AASM Board Review - Lecture 5 Circadian Rhythm

Effects of circadian rhythms on growth hormone?
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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
morningness-eveningness questionnaire
actigraphy
ICSD-3 definition of advanced sleep wake phase disorder?
A+B

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
- age
- autism
- 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

Not recommended:
- occasionally early AM melatonin could be helpful (not recommended since it can cause daytime sleepiness)
- chronotherapy not recommended as sole therapy