Practical Approaches to the Management of Shift Work Disorder

Target Audience

The educational design of this activity addresses the needs of family physicians and other primary care providers who care for patients with shift work disorder.

Statement of Need

Characterized by insomnia and/or excessive sleepiness, shift work disorder occurs in patients who are sensitive to a mismatch between their endogenous circadian rhythms and the timing of alternative work schedules^.1,2 The underlying circadian dyssynchrony—together with the common consequence of sleep deficiencies—can significantly impair mood, cognition, and alertness.^2,3 Moreover, chronically affected individuals show molecular, immune, and neural changes that can induce or exacerbate a range of other diseases.³ For example, disrupted circadian rhythms markedly affect cardiometabolic function, contributing to increased risks for diabetes, obesity, and cardiovascular disease among individuals working night or rotating shifts.^4,5 Despite documented adverse effects on patient health, functioning, and quality of life, shift work disorder is underdiagnosed and undertreated.⁶ This Interactive Exchange^™ program will examine the diagnostic criteria for shift work disorder and explore approaches to patient assessment, including the components of a comprehensive sleep history and practical clinical interviewing techniques. Management recommendations will address good sleep hygiene, behavioral modifications, and pharmacotherapy that targets residual excessive sleepiness, insomnia, and other clinical signs and symptoms of shift work disorder. 

References

1. Sack RL, Auckley D, Auger RR, et al. Circadian rhythm sleep disorders: part I, basic principles, shift work and jet lag disorders. An American Academy of Sleep Medicine review. Sleep. 2007;30(11):1460-1483.
2. Roth T. Shift work disorder: overview and diagnosis. J Clin Psychiatry. 2012;73(3):e09.
3. Benca R, Duncan MJ, Frank E, et al. Biological rhythms, higher brain function, and behavior: Gaps, opportunities, and challenges. Brain Res Rev. 2009;62(1):57-70.
4. Morris CJ, Yang JN, Scheer FA. The impact of the circadian timing system on cardiovascular and metabolic function. Prog Brain Res. 2012;199:337-358.
5. Cappuccio FP, D'Elia L, Strazzullo P, Miller MA. Quantity and quality of sleep and incidence of type 2 diabetes: a systematic review and meta-analysis. Diabetes Care. 2010;33(2):414-420.
6. Morgenthaler TI, Lee-Chiong T, Alessi C, et al. Practice parameters for the clinical evaluation and treatment of circadian rhythm sleep disorders. An American Academy of Sleep Medicine report. Sleep. 2007;30(11):1445-1459.

Educational Objectives

After completing this activity, the participant should be better able to:

1. Describe the neurophysiologic mechanisms of circadian rhythms and adverse multisystem consequences of misalignment on patient health and function 
2. Evaluate sleep patterns and symptoms of shift work disorder using clinical tools and strategies, such as sleep logs and the Epworth Sleepiness Scale
3. Diagnose shift work disorder based on identified symptoms, patient history and work schedule, and a comprehensive sleep history 
4. Tailor therapeutic regimens for shift work disorder that include appropriate combinations of nonpharmacologic and pharmacologic modalities
5. Educate patients on the potential consequences of poorly managed shift work disorder and the fundamentals of sleep hygiene

Program Agenda

6:30-7:00: Registration and Introductions

7:00-7:10: Preactivity Outcomes Assessment

7:10-7:20: Disease Primer: Scientific Insights Into Circadian Rhythms and the Consequences of Misalignment

7:20-8:00: Best Practices in the Diagnosis and Management of Shift Work Disorder: A Case-Based Discussion

8:00-8:15: Build-a-Case Collaboration

8:15-8:30: Ask the Experts and Postactivity Outcomes Assessment

Physician Continuing Medical Education

This activity has been planned and implemented in accordance with the Essential Areas and Policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint sponsorship of Global Education Group (Global) and Integritas Communications. Global is accredited by the ACCME to provide continuing medical education for physicians.

This CME activity complies with all requirements of the federal Physician Payment Sunshine Act. If a reportable event is associated with this activity, the accredited provider managing the program will provide the appropriate physician data to the Open Payments database.

Physician Credit Designation

Global Education Group designates this live activity for a maxiumum of 1.5 AMA PRA Category 1 Credits^TM. Physicians should claim only the credit commensurate with the extent of their partcipation in this activity. 

AAFP Credit Designation

This live activity, Practical Approaches to the Management of Shift Work Disorder: Overcoming Barriers to Improve Patient Outcomes with a beginning date of 10/22/2014, has been reviewed and is acceptable for up to 1.5 Prescribed credit(s) by the American Academy of Family Physicians. Physicians should claim only the credit commensurate with the extent of their partcipation in this activity. 

Fee Information & Refund/Cancellation Policy

There is no fee for this educational activity.

For information about the accreditation of this program, please contact Global at 303-395-1782 or inquire@globaleducationgroup.com

Disclosure of Unlabeled Use

This educational activity may contain discussion of published and/or investigational uses of agents that are not indicated by the FDA. Global Education Group (Global) and Integritas Communications do not recommend the use of any agent outside of the labeled indications.  

The opinions expressed in the educational activity are those of the faculty and do not necessarily represent the views of any organization associated with this activity. Please refer to the official prescribing information for each product for discussion of approved indications, contraindications, and warnings.

Disclaimer

Participants have an implied responsibility to use the newly acquired information to enhance patient outcomes and their own professional development. The information presented in this activity is not meant to serve as a guideline for patient management. Any procedures, medications, or other courses of diagnosis or treatment discussed in this activity should not be used by clinicians without evaluation of patient conditions and possible contraindications on dangers in use, review of any applicable manufacturer’s product information, and comparison with recommendations of other authorities.

This activity is jointly sponsored by Global Education Group and Integritas Communications.

This activity is supported by an educational grant from Teva CNS.