized placebo-controlled trials. Sleep Med Rev, 2015, 19: 75-83.

38. Winkler A, Auer C, Doering BK, Rief W. Drug treatment of primary insomnia: a meta-analysis of polysomnographic randomized controlled trials. CNS Drugs, 2014, 28(9): 799-816.

39. Griend JPV, Anderson SL. Histamine-1 receptor antagonism for treatment of insomnia. J Am Pharm Assoc, 2012, 52(6): e210-e219.

40. Michelson D, Snyder E, Paradis E et al. Safety and efficacy of suvorexant during 1-year treatment of insomnia with subsequent abrupt treatment discontinuation: a phase 3 randomised, doubleblind, placebo-controlled trial. Lancet Neurol, 2014, 13(5): 461-471.

41. Herring WJ, Connor KM, Ivgy-May N et al. Suvorexant in patients with insomnia: results from two 3-month randomized controlled clinical trials. Biol Psychiatry, 2016, 79(2): 136-148.

42. Monti J, Torterolo P, Pandi-Perumal SR. The effects of second generation antipsychotics in healthy subjects and patients with schizophrenia. Sleep Med Rev, 2017, 33: 51-57.

43. Thompson W, Quay TAW, Rojas-Fernandez C, Farrell B. Atypical antipsychotics for insomnia: a systematic review. Sleep Med, 2016, 22: 13-17.

44. Schadeck SB, Chelly M, Amsellem D et al. Comparative efficacy of doxylamine (15 mg) and zolpidem (10 mg) for the treatment of common insomnia -- a placebo-controlled study. Sep Hop Pari, 1996, 72(13-14): 428-439.

45. Ковальзон В. М., Стрыгин К. Н. Нейрохимические механизмы регуляции сна и бодрствования: роль блокаторов гистаминовых рецепторов в лечении инсомнии. Эффективная фармакотерапия, 2013, 12: 8-14.

46. Бабак С.Л., Голубев Л.А., Горбунова М.В. Хроническая инсомния в клинической практике терапевта. РМЖ, 2008, 16(5): 259-266.

47. Адаменко Р.Я. Лечение инсомнии у больных хронической недостаточностью мозгового кровообращения. Журнал практического врача, 2001, 5: 45-51.

48. Левин Я.И. Сон, инсомния, доксиламин (Донормил). РМЖ, 2007, 15(10): 850-855.

49. Koren G. Safety considerations surrounding use of treatment options for nausea and vomiting in pregnancy. Expert Opin Drug Saf, 2017, 16(11): 1227-1234.

50. American Geriatrics Society. Updated Beers criteria for potentially inappropriate medication use in older adults. J Am Geriatr Soc, 2012, 60(4): 616-631.

51. Bent S, Padula A, Moore D, Patterson M et al. Valerian for sleep: a systematic review and meta-analysis. Am. J. Med., 2006, 119(12): 1005-1012.

52. Sateia MJ, Buysse DJ, Krystal AD et al. Clinical practice guideline for the pharmacologic treatment of chronic insomnia in adults: an American Academy of Sleep Medicine clinical practice guideline. J Clin Sleep Med, 2017, 13(2): 307-349.

53. Qaseem A, Kansagara D, Forciea MA et al. Management of chronic insomnia disorder in adults: a clinical practice guideline from the American College of Physicians. Ann Intern Med, 2016, 165(2): 125-133.