绝经相关失眠临床管理中国专家共识

doi:10.12114/j.issn.1007-9572.2023.0192

摘要/Abstract

摘要： 绝经相关失眠是（围）绝经期女性常见的症状，临床多见却易被忽视，绝经相关失眠会影响女性（围）绝经期甚至老年期的健康水平。国内尚缺乏关于绝经相关失眠临床管理的共识及指南。为规范绝经相关失眠的管理，提高（围）绝经期女性睡眠健康管理水平，组织专家制订本共识。绝经相关失眠管理内容主要包括成立多学科专家团队、药物管理和非药物管理等，希望能对临床实践起到一定的指导作用。

关键词: 围绝经期, 绝经期, 失眠, 药物治疗, 非药物治疗, 共识

Abstract:

Menopause-related insomnia is a common symptom of perimenopausal women, which is clinically common but easy to be neglected. Menopause-related insomnia will affect the health of perimenopausal women and even in the old age. There is still a lack of consensus and guidelines on the clinical management of menopause-related insomnia in China. In order to standardize the management of menopause-related insomnia and improve the management of menopause-related sleep health, experts were organized to develop this consensus. The management of menopause-related insomnia mainly includes the establishment of a multidisciplinary expert team, pharmacological and nonpharmacological management, which is expected to play a guiding role in the clinical practice.

Key words: Perimenopause, Menopause, Insomnia, Pharmacotherapy, Non pharmacotherapy, Consensus

中华预防医学会更年期保健分会,中国人体健康科技促进会妇科内分泌和生育力促进专委会,北京中西医结合学会更年期专业委员会. 绝经相关失眠临床管理中国专家共识[J]. 中国全科医学, 2023, 26(24): 2951-2958. DOI: 10.12114/j.issn.1007-9572.2023.0192.
Climacteric Health Care Branch of Chinese Preventive Medicine Association,Gynecologic Endocrinology and Fertility Professional Committees of China Association for Promotion of Health Science and Technology,Professional Committees of Beijing Association of the Integrating of Traditional and Western Medicine. Chinese Expert Consensus on Clinical Management of Menopause-related Insomnia[J]. Chinese General Practice, 2023, 26(24): 2951-2958. DOI: 10.12114/j.issn.1007-9572.2023.0192.

