ЭКОЛОГИЧЕСКИЕ И КЛИНИКО-БИОЛОГИЧЕСКИЕ АСПЕКТЫ НАРУШЕНИЙ ЦИРКАДИАННЫХ РИТМОВ СОН-БОДРСТВОВАНИЕ У ДЕТЕЙ И ПОДРОСТКОВ

И.А. Кельмансон

Аннотация


В промышленно развитых странах интенсивное применение искусственного освещения в темное время суток создает серьезную экологическую проблему, получившую название «световое загрязнение» среды, которое может приводить к нарушениям биологических ритмов. Наиболее значимым и заметным ритмическим феноменом, наблюдаемым в организме человека, является ритм сна-бодрствования и связанные с ним изменения физиологических и психических процессов. Есть и другие, так называемые циркадианные ритмы, включающие процессы, которые меняются с периодичностью приблизительно в 24 часа. Формирование циркадианных ритмов происходит в онтогенезе ребенка, обеспечивается за счет участия эндогенных факторов с вовлечением определенных анатомических структур, и для нормального функционирования циркадианных ритмов сон-бодрствование требуется их синхронизация с чередованием темного и светлого времени суток. Нарушения циркадианного ритма сон-бодрствование представляют собой серьезную клинико-биологическую проблему в детском и подростковом возрастах. Рассмотрены важнейшие клинические варианты нарушений циркадианных ритмов, в числе которых задержка и опережение фазы сна, нерегулярный ритм сон-бодрствование, свободно текущий (несинхронизированный) ритм; нарушения, связанные с длинными перелетами и сменной работой. Обсуждаются главные причины возникновения указанных нарушений, их возможные негативные последствия для ребенка, подходы к диагностике, профилактике и коррекции.

Ключевые слова


мелатонин сон фототерапия хронотип циркадианные ритмы

Полный текст:

PDF

Как процитировать материал

Литература


Кельмансон И.А. Расстройства сна у детей с умственной отсталостью // Вопросы современной педиатрии. - 2014. - Т. 13, № 6. - С. 15- 20.

Кельмансон И.А. Сон и дыхание детей раннего возраста. - СПб. : ЭЛБИ-СПб., 2006. - 392 с.

Кельмансон И.А. Эмоциональные расстройства и расстройства поведения у детей, связанные с нарушениями сна // Росc. вестн. перинатол. педиат. - 2014. - Т. 59, № 4. - С. 32- 40.

Кельмансон И.А., Адулас Е.И. Нарушения сна у детей раннего возраста // Росс. вестник перинатол. педиатр. - 2004.- Т. 49, № 4. - С. 30- 37.

Ковальзон В.М. Основы сомнологии. Физиология и нейрохимия цикла бодрствование-сон. - М. : Бином. Лаборатория знаний, 2011. - 240 с.

Хильдебрандт Г., Мозер М., Лехофер М. Хронобиология и хрономедицина / Пер. с нем. - М. : Арнебия, 2006. - 144 с.

American Academy of Sleep Medicine. The International Classification of Sleep Disorders: Diagnostic and Coding Manual. - Westchester, Ill.: American Academy of Sleep Medicine, 2005. - 297 p.

Ancoli-Israel S., Martin J.L., Kripke D.F. et al. Effect of light treatment on sleep and circadian rhythms in demented nursing home patients // J. Am. Geriatr. Soc. - 2002. - Vol. 50. - P. 282-289.

Archer S.N., Robilliard D.L., Skene D.J. et al. A length polymorphism in the circadian clock gene Per3 is linked to delayed sleep phase syndrome and extreme diurnal preference // Sleep. - 2003. - Vol. 26. - P. 413-415.

Ardura J., Gutierrez R., Andres J., Agapito T. Emergence and evolution of the circadian rhythm of melatonin in children // Horm Res. - 2003. - Vol. 59. - P. 66-72.

