关键词: 夜间进食综合征 饮食障碍 生理神经机制 干预治疗

Abstract: Night eating syndrome（NES）is characterized by morning loss of appetite, evening hyperphagia or nocturnal awakening to eat, and is associated with sleep problems. NES has been described as a unique combination of an eating disorder, a sleep disorder and a mood disorder and is now included in the Diagnostic and Statistical Manual of Mental Disorders Fifth Edition (DSM-V) as an Other Specified Feeding or Eating Disorder. With the development of the national economy, the pace of life of Chinese is becoming quicker and quicker. The growing pressure of life and competition may result in an unhealthy life style, which might further lead to an irregular diet. According to studies available, NES is associated with life stress, psychoneurotocism, low mood, and adverse reactions to weight loss and its comorbidities include eating disorders, overweight and obesity, sleep disorders, depression, anxiety, and substance abuse. Night eating syndrome is of importance clinically, of which development and maintenance is likely to be influenced by physiological, psychological, and social factors. Although the disorder has gained a great deal of attention in recent years, neural mechanisms of NES remain understudied in contrast to other eating disorders. Stunkard et al. (2009) proposed a biobehavioral model for NES, which is based on the function of the serotonin system and supported by a one single photon emission computed tomography (SPECT) study. It predicts that the interaction of stress and genetic vulnerability may elevates the serotonin transporters (SERT) levels in the midbrain, leading circadian delay and decreased satiety through the serotonin system. Additionally, the role of prefrontal and limbic system dysregulation in the development and maintenance of NES is plausible. The model suggests that the decrease of cognitive and behavioral self-regulation could be produced by the prefrontal and limbic brain, which could further increase reward sensitivity to palatable food in the evening and night in persons with NES. To sum up, this study summarized physiological or neural mechanisms of NES and discussed inadequacies of these models. Notably, the review of the literature on the treatment of NES in the last 10 years shows a variety of strategies including pharmacologic treatments such as sertraline and other SSRIs, topiramate, agomelatine, psychological treatments such as cognitive behavior therapy (CBT), progressive muscle relaxation (PMR), and several other treatment alternatives such as phototherapy (PT), exercise and lifestyle interventions. However, the treatment of the syndrome is still in its infancy. For instance, the long-term therapeutic effects and internal mechanism of topiramate and agomelatine have not been determined and justify further studies involving these substances and similar medications. The future research should focus on the following aspects: (a) to explore the diagnosis of NES and make the measurement of it enriched, (b) to further explore the pathogenesis of NES, (c) to develop the treatment of NES, including alternative pharmacological and combination therapies (pharmacological, phototherapy, weight loss and dietary, and psychological interventions), (d) to increase localization studies in China.

Key words: Night eating syndrome, eating disorders, physiological or neural mechanisms, treatment