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参考文献 41

[1]	KRYGER M, ROTH T, GOLDSTEIN C A，et al. Principles and practice of sleep medicine，seventh edition[M]. Elsevier，2022：678-688.
[2]	BOUREY R E. Primary menopausal insomnia：definition，review，and practical approach[J]. Endocr Pract，2011,17(1):122-131. DOI：10.4158/EP08121.RA.
[3]	中国睡眠研究会. 中国失眠症诊断和治疗指南[J]. 中华医学杂志，2017,97(24):1844-1856. DOI：10.3760/cma.j.issn.0376-2491.2017.24.002.
[4]	WU W J, JIANG Y G, WANG N，et al. Sleep quality of Shanghai residents：population-based cross-sectional study[J]. Qual Life Res，2020,29(4):1055-1064. DOI：10.1007/s11136-019-02371-x.
[5]	ADIMI NAGHAN P, HASSANI S, SADR M，et al. Sleep disorders and mental health in menopausal women in Tehran[J]. Tanaffos，2020,19(1):31-37.
[6]	刘帝，冉利梅，聂四平，等. 贵州地区少数民族女性围绝经期症状分布特征及影响因素[J]. 中国老年学杂志，2021,41(11):2417-2420. DOI：10.3969/j.issn.1005-9202.2021.11.051.
[7]	盛祝梅，黄坚，马林，等. 杭州地区围绝经期综合征患病状况分析调查[J]. 中国现代医生，2018,56(36):121-124. DOI：10.3760/cma.j.issn.1674-0815.2017.03.002.
[8]	DUGRAL E, ORDU G. Differences in polysomnography parameters of women in the post and transitional phases of menopause[J]. Cureus，2021,13(12):e20570. DOI：10.7759/cureus.20570.
[9]	赵媛，陈庆秋，蒋成刚. 多导睡眠监测研究围绝经期女性失眠障碍的临床特征[J]. 第三军医大学学报，2021,43(19):1854-1859. DOI：10.16016/j.1000-5404.202103229.
[10]	PROSERPIO P, MARRA S, CAMPANA C，et al. Insomnia and menopause：a narrative review on mechanisms and treatments[J]. Climacteric，2020,23(6):539-549. DOI：10.1080/13697137.2020.1799973.
[11]	ZOLFAGHARI S, YAO C, THOMPSON C，et al. Effects of menopause on sleep quality and sleep disorders：Canadian Longitudinal Study on Aging[J]. Menopause，2020,27(3):295-304. DOI：10.1097/GME.0000000000001462.
[12]	BROWN A M C, GERVAIS N J. Role of ovarian hormones in the modulation of sleep in females across the adult lifespan[J]. Endocrinology，2020,161(9):bqaa128. DOI：10.1210/endocr/bqaa128.
[13]	CARUSO D, MASCI I, CIPOLLONE G，et al. Insomnia and depressive symptoms during the menopausal transition：theoretical and therapeutic implications of a self-reinforcing feedback loop[J]. Maturitas，2019,123:78-81. DOI：10.1016/j.maturitas.2019.02.007.
[14]	BAKER F C, DE ZAMBOTTI M, COLRAIN I M，et al. Sleep problems during the menopausal transition：prevalence，impact，and management challenges[J]. Nat Sci Sleep，2018,10:73-95. DOI：10.2147/NSS.S125807.
[15]	EL KHOUDARY S R, GREENDALE G, CRAWFORD S L，et al. The menopause transition and women's health at midlife: a progress report from the Study of Women's Health Across the Nation (SWAN)[J]. Menopause，2019,26(10):1213-1227. DOI：10.1097/gme.0000000000001424.
[16]	PINES A. Sleep duration and midlife women's health[J]. Climacteric，2017,20(6):528-530. DOI：10.1080/13697137.2017.1335702.
[17]	FERNANDEZ-MENDOZA J, VGONTZAS A N. Insomnia and its impact on physical and mental health[J]. Curr Psychiatry Rep，2013,15(12):418. DOI：10.1007/s11920-013-0418-8.
[18]	WANG D, RUAN W, PENG Y，et al. Sleep duration and the risk of osteoporosis among middle-aged and elderly adults：a dose-response meta-analysis[J]. Osteoporos Int，2018,29(8):1689-1695. DOI：10.1007/s00198-018-4487-8.
[19]	HERTENSTEIN E, FEIGE B, GMEINER T，et al. Insomnia as a predictor of mental disorders：a systematic review and meta-analysis[J]. Sleep Med Rev，2019,43:96-105. DOI：10.1016/j.smrv.2018.10.006.
[20]	PIGEON W R, BISHOP T M, KRUEGER K M. Insomnia as a precipitating factor in new onset mental illness：a systematic review of recent findings[J]. Curr Psychiatry Rep，2017,19(8):44. DOI：10.1007/s11920-017-0802-x.
[21]	BALLOT O, IVERS H, JI X，et al. Sleep disturbances during the menopausal transition：the role of sleep reactivity and arousal predisposition[J]. Behav Sleep Med，2022,20(4):500-512. DOI：10.1080/15402002.2021.1937171.
[22]	MARINO M, LI Y, RUESCHMAN M N，et al. Measuring sleep：accuracy，sensitivity，and specificity of wrist actigraphy compared to polysomnography[J]. Sleep，2013,36(11):1747-1755. DOI：10.5665/sleep.3142.
[23]	WITHROW D, ROTH T, KOSHOREK G，et al. Relation between ambulatory actigraphy and laboratory polysomnography in insomnia practice and research[J]. J Sleep Res，2019,28(4):e12854. DOI：10.1111/jsr.12854.
[24]	CARETTO M, GIANNINI A, SIMONCINI T. An integrated approach to diagnosing and managing sleep disorders in menopausal women[J]. Maturitas，2019,128:1-3. DOI：10.1016/j.maturitas.2019.06.008.
[25]	中华医学会妇产科学分会绝经学组. 中国绝经管理与绝经激素治疗指南2023版[J]. 中华妇产科杂志，2023,58(1):4-21. DOI：10.3760/cma.j.cn112141-20221118-00706.
[26]	PAN Z, WEN S, QIAO X Y，et al. Different regimens of menopausal hormone therapy for improving sleep quality：a systematic review and meta-analysis[J]. Menopause，2022,29(5):627-635. DOI：10.1097/GME.0000000000001945.
[27]	NOLAN B J, LIANG B, CHEUNG A S. Efficacy of micronized progesterone for sleep：a systematic review and meta-analysis of randomized controlled trial data[J]. J Clin Endocrinol Metab，2021,106(4):942-951. DOI：10.1210/clinem/dgaa873.
[28]	KANG S, KWON D J, HONG J，et al. Association of hormone therapy and changes of objective sleep quality in women of late menopausal transition with sleep disorder：a preliminary study[J]. Menopause，2022,29(11):1296-1307. DOI：10.1097/GME.0000000000002055.
[29]	LOW T L, CHOO F N, TAN S M. The efficacy of melatonin and melatonin agonists in insomnia—an umbrella review[J]. J Psychiatr Res，2020,121:10-23. DOI：10.1016/j.jpsychires.2019.10.022.
[30]	SILVESTRI R, ARICÒ I, BONANNI E，et al. Italian Association of Sleep Medicine （AIMS） position statement and guideline on the treatment of menopausal sleep disorders[J]. Maturitas，2019,129:30-39. DOI：10.1016/j.maturitas.2019.08.006.
[31]	中国妇幼保健协会妇女保健专科能力建设专业委员会. 更年期女性心理健康管理专家共识[J]. 中国妇幼健康研究，2021,32(8):1083-1089. DOI：10.3969/j.issn.1673-5293.2021.08.001.
[32]	SHEA A K, WOLFMAN W, FORTIER M，et al. Guideline No. 422c：menopause：mood，sleep，and cognition[J]. J Obstet Gynaecol Can，2021,43(11):1316-1323.e1. DOI：10.1016/j.jogc.2021.08.009.
[33]	DRAKE C L, KALMBACH D A, ARNEDT J T，et al. Treating chronic insomnia in postmenopausal women：a randomized clinical trial comparing cognitive-behavioral therapy for insomnia，sleep restriction therapy，and sleep hygiene education[J]. Sleep，2019,42(2):zsy217. DOI：10.1093/sleep/zsy217.
[34]	HAM O K, LEE B G, CHOI E，et al. Efficacy of cognitive behavioral treatment for insomnia：a randomized controlled trial[J]. West J Nurs Res，2020,42(12):1104-1112. DOI：10.1177/0193945920914081.
[35]	OTTE J L, CARPENTER J S, ROBERTS L，et al. Self-hypnosis for sleep disturbances in menopausal women[J]. J Womens Health （Larchmt），2020,29(3):461-463. DOI：10.1089/jwh.2020.8327.
[36]	张晓莹，夏亲华. 低阻抗意念导入疗法配合中药治疗围绝经期失眠的策略[J]. 中华中医药杂志，2020,35(6):2984-2986. DOI：10.3969/j.issn.1000-7369.2019.07.035.
[37]	周璇梓，李桂侠，彭飞. 更年期综合征群体探究失眠症状心理治疗的随机对照研究[J/OL]. 中国健康心理学杂志：1-7.[2023-04-11].
[38]	SHAFIE M, HOMAYOUNI RAD A, MOHAMMAD-ALIZADEH-CHARANDABI S，et al. The effect of probiotics on mood and sleep quality in postmenopausal women：a triple-blind randomized controlled trial[J]. Clin Nutr ESPEN，2022,50:15-23. DOI：10.1016/j.clnesp.2022.06.005.
[39]	YANG T H, CHEN Y C, OU T H，et al. Dietary supplement of tomato can accelerate urinary aMT6s level and improve sleep quality in obese postmenopausal women[J]. Clin Nutr，2020,39(1):291-297. DOI：10.1016/j.clnu.2019.02.009.
[40]	MIN J A, KB A, PH B. The effects of auricular acupressure on the sleep of the elderly using polysomnography，actigraphy and blood test：randomized，single-blind，sham control[J]. Complementary Ther Clin Pract，2021,45:101464. DOI：10.1016/j.ctcp.2021.101464.
[41]	盖海云，杭嘉敏，陈红，等. 引阳入阴推拿配合中药足浴对围绝经期不寐症患者睡眠质量的应用研究[J]. 四川中医，2018,36(7):196-198. DOI：10.3969/j.issn.1000-7369.2014.08.035.