Barion A., Zee P.C. A clinical approach to circadian rhythm sleep disorders // Sleep Med. - 2007. - Vol. 8. - P. 566-577.

Berry R.B. Fundamentals of sleep medicine. - Philadelphia, PA : Elsevier/Saunders, 2012. - 661 p.

Bjorvatn B., Pallesen S. A practical approach to circadian rhythm sleep disorders // Sleep Med. Rev. - 2009. - Vol. 13. - P. 47-60.

Boivin D.B., Czeisler C.A., Dijk D.J. et al. Complex interaction of the sleep-wake cycle and circadian phase modulates mood in healthy subjects // Arch. Gen. Psychiatry. - 1997. - Vol. 54. - P. 145-152.

Boivin D.B., James F.O. Circadian adaptation to night-shift work by judicious light and darkness exposure // J. Biol. Rhythms. - 2002. - Vol. 17. - P. 556-567.

Brzezinski A. Melatonin in humans // N. Engl. J. Med. - 1997. - Vol. 336. - P. 186-195.

Burgess H.J., Revell V.L., Eastman C.I. A three pulse phase response curve to three milligrams of melatonin in humans // J. Physiol. - 2008. - Vol. 586. - P. 639-647.

Chepesiuk R. Missing the dark: health effects of light pollution // Environ. Health Perspect. - 2009. - Vol. 117. - P. A20-A27.

Crowley S.J., Lee C., Tseng C.Y. et al. Combinations of bright light, scheduled dark, sunglasses, and melatonin to facilitate circadian entrainment to night shift work // J. Biol. Rhythms. - 2003. - Vol. 18. - P. 513-523.

Crowley S.J., Lee C., Tseng C.Y. et al. Complete or partial circadian re- entrainment improves performance, alertness, and mood during night- shift work // Sleep. - 2004. - Vol. 27. - P. 1077-1087.

Czeisler C.A., Duffy J.F., Shanahan T.L. et al. Stability, precision, and near-24-hour period of the human circadian pacemaker // Science. - 1999. - Vol. 284. - P. 2177-2181.

Czeisler C.A., Walsh J.K., Roth T. et al. Modafinil for excessive sleepiness associated with shift-work sleep disorder // N. Engl. J. Med. - 2005. - Vol. 353. - P. 476-486.

Czeisler C.A., Walsh J.K., Wesnes K.A. et al. Armodafinil for treatment of excessive sleepiness associated with shift work disorder: a randomized controlled study // Mayo Clin Proc. - 2009. - Vol. 84. - P. 958-972.

Dijk D.J., Archer S.N. Light, sleep, and circadian rhythms: together again // PLoS Biol. - 2009. - Vol. 7. - P. e1000145.

Durand V.M. When Children Don’t Sleep Well: Interventions for Pediatric Sleep Disorders: Therapist Guide. - Oxford, New York : Oxford University Press, 2008. - 148 p.

Eastman C.I., Burgess H.J. How to travel the world without jet lag // Sleep Med. Clin. - 2009. - Vol. 4. - P. 241-255.

Eastman C.I., Gazda C.J., Burgess H.J. et al. Advancing circadian rhythms before eastward flight: a strategy to prevent or reduce jet lag // Sleep. - 2005. - Vol. 28. - P. 33-44.

Gronfier C., Wright K.P., Jr., Kronauer R.E. et al. Efficacy of a single sequence of intermittent bright light pulses for delaying circadian phase in humans // Am. J. Physiol. Endocrinol. Metab. - 2004. - Vol. 287. - P. E174-E181.

Hack L.M., Lockley S.W., Arendt J., Skene D.J. The effects of low-dose 0.5-mg melatonin on the free-running circadian rhythms of blind subjects // J. Biol. Rhythms. - 2003. - Vol. 18. - P. 420-429.

Hayakawa T., Uchiyama M., Kamei Y. et al. Clinical analyses of sighted patients with non-24-hour sleep-wake syndrome: a study of 57 consecutively diagnosed cases // Sleep. - 2005. - Vol. 28. - P. 945-952.

