Diagnosis, Cause, and Treatment Approaches for Delayed Sleep-Wake Phase Disorder

Magee, Michelle; Marbas, Emily M.; Wright, Kenneth P.; Rajaratnam, Shanthakumar M W; Broussard, Josiane L.

doi:10.1016/j.jsmc.2016.05.004

Cited by 25 publications

(24 citation statements)

References 87 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Specifically, DSWPD participants were more variable in their wake times and total sleep time than healthy controls. These differences are consistent with the observation that people with DSWPD often wake later when their social schedule permits, but force themselves to wake up earlier, to meet morning social obligations [22]. This behavior would be expected to lead to increased variability in wake times, and consequently increased variability in total sleep time in DSWPD.…”

Section: 0 Discussionsupporting

confidence: 84%

“…The assessment of the DLMO in DSWPD is encouraged to improve diagnostic accuracy [1, 14], and to optimize the timing of post-awakening light and afternoon/evening exogenous melatonin treatment of DSWPD [15–18]. Treatment recommendations [19], derived from the light and/or melatonin phase response curves [20, 21], often implicitly assume a stable DLMO in DSWPD[22]. To our knowledge, only one study has assessed the variability of the DLMO in people with DSWPD [23].…”

Section: 0 Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Sleep and circadian variability in people with delayed sleep–wake phase disorder versus healthy controls

et al. 2017

View full text Add to dashboard Cite

Objective/Background To compare sleep and circadian variability in adults with delayed sleep-wake phase disorder (DSWPD) to healthy controls. Patients/Methods Forty participants (22 DSWPD, 18 healthy controls) completed a 10-day protocol, consisting of DLMO assessments on two consecutive nights, a five-day study break, followed by two more DLMO assessments. All participants were instructed to sleep within one hour of their self-reported average sleep schedule for the last four days of the study break. We analyzed the participants’ wrist actigraphy data during these four days to examine intraindividual variability in sleep timing, duration and efficiency. We also examined shifts in the DLMO from before and after the study break. Results and Conclusions Under the same conditions, people with DSWPD had significantly more variable wake times and total sleep time than healthy controls (p≤0.015). Intraindividual variability in sleep onset time and sleep efficiency was similar between the two groups (p≥0.30). The DLMO was relatively stable across the study break, with only 11% of controls but 27% of DSWPDs showed more than a one hour shift in the DLMO. Only in the DSWPD sample was greater sleep variability associated with a larger shift in the DLMO (r=0.46, p=0.03). These results suggest that intraindividual variability in sleep can be higher in DSWPD versus healthy controls, and this may impact variability in the DLMO. DSWPD patients with higher intraindividual variability in sleep are more likely to have a shifting DLMO, which could impact sleep symptoms and the optimal timing of light and/or melatonin treatment for DSWPD.

show abstract

Section: 0 Discussionsupporting

confidence: 84%

Section: 0 Introductionmentioning

confidence: 99%

Sleep and circadian variability in people with delayed sleep–wake phase disorder versus healthy controls

et al. 2017

View full text Add to dashboard Cite

show abstract

“…Adolescents recover from sleep deprivation during the weekend, known as a ‘social jetlag’ (Roenneberg et al ., ; Wittmann et al ., ). The delayed sleep–wake phase is classified as a delayed sleep–wake phase disorder (DSWPD) if it (a) is present over 3 months; (b) leads to insomnia; (c) leads to excessive daytime sleepiness and (d) causes distress and/or impairment of important functioning (Magee et al ., ).…”

Section: Introductionmentioning

confidence: 97%

“…A recent review stated that sleep disorders are prevalent in adolescent CFS, but more research is needed due to few studies with overall low quality (Snodgrass et al ., ). As sleep–wake disturbances might improve with effective treatment (Magee et al ., ), sleep patterns should be characterized to identify possible therapeutic targets in adolescent CFS.…”

Section: Introductionmentioning

confidence: 99%

Sleep–wake rhythm disturbances and perceived sleep in adolescent chronic fatigue syndrome

Pedersen

Ekstedt

Småstuen

et al. 2017

Journal of Sleep Research

View full text Add to dashboard Cite

Chronic fatigue syndrome (CFS) is characterized by long-lasting, disabling and unexplained fatigue that is often accompanied by unrefreshing sleep. The aim of this cross-sectional study was to investigate sleep-wake rhythm and perceived sleep in adolescent CFS patients compared to healthy individuals. We analysed baseline data on 120 adolescent CFS patients and 39 healthy individuals included in the NorCAPITAL project. Activity measures from a uniaxial accelerometer (activPAL) were used to estimate mid-sleep time (mid-point of a period with sleep) and time in bed. Scores from the Karolinska Sleep Questionnaire (KSQ) were also assessed. The activity measures showed that the CFS patients stayed significantly longer in bed, had a significantly delayed mid-sleep time and a more varied sleep-wake rhythm during weekdays compared with healthy individuals. On the KSQ, the CFS patients reported significantly more insomnia symptoms, sleepiness, awakening problems and a longer sleep onset latency than healthy individuals. These results might indicate that disrupted sleep-wake phase could contribute to adolescent CFS; however, further investigations are warranted.

show abstract

“…Current recommended treatments for DSPD include interventions which are designed to normalise circadian timing, such as morning bright light therapy or melatonin administration [ 3 ]. Each of these are intended to advance circadian timing.…”

Section: Introductionmentioning

confidence: 99%

The pupillary light reflex distinguishes between circadian and non-circadian delayed sleep phase disorder (DSPD) phenotypes in young adults

et al. 2018

Self Cite

View full text Add to dashboard Cite

This study investigated the utility of the pupillary light reflex as a method of differentiating DSPD patients with delayed melatonin timing relative to desired/required sleep time (circadian type) and those with non-delayed melatonin timing (non-circadian type). All participants were young adults, with a total of 14 circadian DSPD patients (M = 28.14, SD = 5.26), 12 non-circadian DSPD patients (M = 29.42, SD = 11.51) and 51 healthy controls (M = 21.47 SD = 3.16) completing the protocol. All participants were free of central nervous system acting medications and abstained from caffeine and alcohol on the day of the assessment. Two pupillary light reflex measurements were completed by each participant, one with a 1s dim (~10 lux) light exposure, and one with a 1s bright (~1500 lux) light exposure. Circadian DSPD patients showed a significantly faster pupillary light reflex than both non-circadian DSPD patients and healthy controls. Non-circadian patients and healthy controls did not differ significantly. Receiver operating characteristic curves were generated to determine the utility of mean and maximum constriction velocity in differentiating the two DSPD phenotypes, and these demonstrated high levels of sensitivity (69.23–-100%) and specificity (66.67–91.67%) at their optimal cut offs. The strongest predictor of DSPD phenotype was the mean constriction velocity to bright light (AUC = 0.87). These results support the potential for the pupillary light reflex to clinically differentiate between DSPD patients with normal vs. delayed circadian timing relative to desired bedtime, without the need for costly and time-consuming circadian assessments.

show abstract

Diagnosis, Cause, and Treatment Approaches for Delayed Sleep-Wake Phase Disorder

Cited by 25 publications

References 87 publications

Sleep and circadian variability in people with delayed sleep–wake phase disorder versus healthy controls

Sleep and circadian variability in people with delayed sleep–wake phase disorder versus healthy controls

Sleep–wake rhythm disturbances and perceived sleep in adolescent chronic fatigue syndrome

The pupillary light reflex distinguishes between circadian and non-circadian delayed sleep phase disorder (DSPD) phenotypes in young adults

Contact Info

Product

Resources

About