Precision Medicine in Circadian Rhythm Sleep–Wake Disorders: Current State and Future Perspectives

Abstract

In circadian rhythm sleep-wake disorders precision medicine is less developed than in other medical disciplines mainly because homeostatic sleep and circadian timing have a very complex phenotype with multiple genetic regulation mechanisms. However, biomarkers, phenotyping and psychosocial characteristics are increasingly used. Devices for polysomnography, actigraphy and sleep-tracking applications in mobile phones and other consumer devices with eHealth technologies are increasingly used. Also sleep-related questionnaires and the assessment of co-morbidities influencing sleep in circadian rhythm sleep-wake disorders are major contributors to precision sleep medicine. To further strengthen the (pharmaco-)genetic and biomarker pillar, technology needs to be evolved further. Routinely measuring treatment results using patient-reported outcome measures and clinical neurophysiological instruments will boost precision sleep medicine.

Association of Sleep Quality and Macronutrient Distribution: A Systematic Review and Meta-Regression

“…Dietary protein (PRO) may also influence sleep by supplying the body with amino acid tryptophan (TRP), which is a potential sleep-promoting nutrient [11]. TRP is first converted to 5-hydroxytryptophan (5-HTP), then to serotonin, which is then metabolized to melatonin to signal night time and the onset of sleep [16] A cross-sectional (CS) study has reported that the intake of PRO is positively correlated with sleep duration, quality and pattern [17]. However, studies on the effect of macronutrient distribution with sleep quality is limited and available results are inconsistent [18].…”

Association Between Dietary Protein Intake and Sleep Quality in Middle-Aged and Older Adults in Singapore

“…Another important sleep-related compound produced from serotonin is the hormone melatonin. This hormone is produced in the pineal gland and plays an important role in regulating the body's circadian rhythm ( 25 , 26 ). It has been reported that melatonin production decreases with age, especially in middle-aged and older individuals with insomnia.…”

Epigenetics of Sleep Disorders: An Emerging Field in Diagnosis and Therapeutics

“…Currently, one of the major challenges in Sleep Medicine is to develop precise diagnostic approaches and tailored interventions leading to Precision Sleep Medicine. The need for biomarkers for diagnosis, monitoring, prognosis and the prediction of treatment effectiveness has been extensively recognized for the majority of sleep disorders and associated morbidities, including Obstructive Sleep Apnea [ 32 , 33 ], cognitive impairment [ 34 ], sleep loss [ 35 ], hypersomnia [ 36 ], behavior disorders [ 37 ], and circadian rhythm sleep-wake disorders [ 38 ]. Furthermore, the application of pharmacogenetic methods [ 39 ] and precision tools for personalized treatment selection [ 40 ] holds the promise for developing uniquely tailored approaches for managing sleep-disorder patients.…”