Hohjoh H., Takasu M., Shishikura K. et al. Significant association of the arylalkylamine N-acetyltransferase (AA- NAT) gene with delayed sleep phase syndrome // Neurogenetics. - 2003. - Vol. 4. - P. 151-153.

Jamieson A.O., Zammit G.K., Rosenberg R.S. et al. Zolpidem reduces the sleep disturbance of jet lag // Sleep Med. - 2001. - Vol. 2. - P. 423-430.

Kayumov L., Brown G., Jindal R. et al. A randomized, double-blind, placebo-controlled crossover study of the effect of exogenous melatonin on delayed sleep phase syndrome // Psychosom Med. - 2001. - Vol. 63. - P. 40-48.

Kerkhof G.A. The 24-hour variation of mood differs between morning-and evening-type individuals // Percept. Mot. Skills. - 1998. - Vol. 86. - P. 264-266.

Khalsa S.B., Jewett M.E., Cajochen C., Czeisler C.A. A phase response curve to single bright light pulses in human subjects // J. Physiol. - 2003. - Vol. 549, Pt 3. - P. 945-952.

Klerman E.B., Shanahan T.L., Brotman D.J. et al. Photic resetting of the human circadian pacemaker in the absence of conscious vision // J. Biol. Rhythms. - 2002. - Vol. 17. - P. 548-555.

Lack L., Wright H., Kemp K., Gibbon S. The treatment of early-morning awakening insomnia with 2 evenings of bright light // Sleep. - 2005. - Vol. 28. - P. 616-623.

Lewy A.J., Bauer V.K., Ahmed S. et al. The human phase response curve (PRC) to melatonin is about 12 hours out of phase with the PRC to light // Chronobiol. Int. - 1998. - Vol. 15. - P. 71- 83.

Lewy A.J., Emens J.S., Lefler B.J. et al. Melatonin entrains free-running blind people according to a physiological dose-response curve // Chronobiol Int. - 2005. - Vol. 22. - P. 1093-1106.

Lockley S.W., Arendt J., Skene D.J. Visual impairment and circadian rhythm disorders // Dialogues Clin. Neurosci. - 2007. - Vol. 9. - P. 301-314.

Lockley S.W., Brainard G.C., Czeisler C.A. High sensitivity of the human circadian melatonin rhythm to resetting by short wavelength light // J. Clin. Endocrinol. Metab. - 2003. - Vol. 88. - P. 4502-4505.

Lockley S.W., Dijk D.J., Kosti O. et al. Alertness, mood and performance rhythm disturbances associated with circadian sleep disorders in the blind // J. Sleep Res. - 2008. - Vol. 17. - P. 207-216.

Lockley S.W., Skene D.J., Butler L.J., Arendt J. Sleep and activity rhythms are related to circadian phase in the blind // Sleep. - 1999. - Vol. 22. - P. 616-623.

Lockley S.W., Skene D.J., James K. et al. Melatonin administration can entrain the free-running circadian system of blind subjects // J. Endocrinol. - 2000. - Vol. 164. - P. R1-R6.

Lu B.S., Zee P.C. Circadian rhythm sleep disorders // Chest. - 2006. - Vol. 130. - P. 1915- 1923.

Mirmiran M., Kok J.H., de Kleine M.J.K. et al. Circadian rhythms in preterm infants: a preliminary study // Early Hum. Dev. - 1990. - Vol. 23. - P. 139-146.

Mistlberger R.E., Skene D.J. Nonphotic entrainment in humans? // J. Biol. Rhythms. - 2005. - Vol. 20 - P. 339-352.

Moldofsky H., Musisi S., Phillipson E.A. Treatment of a case of advanced sleep phase syndrome by phase advance chronotherapy // Sleep. - 1986. - Vol. 9. - P. 61-65.

