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POC 101

Improving Outcomes in Non–24-Hour Sleep-Wake Disorder

Identifying Patients and Tailoring Therapy

Guidelines

International Classification of Sleep Disorders – Third Edition (ICSD-3).

The ICSD-3 is the authoritative clinical text for the diagnosis of sleep disorders. Updated in 2014, the third revision to the ICSD features significant changes, including new nomenclature, classifications, and diagnoses. The book also includes current and accurate diagnostic and treatment reimbursement codes (eg, ICD-10). Disorders are grouped into 6 major categories, one of which is circadian rhythm sleep-wake disorders.

American Academy of Sleep Medicine. 2014; Westchester, IL.

Clinical practice guideline for the treatment of intrinsic circadian rhythm sleep-wake disorders: advanced sleep-wake phase disorder (ASWPD), delayed sleep-wake phase disorder (DSWPD), non-24-hour sleep-wake rhythm disorder (N24SWD), and irregular sleep-wake rhythm disorder (ISWRD). An update for 2015. 

The American Academy of Sleep Medicine has recently updated clinical guidelines for the treatment of intrinsic circadian rhythm sleep-wake disorders. These guidelines were created using a systematic literature review, assessment of evidence using Grading of Recommendations Assessment, Development and Evaluation (GRADE) methodology, and meta-analyses.

Auger RR, et al. J Clin Sleep Med. 2015;11(10):1199-1236.

Patient and Caregiver Resources

2009 Sleep in America Poll: Summary of Findings.

The National Sleep Foundation’s 2009 Sleep in America™ poll of 1000 respondents highlights behaviors that adversely impact sleep and the consequences of insufficient sleep.

Information on Non–24-Hour Sleep-Wake Disorder From the National Sleep Foundation.

The National Sleep Foundation website offers patient-centered information regarding symptoms, diagnosis, pharmacologic therapies, other management modalities, and associations between non–24-hour sleep-wake disorder and other medical/psychiatric conditions.

Circadian Sleep Disorders Network: Advocating for People With Misalligned Body Clocks.

The Circadian Sleep Disorders Network is a volunteer-driven nonprofit organization that is dedicated to increasing awareness of chronic circadian rhythm disorders, advocating for accommodations, and providing support for those living with these conditions.

Clinical Tools

Epworth Sleepiness Scale. 

The Epworth Sleepiness Scale (ESS) is a self-administered questionnaire that quantifies an individual’s general level of sleepiness. The total ESS score can range between 0 and 24. A score >12 indicates a significant amount of sleepiness.

Johns MW. Sleep. 1991;14(6):540-545.

National Sleep Foundation Sleep Diary.

The National Sleep Foundation’s sleep diary can help patients and clinicians track and evaluate sleep habits and problems over time, thereby standardizing an essential step in the diagnosis and management of circadian rhythm sleep-wake disorders.

The Insomnia Severity Index.

The Insomnia Severity Index is a validated instrument used to assess the degree of insomnia and treatment responses. A score of 8 to 14 indicates subthreshold insomnia, whereas a score of ≥15 indicates clinical insomnia.

Morin CM, et al. Sleep. 2011;34(5):601-608.

Suggested Readings

Non-24-hour disorder in blind individuals revisited: variability and the influence of environmental time cues.

Emens JS, et al. Sleep. 2013;36(7):1091-1100

Non-24-hour sleep-wake disorder revisited: a case study.

Garbazza C, et al. Front Neurol. 2016:7:17.

Safety profile of tasimelteon, a melatonin MT1 and MT2 receptor agonist: pooled safety analyses from six clinical studies

Leger D, et al. Expert Opin Drug Saf. 2015;14(11):1673-1685.

Alertness, mood, and performance rhythm disturbances associated with circadian sleep disorders in the blind.

Lockley SW, et al. J. Sleep. Res. 2008;17(2):207-216. 

Tasimelteon for non-24-hour sleep-wake disorder in totally blind people (SET and RESET): two multicentre, randomised, double-masked, placebo-controlled phase 3 trials.

Lockley SW, et al. Lancet. 2015;386(10005):1754-1764.

Sleep: a health imperative.

Luyster FS, et al. Sleep. 2012;35(6):727-734.

Personality differences in delayed sleep-wake phase disorder and non-24-hour sleep-wake rhythm disorder patients relative to healthy sleepers.

Micic G, et al. Sleep Med. 2016 Jun 16. [Epub ahead of print].

Excessive sleepiness: Under-recognized and essential marker for sleep/wake disorder management.

Roth T, et al. Curr Med Res Opin. 2010;26(suppl 2):S3-S24.

Adverse metabolic and cardiovascular consequences of circadian misalignment.

Scheer FA, et al. Proc Natl Acad Sci U S A. 2009;106(11):4453-4458.

Caffeine does not entrain the circadian clock but improves daytime alertness in blind patients with non-24-hour rhythms.

St Hilaire MA, Lockley SW. Sleep Med. 2015;16(6):800-804

Circadian rhythm abnormalities

Zee PC, et al. Continuum (Minneap Minn). 2013;19(1 Sleep Disorders):132-147.

Interactive Presentation

Improving Outcomes in Non–24-Hour Sleep-Wake Disorder

Karl Doghramji, MD; Paul P. Doghramji, MD, FAAFP


Activity
Improving Outcomes in Non–24-Hour Sleep-Wake Disorder

Identifying Patients and Tailoring Therapy

Activity
Non-24–Hour Sleep-Wake Disorder

A Case-Based Discussion on Diagnosis and Treatment

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