条目	具体内容
A：患者报告，或患者的父母或照顾者观察到以下1条或多条：	（1）入睡困难；（2）难以维持睡眠；（3）醒得比预想的要早；（4）在适当的时间不肯上床睡觉；（5）没有父母或照顾者的干预很难入睡。
B：患者报告，或者患者的父母或照顾者观察到以下1种或多种与夜间睡眠困难有关：	（1）疲劳或萎靡不振；（2）注意力、专注力或记忆力下降；（3）社交、家庭、职业或学业功能受损；（4）情绪紊乱或易激惹；（5）日间瞌睡；（6）行为问题（如活动过度、冲动、攻击性）；（7）动力/精力/工作主动性降低；（8）容易出错/事故；（9）对睡眠的质量非常关切或不满意。
C：报告的睡眠/唤醒主诉不能仅以不合适的睡眠机会（如充足的睡眠时间）或睡眠环境（即环境安全、黑暗、安静和舒适）来解释。
D：睡眠障碍和相关的日间症状每周至少出现3次。
E：睡眠障碍和相关的日间症状已经存在至少3个月。
F：睡眠/觉醒困难不能用另一种睡眠障碍来更好地解释。

条目	具体内容
A：患者报告，或患者的父母或照顾者观察到以下1条或多条：	（1）入睡困难；（2）难以维持睡眠；（3）醒得比预想的要早；（4）在适当的时间不肯上床睡觉；（5）没有父母或照顾者的干预很难入睡。
B：患者报告，或者患者的父母或照顾者观察到以下1种或多种与夜间睡眠困难有关：	（1）疲劳或萎靡不振；（2）注意力、专注力或记忆力下降；（3）社交、家庭、职业或学业功能受损；（4）情绪紊乱或易激惹；（5）日间瞌睡；（6）行为问题（如活动过度、冲动、攻击性）；（7）动力/精力/工作主动性降低；（8）容易出错/事故；（9）对睡眠的质量非常关切或不满意。
C：报告的睡眠/唤醒主诉不能仅以不合适的睡眠机会（如充足的睡眠时间）或睡眠环境（即环境安全、黑暗、安静和舒适）来解释。
D：睡眠障碍和相关的日间症状每周至少出现3次。
E：睡眠障碍和相关的日间症状已经存在至少3个月。
F：睡眠/觉醒困难不能用另一种睡眠障碍来更好地解释。