Mundey K., Benloucif S., Harsanyi K. et al. Phase-dependent treatment of delayed sleep phase syndrome with melatonin // Sleep. - 2005. - Vol. 28. - P. 1271-1278.

Nagtegaal J.E., Kerkhof G.A., Smits M.G. et al. Delayed sleep phase syndrome: A placebo-controlled cross-over study on the effects of melatonin administered five hours before the individual dim light melatonin onset // J. Sleep Res. - 1998. - Vol. 7. - P. 135-143.

Navara K.J., Nelson R.J. The dark side of light at night: physiological, epidemiological, and ecological consequences // J. Pineal Res. - 2007. - Vol. 43. - P. 215-224.

Pillar G., Shahar E., Peled N. et al. Melatonin improves sleep-wake patterns in psychomotor retarded children // Pediatr. Neurol. - 2000. - Vol. 23. - P. 225-228.

Reid K.J., Zee P.C. Circadian rhythm disorders // Semin. Neurol. - 2009. - Vol. 29. - P. 393-405.

Revell V.L., Burgess H.J., Gazda C.J. et al. Advancing human circadian rhythms with afternoon melatonin and morning intermittent bright light // J. Clin. Endocrinol. Metab. - 2006. - Vol. 91. - P. 54-59.

Revell V.L., Eastman C.I. How to trick mother nature into letting you fly around or stay up all night // J. Biol. Rhythms. - 2005. - Vol. 20. - P. 353-365.

Rimmer D.W., Boivin D.B., Shanahan T.L. et al. Dynamic resetting of the human circadian pacemaker by intermittent bright light // Am. J. Physiol. Regul. Integr. Comp. Physiol. - 2000. - Vol. 279. - P. R1574-R1579.

Rosenberg R.P., Bogan R.K., Tiller J.M. et al. A phase 3, double-blind, randomized, placebo-controlled study of armodafinil for excessive sleepiness associated with jet lag disorder // Mayo Clin. Proc. - 2010. - Vol. 85. - P. 630-638.

Sack R.L. Clinical practice. Jet lag // N.-Engl. J. Med. - 2010. - Vol. 362. - P. 440-447.

Sack R.L., Auckley D., Auger R.R. et al. Circadian rhythm sleep disorders: part II, advanced sleep phase disorder, delayed sleep phase disorder, free-running disorder, and irregular sleep-wake rhythm. An American Academy of Sleep Medicine review // Sleep. - 2007. - Vol. 30. - P. 1484-1501.

Sack R.L., Brandes R.W., Kendall A.R., Lewy A.J. Entrainment of free-running circadian rhythms by melatonin in blind people // N.-Engl. J. Med. - 2000. - Vol. 343. - P. 1070-1077.

Sallinen M., Harma M., Akerstedt T. et al. Promoting alertness with a short nap during a night shift // J. Sleep Res. - 1998. - Vol. 7. - P. 240-247.

Schweitzer P.K., Randazzo A.C., Stone K. et al. Laboratory and field studies of naps and caffeine as practical countermeasures for sleep-wake problems associated with night work // Sleep. - 2006. - Vol. 29. - P. 39-50.

Sharkey K.M., Eastman C.I. Melatonin phase shifts human circadian rhythms in a placebo-controlled simulated night-work study // Am. J. Physiol. Regul. Integr. Comp. Physiol. - 2002. - Vol. 282. - P. R454-R463.

Shirani A., St Louis E.K. Illuminating rationale and uses for light therapy // J. Clin. Sleep Med. - 2009. - Vol. 5. - P. 155-163.

Singer C., Tractenberg R.E., Kaye J. et al. A multicenter, placebo-controlled trial of melatonin for sleep disturbance in Alzheimer’s disease // Sleep. - 2003. - Vol. 26. - P. 893-901.

Smith M.R., Eastman C.I. Phase delaying the human circadian clock with blue-enriched polychromatic light // Chronobiol Int. - 2009. - Vol. 26. - P. 709-725.

