缓释哌甲酯用于伴清晨睡眠惰性和脑雾的儿科患者：病例系列及文献综述

文献信息

中文摘要

背景： 清晨睡眠惰性和脑雾在睡眠时相延迟综合征及其他睡眠障碍（包括发作性睡病）中可成为严重且导致功能残疾的症状。包括褪黑素、强光疗法、行为睡眠-觉醒时间安排及日间促觉醒药物在内的标准治疗在相当比例患者中反应不完全。
方法： 我们开展了一项经机构审查委员会批准的回顾性病历审查，纳入15例接受每晚缓释哌甲酯治疗的难治性清晨睡眠惰性和脑雾患者。9例具有完整干预前后Likert评分的儿科患者（13-17岁）被纳入分析。
结果： 该队列包括9例患者，诊断包括睡眠时相延迟综合征（n=7）、1型发作性睡病（n=1）和2型发作性睡病（n=1）。常见共病包括注意缺陷多动障碍、重性抑郁障碍和广泛性焦虑障碍。清晨Likert评分中位数从6/7（范围5-7）改善至干预后2/7（范围1-4），9例患者中有7例（78%）报告睡眠惰性和脑雾改善>50%。不良事件包括抑郁加重、轻度食欲抑制以及因胶囊给药不当导致的失眠，经指导后缓解。1例患者的难治性症状归因于未诊断的阻塞性睡眠呼吸暂停，经持续气道正压通气治疗后有改善。
结论： 在这一小规模、对标准治疗难治的儿科队列中，每晚缓释哌甲酯与大多数患者清晨睡眠惰性和脑雾严重程度的显著改善相关。需要更大规模的对照研究来确定疗效、最佳剂量和患者选择标准。

英文摘要

BACKGROUND: Early morning sleep inertia and brain fog can become severe and functionally disabling symptoms in delayed sleep phase syndrome and other sleep disorders, including narcolepsy. Standard treatments including melatonin, bright light therapy, behavioral sleep-wake scheduling, and daytime wake-promoting agents yield incomplete responses in a substantial proportion of patients.
METHODS: We conducted an institutional review board-approved retrospective chart review of 15 patients with refractory early morning sleep inertia and brain fog treated with nightly delayed-release methylphenidate. Nine pediatric patients (ages 13-17) with complete preintervention and postintervention Likert scores were included for analysis.
RESULTS: The cohort included nine patients with diagnoses including delayed sleep phase syndrome (n = 7), narcolepsy type 1 (n = 1), and narcolepsy type 2 (n = 1). Common comorbidities included attention-deficit hyperactivity disorder, major depressive disorder, and generalized anxiety disorder. Median early morning Likert scores improved from 6/7 (range 5-7) to 2/7 (range 1-4) postintervention, with 7 of the 9 patients (78%) reporting >50% improvement in sleep inertia and brain fog. Adverse effects included worsening depression, mild appetite suppression, and insomnia from improper capsule administration, which resolved with counseling. One patient's refractory symptoms were attributed to undiagnosed obstructive sleep apnea, which responded to continuous positive airway pressure.
CONCLUSIONS: Nightly delayed-release methylphenidate was associated with meaningful improvement in early morning sleep inertia and brain fog severity in the majority of this small pediatric cohort with symptoms refractory to standard therapy. Larger, controlled studies are needed to establish efficacy, optimal dosing, and patient selection criteria.