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AASM Board Review - Lecture 5 Circadian Rhythm
Terms in this set (64)
Effects of circadian rhythms on growth hormone?
growth hormone doesn't peak unless sleep occurs
when does performance (alertness, cognitive performance, short term memory) hits nadir?
at CT min
what tests are helpful in determining circadian rhythm characteristics?
munich chronotype questionnaire
ICSD-3 definition of advanced sleep wake phase disorder?
A - symptoms: all of the following
- advance in major sleep episode relative to desired / required sleep wake times leads to early evening sleepiness and waking earlier than desired
- symptoms present for 3 or more months
- improved sleep quality and longer sleep duration when patients sleep ad libitum at their naturally advanced sleep wake schedule
B - assessment:
- sleep log and actigraphy for 7 or more days shows stable advanced habitual sleep period
ICSD 3 definition of circadian rhythm sleep-wake disorder
ICSD 3 - A + B + C
A. Symptoms: insomnia or EDS or both
B. Disruption of sleep-wake rhythm
- recurrent or persistent misalignment between the desired or imposed sleep schedule and the circadian sleep-wake rhythm or by a disorder of the endogenous circadian system
C. Associated features
- distress or impaired functioning
associated conditions with advanced sleep wake phase
- smith magenis
what's the mutation associated with familial advanced phase sleep disorder?
missense mutation in a casein kinase (CK1 epsilon) binding region of a period gene (HPer2) --> hypophosphorylation by CK1 epsilon in vitro --> hypophosphorylation on the Period protein causes promotion of its transcription --> decrease in period length clock --> shortened endogenous circadian period
onset of advanced sleep phase issues?
middle or old age
diagnosis of advanced sleep wake phase disorder
sleep logs or actigraphy
rule out depresion
therapy for ASWPD
- which modalities are not recommended
early evening bright light therapy (before CT min)
avoid light in early AM
- occasionally early AM melatonin could be helpful (not recommended since it can cause daytime sleepiness)
- chronotherapy not recommended as sole therapy
what other tests are helpful in providing information about ASWPD?
advance of > 2 hours in timing of other circadian rhythms such as DLMO or urinary 6 sulfatoxymelatonin (helpful but not required)
side effects of light therapy
can cause mania
what conditions are contraindications for light therapy
underlying eye disease or photosensitive disorders
Review human phase response curve to bright light and melatonin
- DLMO is the up airway
- rectangle typical sleep period
- down arrow in box is CT min
- before DLMO --> advances bedtime
- after DLMO --> causes delay
Of note, with higher doses of melatonin, maximal effect occurs at an earlier time compared to lower dose of melatonin.
Which proposed treatment of ASWPD is the only one with evidence for in the AASM guidelines?
Everything else has no recommendation:
- avoidance of light
- sleep promoting medications
- timer oral melatonin
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