Smith M.R., Lee C., Crowley S.J. et al. Morning melatonin has limited benefit as a soporific for daytime sleep after night work // Chronobiol. Int. - 2005. - Vol. 22. - P. 873-888.

Tabandeh H., Lockley S.W., Buttery R. et al. Disturbance of sleep in blindness // Am. J. Ophthalmol. - 1998. - Vol. 126. - P. 707-712.

Toh K.L., Jones C.R., He Y. et al. An hPer2 phosphorylation site mutation in familial advanced sleep phase syndrome // Science. - 2001. - Vol. 291. - P. 1040-1043.

Uchiyama M., Lockley S.W. Non-24-hour sleep-wake syndrome in sighted and blind patients // Sleep. Med. Clin. - 2009. - Vol. 4. - P. 195-211.

Uchiyama M., Okawa M., Shibui K. et al. Altered phase relation between sleep timing and core body temperature rhythm in delayed sleep phase syndrome and non-24-hour sleep-wake syndrome in humans // Neurosci. Lett. - 2000. - Vol. 294. - P. 101-104.

von Schantz M., Archer S.N. Clocks, genes and sleep // J. Roy. Soc. Med. - 2003. - Vol. 96. - P. 486-489.

Walsh J.K., Sugerman J.L., Muehlbach M.J., Schweitzer P.K. Physiological sleep tendency on a simulated night shift: adaptation and effects of triazolam // Sleep. - 1988. - Vol. 11. - P. 251-264.

Wasdell M.B., Jan J.E., Bomben M.M. et al. A randomized, placebo-controlled trial of controlled release melatonin treatment of delayed sleep phase syndrome and impaired sleep maintenance in children with neurodevelopmental disabilities // J. Pineal. Res. - 2008. - Vol. 44. - P. 57-64.

Watanabe T., Kajimura N., Kato M. et al. Sleep and circadian rhythm disturbances in patients with delayed sleep phase syndrome // Sleep. - 2003. - Vol. 26. - P. 657-661.

Watanabe T., Kajimura N., Kato M. et al. Effects of phototherapy in patients with delayed sleep phase syndrome // Psychiatry Clin. Neurosci. - 1999. - Vol. 53. - P. 231-233.

Wyatt J.K., Dijk D.J., Ritz-de-Cecco A. et al. Sleep-facilitating effect of exogenous melatonin in healthy young men and women is circadian-phase dependent // Sleep. - 2006. - Vol. 29. - P. 609-618.

Wyatt J.K., Ritz-de-Cecco A., Czeisler C.A., Dijk D.J. Circadian temperature and melatonin rhythms, sleep, and neurobehavioral function in humans living on a 20-h day // Am. J. Physiol. - 1999. - Vol. 277. - P. R1152-R1163.

Zaidi F.H., Hull J.T., Peirson S.N. et al. Short-wavelength light sensitivity of circadian, pupillary, and visual awareness in humans lacking an outer retina // Curr. Biol. - 2007. - Vol. 17. - P. 2122-2128.

Zee P.C., Manthena P. The brain’s master circadian clock: implications and opportunities for therapy of sleep disorders // Sleep Med. Rev. - 2007. - Vol. 11. - P. 59-70.

Zee P.C., Vitiello M.V. Circadian rhythm sleep disorder: Irregular sleep wake rhythm type // Sleep Med. Clin. - 2009. - Vol. 4. - P. 213-218.

Zeitzer J.M., Dijk D.J., Kronauer R. et al. Sensitivity of the human circadian pacemaker to nocturnal light: melatonin phase resetting and suppression // J. Physiol. - 2000. - Vol. 526, Pt 3. - P. 695-702.




DOI: http://dx.doi.org/10.24855/biosfera.v7i1.52

© ФОНД НАУЧНЫХ ИССЛЕДОВАНИЙ "XXI ВЕК"