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中国临床药理学与治疗学 ›› 2025, Vol. 30 ›› Issue (12): 1587-1595.doi: 10.12092/j.issn.1009-2501.2025.12.001

• 日间过度思睡（EDS）诊疗进展 • 上一篇    下一篇

日间过度思睡病因及诊疗现状

李庆云，黄珂   

  1. 上海交通大学医学院附属瑞金医院呼吸与危重症医学科，上海  200025
  • 收稿日期:2025-11-10 修回日期:2025-12-12 出版日期:2025-12-26 发布日期:1900-01-01
  • 通讯作者: 李庆云，男，博士，主任医师，教授，研究方向：睡眠呼吸疾病及慢性气道疾病。 E-mail： liqingyun68@hotmail.com 李庆云，主任医师，教授，博士生导师和博士后导师。上海交通大学医学院附属瑞金医院呼吸与危重症医学科主任，上海交通大学医学院呼吸病研究所副所长，上海交通大学医学院智能医学技术系副主任。中国医师协会睡眠医学专业委员会主任委员，中国睡眠研究会副理事长、睡眠呼吸障碍专委会候任主委，中华医学会呼吸分会睡眠学组副组长，上海医学会呼吸分会副主任委员、睡眠学组组长，上海医学会重症应急救治分会副主任委员，国之民医·优秀风范。主持国家科技部十三五、十四五重点研发课题，工信部人工智能医疗器械创新任务揭榜挂帅项目及国家自然科学基金项目等。在Cell等杂志发表论文200余篇，出版学术专著30余部。获上海市科技进步一等奖，上海康复医学奖一等奖等。
  • 基金资助:
    国家自然科学基金面上项目（82270100）；国家自然科学基金项目（82070089）

Etiology, diagnosis, and current treatment of excessive daytime sleepiness

LI Qingyun, HUANG Ke   

  1. Department of Respiratory and Critical Care Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China
  • Received:2025-11-10 Revised:2025-12-12 Online:2025-12-26 Published:1900-01-01

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摘要：

日间过度思睡（excessive daytime sleepiness，EDS）可降低警觉性和损害日间功能，增加交通或职业事故风险，危害性高，其核心病理生理基础为睡眠结构紊乱和大脑促觉醒功能障碍，涉及睡眠障碍、躯体疾病、精神障碍和药物/物质使用等多种病因。临床上应重点关注职业司机和交通运输从业者、轮班工作者、合并慢性躯体疾病、精神障碍以及药物/物质使用者等EDS高危人群。EDS的诊断以详细病史和睡眠/作息评估为基础，结合主观量表及多导睡眠监测、多次小睡潜伏期试验等客观检查，并需与疲劳加以鉴别。治疗尚无统一方案，以消除病因和缓解嗜睡症状为主，并联合促觉醒剂（wake-promoting agent，WPAs）充分治疗。本文总结EDS的病因及相应病理生理机制、高危人群、诊断、鉴别诊断及治疗现状，并就未来研究方向提出思考，为临床规范化诊疗与管理提供参考，推动EDS诊疗向精准化方向发展。

关键词: 日间过度思睡, 嗜睡量表, 睡眠结构紊乱, 评估方法, 治疗现状, 促觉醒剂 ,   

Abstract:

Excessive daytime sleepiness (EDS) is a clinical condition characterized by an inability to maintain alertness and wakefulness during the daytime, leading to diminished vigilance, impaired daytime functioning, and increased risks of traffic or occupational accidents. The core pathophysiology involves disrupted sleep architecture and dysfunction of brain arousalpromoting systems, which can stem from diverse etiologies including sleep disorders, systemic diseases, psychiatric disorders, and medication/substance use. Clinically, high-risk populations for EDS include occupational drivers and transportation workers, shift workers, individuals with chronic systemic diseases or psychiatric disorders, and users of sedative substances. Diagnosis of EDS relies on a detailed medical history and sleep/wake cycle assessment, supplemented by subjec‐tive scales (e.g., Epworth sleepiness scale) and ob‐jective tests such as polysomnography (PSG) and the multiple sleep latency test (MSLT). It is crucial to differentiate EDS from fatigue. Currently, there is no universally standardized treatment protocol for EDS. Management focuses on addressing underlying causes and alleviating symptoms, often combined with wake-promoting agents (WPAs) for sufficient therapeutic effect. This article summarizes the etiology, pathophysiological mechanisms, high-risk populations, diagnostic approaches, and current treatment strategies for EDS. It also proposes future research directions to advance standardized clinical management and promote precision medicine in EDS diagnosis and therapy.

Key words: excessive daytime sleepiness, sleepiness scales, disrupted sleep architecture, assessment methods, current treatment status, wake-promoting agents

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