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Sleep and Its Disorders: Is the Problem 38 ISSN 0049-6804. «Врачеб. дело». 2017, № 1–2 ОБЗОР ЛИТЕРАТУРЫ 43. Williams G. R., Duncan Bassett J. H. Local control of thyroid hormone action: role of type 2 deiodinase Deiodinases: the balance of thyroid hormone // J. of Endocrinol. – 2011. – Vol. 209. – P. 261–272. 44. Wittmann G., Harney J. W., Singru P. S. et al. Inflammation-inducible type 2 deiodinase expres- sion in the leptomeninges, choroid plexus, and at brain blood vessels in male rodents // Endocri- nology. – 2014. – Vol. 155. – P. 2009–2019. 45. Yu J., Koenig R. J. Induction of type 1 iodothyronine deiodinase to prevent the nonthyroidal illness syndrome in mice // Endocrinol. – 2006. – Vol. 147, N 7. – Р. 3580–3585. СУЧАСНІ УЯВЛЕННЯ ПРО СИНДРОМ НЕТИРЕОЇДНОЇ ПАТОЛОГІЇ В КЛІНІЧНІЙ ПРАКТИЦІ Н. О. Абрамова, Н. В. Пашковська (Чернівці) Будь-які гострі та хронічні захворювання, що втягують у патологічний процес весь організм, можуть викликати порушення обміну тиреоїдних гормонів на фоні відсутності супутньої патології щитоподібної залози, гіпофіза та (або) гіпоталамуса. Такі порушення називають «син- дромом нетиреоїдної патології» (СНТП), або «синдромом низького Т3», і зустрічаються у 70 % госпіталізованих. У даному огляді ми розглянули етіологію, патогенез та частково шляхи корекції синдрому нетиреоїдної патології. Ключові слова: синдром нетиреоїдної патології, синдром низького Т3, порушення обміну тиреоїдних гормонів. CURRENT VIEWS ON NONTHYROIDAL ILLNESS SYNDROME IN CLINICAL PRACTICE (REVIEW) N. O. Abramova, N. V. Pashkovska (Chernivtsi, Ukraine) Higher State Educational Establishment of Ukraine «Bukovinian State Medical University» Any acute and chronic diseases that involve the whole organism into pathological process, can cause violation of thyroid hormones metabolism against a background of absence of concomitant diseases of thyroid gland, pituitary gland or hypothalamus. Such violations are called “nonthyroidal illness syndrome” (NTIS) or “low T3 syndrome” and occur in 70 % of hospitalized patients. In this review we described etiology, pathogenesis and partly ways of correction of NTIS. Key words: nonthyroidal illness syndrome, low T3 syndrome, violation of thyroid hormones metabolism. УДК 613.79 : 159.963.233/.232 Поступила 16.02.2016 V. I. PONOMARYOV1, V. I. VOVK1, M. E. CHERNENKO2, V. V. PONOMARYOVA1 (Kharkiv, Ukraine) SLEEP AND ITS DISORDERS: IS THE PROBLEM NEUROPSYCHIATRIC OR SOMATIC? 1Department of Psychiatry, Narcology, Neurology and Medical Psychology (Headofthe Department – Full Professor Vladimir I. Ponomaryov) of the V. N. Karazin Kharkiv National University; 2GI “Institute of Neurology, Psychiatry and Addiction” Medical Sciences of Ukraine <[email protected]> In this article, we showed the results of an analysis of the scientific literature on sleep issues and its violations. Wedes cribed somno logical disorders according to existing classifications, etiological factors and pathogenetic mechanisms of data generation disorders. We briefly de- scribed the algorithm for treating in somnia. We concluded that the data presented reflect the complexity of the problemofs leep disturbance and the import ance of doubtforboth psycho- neurological specialists and general practitioners. We expres sed the state ment that knowledge of somnologyis mandatory in the predegree and postgraduatet raining of doctors. Key words: sleep disturbance, somnology, insomnia. © Â. È. Ïîíîìàðёâ, Â. È. Âîâê, Ì. Å. ×åðíåíêî, Â. Â. Ïîíîìàðёâà, 2017 В. І. Пономарьов та ін. Сон та його порушення: проблема нейропсихіатрична? 39 Introduction. According to various data, 30–55 % of planet’s population have periods of sleep problems. Complaints about sleep disorders are rarely the primary reason for the patients to turn for medical help, and they can be mainly met in the list of other physical or psychoneurological complaints. Despite the statistic fact that two of three cases of sleep disorders are connected with psychic problems, most patients turn to therapists, some of them – to neurologists, and only few of them – to psy- chiatrists. Most general practitioners do not try to analyze and explain this patho- logical phenomenon, confining themselves only to prescribing a medicine that improves the sleep. The physicians’ lack of knowledge in clinical picture and general notions of sleep disorders defines the goal of this work – to analyze the literary data concerning insomnia disorders (sleep disorders). Results of the study. In 2005, the new International Classification of Sleep Dis- orders (ICSD-2) was approved, according to which the known sleep disorders were divided into 8 main groups that included 85 nosologic units (insomnia; sleep-disordered breathing; hypersomnia; circadian rhythm sleep disorders; parasomnia; increased acti- vation of sympathetic