Medikamentöse Therapie des Schichtarbeitersyndroms

Schwerpunkt
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Zusammenfassung

Die Therapie des Schichtarbeitersyndroms beinhaltet Änderungen der Schlafhygiene und der Schichtabfolge sowie die Anwendung hellen Lichts am Arbeitsplatz ebenso wie eine unterstützende Medikation. Medikamente lösen das Problem jedoch nicht, sondern helfen zu funktionieren. Eine Indikation für eine medikamentöse Behandlung besteht v. a. dann, wenn ein Dienstwechsel nicht umsetzbar ist, die Störung voll ausgeprägt ist und subjektiv erheblicher Leidensdruck besteht, die Vigilanz gestört und die Leistungsfähigkeit beeinträchtigt ist, der Betroffene einer dadurch verminderten Lebensbewältigung und erhöhten Fehler -und Unfallrate in Beruf und Privatleben ausgesetzt ist oder gesundheitliche Folgen der Störung auftreten, wie gastrointestinale, metabolische oder kardiale Erkrankungen. Pharmaka lassen sich erfolgreich einsetzen, wenn deren individuelles Nutzen-Risiko-Profil beachtet wird. Die evidenzbasierte und zulässige Pharmakotherapie umfasst die Schlafverbesserung durch Hypnotika und die Vigilanz- und Leistungssteigerung durch Stimulanzien. Sie wird bevorzugt mit kurzwirksamen Benzodiazepinrezeptoragonisten wie Zaleplon, Zolpidem oder Zopiclon und mit modernen Stimulanzien wie Modafinil durchgeführt. Explorativ können chronobiotisch wirksame Substanzen, z. B. mit melatoninrezeptoragonistischer Wirkung, schlaf- oder vigilanzfördernde Antidepressiva sowie zahlreiche, die Folgeerkrankungen kompensierende Pharmaka eingesetzt werden.

Schlüsselwörter

Schichtarbeitersyndrom Schlaf-Wach-Rhythmus-Störung Zirkadianes System Insomnie Hypersomnie Hypnotika Stimulanzien 

Pharmacological treatment of shift work disorder

Abstract

Treatment of shift work disorder is complex, including changes in shift work pattern, use of bright light during night shift as well as behavioral changes, e. g., a biphasic sleep–wake rhythm during daytime hours, or sleep hygiene. Medication, however, does not solve the problem per se but improves functioning. Patients may require treatment, in particular, if they suffer from shift work sleep disorder with impaired vigilance and functioning, it is not possible to change the shift pattern, and they complain of consecutive or comorbid disorders, such as depression or gastrointestinal, metabolic or cardiovascular diseases. Evidence-based pharmaceutical treatments include modern stimulants, such as modafinil, to enhance wakefulness, and short-acting benzodiazepine receptor agonistic hypnotics, e. g., Zaleplon, Zolpidem or Zopiclone, to improve sleep. Exploratory treatments with inconsistent evidence cover agents with chronobiotic, melatonin-receptor agonistic properties, sleep- or vigilance-promoting antidepressants as well as numerous drugs which are used to compensate diseases secondary to shift work sleep disorder.

Keywords

Shift work disorder Circadian rhythm sleep disorder Circadian system Insomnia Hypersomnia Hypnotics Stimulants 

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Copyright information

© Springer 2010

Authors and Affiliations

  1. 1.Klinik und Poliklinik für PsychiatriePsychosomatik und Psychotherapie der Universität RegensburgRegensburgDeutschland
  2. 2.Institut für PhysiologieCharité - Universitätsmedizin Berlin, Campus Benjamin FranklinBerlinDeutschland

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