nervous system, circadian rhythm (‘inner clock’), high insulin sensitivity, endocrine system ingestive behavior, energy consumption, α- and β-secretion, physical activity of energy consumption, lipidic and carbohydrate metabolism, reduced satiation, S. Schmidt metabolic syndrome, ‘sleep-wake’ cycle disorders, sleep deficit, quality of sleep, other sleep disorders) [2, 14, 16]. Among the clinically significant sleep disorders in population one can often meet insomnias, sleep-disordered breathing and circadian rhythm sleep disorders that represent the heterogeneous group of pri- mary and secondary type. Insomnia (sleeplessness) is a clinical syndrome that is characterized by recurrent disorders in initiation, duration, consolidation and quality of sleep that appear despite the availability of time and conditions and develop into various disorders in daytime activity. The polysomnographic correlates of these disorders are prevailing light sleep stages, frequent awakening, long periods of wakefulness in sleep, reduction of deep sleep stages, and increased motor activity. The occurrence of insomnia in population is quite high. At the same time, the data as for occurrence vary in quite a wide range, depending on diagnostic criteria – from 3.9 % to 48 %. Thus 30–48 % of population complain about symptoms of insomnia [4, 17]. According to the criteria of Diagnostic and Statistical Manual of Mental Disorders (DSM-IV, 1994) (complaints about sleep disorders three or more nights a week ac- companied with daytime impairments), 22.1 % of the population have insomnia. 9.8 % have insomnia while meeting the criterion of disorders that last no less than 1 month, and only 6.6 % are diagnosed with insomnia while having no concomitant psychic pathology (primary insomnias). At the same time, the occurrence of insomnia, accord- ing to the diagnostic criteria of ICSD-2 (three criteria of diagnosis listed below), is 14.7 %, and in case of exclusion of primary sleep disorders (obstructive sleep apnea syndrome – OSA, restless leg syndrome, circadian rhythm sleep disorders) – less than 6 %. It needs be noted, that the cases of OSA in patients with insomnia in general population make up only 2.1 % [3, 11]. According to the ICD-10, insomnia is defined as 'nonorganic insomnia' (primary) and occurs only in 3.9 % of population. Insomnia is more often diagnosed in women due to widely-spread psychic disorders, especially during menopause. Aging promotes insomnia. About half of the population of 65 years old and more have sleep disorders. It has been found out that development of insomnia in most cases is connected with emotional stress and psychic disorders. The clinical significance of insomnia is deter- mined by the length of night sleep, apparent deterioration of cognitive functions and quality of life [13, 17, 18]. Nowadays, the most widely used in clinical practice are the diagnostic criteria of 'insomnia' according to ICSD-2 (2005): 1) presence of sleep disorders 3 nights a week (difficulty falling asleep, night awak- enings, feeling of superficial non-deep sleep, early morning wakening); 2) adequate opportunity and circumstances for sleep; 3) symptoms connected with sleep disorders in the daytime (fatigue, attention impair- ment, memory impairment, mood disturbance, daytime sleepiness and others). 40 ISSN 0049-6804. «Врачеб. дело». 2017, № 1–2 ОБЗОР ЛИТЕРАТУРЫ The primary form includes adaptive, psychophysiological, paradoxical, idiopathic, behavioral insomnia in children as well as insomnia as a result of sleep hygiene non- observance. Adaptive (acute) insomnia develops as a result of identifiable impact (emo- tional, physical or environmental) and disappears after the stressor's impact stops. The duration of sleep disorders in this case is no longer than 3 months. Psychophysiological insomnia is a disorder caused by associations that disturb the sleep (“fear of not falling asleep”). The patient is usually anxious about sleep problems and their consequences, and it leads to the 'vicious circle' of arousal which results in further sleep disorders. Paradoxical insomnia is a special form of insomnia that is characterized by the sleep disorder 'misperception' by the patient while the main complaints are partial or total absence of night sleep during a long period of time with no apparent disorders in the daytime. Polysomnography shows the discrepancy between the stated duration of sleep and the real one that is less than 50 %. Insomnia as a result of sleep hygiene non-ob- servance develops under the influence of behavioral factors (coffee, alcohol, smoking, physical activity before sleep and others) that cause excessive arousal or impede the sleep directly (irregular sleep pattern, bright light in the bedroom and others). Idio- pathic insomnia first appears
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