The usefulness of various subjective and objective measures of circadian phase in sleep medicine diagnostics
DOI:
https://doi.org/10.18203/2320-6012.ijrms20253219Keywords:
CRSDs, Circadian clock, Zeitgebers, Subjective and objective measuresAbstract
Circadian rhythm sleep disorders (CRSDs)can be difficult to diagnose as they usually present with a wide array of complaints ranging from insomnia to excessive sleepiness or impairment in the quality of life. Malalignment of the endogenous circadian clock to the external day-night cycle leads to these disorders. There are various subjective and objective methods for assessing these disorders. Both individual subjective and objective measures of circadian phase have their own merits and limitations and a combination of both- especially sleep logs and questionnaires along with actigraphy usually suffice for diagnosing most cases. Dim light melatonin onset (DLMO) and core body temperature (CBT) minimum are also very useful in some cases. Recent advances in the knowledge of neurobiology and genetics of the circadian rhythm should hopefully lead us to improved diagnostic tools and provide us with evidence base practical guidelines for diagnosis and treatment of CRSDs.
Circadian Rhythm Sleep Disorders (CRSDs)can be difficult to diagnose as they usually present with a wide array of complaints ranging from insomnia to excessive sleepiness or impairment in the quality of life. Malalignment of the endogenous circadian clock to the external day-night cycle leads to these disorders. There are various subjective and objective methods for assessing these disorders. Both individual subjective and objective measures of circadian phase have their own merits and limitations and a combination of both- especially sleep logs and questionnaires along with actigraphy usually suffice for diagnosing most cases. Dim light melatonin onset(DLMO) and Core body temperature(CBT)minimum are also very useful in some cases. Recent advances in the knowledge of neurobiology and genetics of the circadian rhythm should hopefully lead us to improved diagnostic tools and provide us with evidence base practical guidelines for diagnosis and treatment of CRSDs.
Metrics
References
Sateia MJ. International classification of sleep disorders. Chest. 2014;146(5):1387-94. DOI: https://doi.org/10.1378/chest.14-0970
Lockley SW, Foster RG. Sleep: A very short introduction. Oxford University Press. 2012. DOI: https://doi.org/10.1093/actrade/9780199587858.001.0001
Wulff K. Chronobiology: Biological rhythms that influence sleep. Sleep. Multi-professional perspectives. London: Jessica Kingsley Publishers. 2012:41-67.
Carrier J, Monk TH, Buysse DJ, Kupfer DJ. Sleep and morningness‐eveningness in the ‘middle’years of life (20–59y). J Sleep Res. 1997;6(4):230-7. DOI: https://doi.org/10.1111/j.1365-2869.1997.00230.x
Jones CR, Campbell SS, Zone SE, Cooper F, DeSano A, Murphy PJ, et al. Familial advanced sleep-phase syndrome: A short-period circadian rhythm variant in humans. Nat Med. 1999;5(9):1062-5. DOI: https://doi.org/10.1038/12502
Sack RL, Auckley D, Auger RR, Carskadon MA, Wright KP, Vitiello MV, et al. Circadian rhythm sleep disorders: part II, advanced sleep phase disorder, delayed sleep phase disorder, free-running disorder, and irregular sleep-wake rhythm. Sleep. 2007;30(11):1484-501. DOI: https://doi.org/10.1093/sleep/30.11.1484
Sadeh A. The role and validity of actigraphy in sleep medicine: an update. Sleep Med Rev. 2011;15(4):259-67. DOI: https://doi.org/10.1016/j.smrv.2010.10.001
Satoh K, Mishima K, Inoue Y, Ebisawa T, Shimizu T. Two pedigrees of familial advanced sleep phase syndrome in Japan. Sleep. 2003;26(4):416-7. DOI: https://doi.org/10.1093/sleep/26.4.416
Carskadon MA, Wolfson AR, Acebo C, Tzischinsky O, Seifer R. Adolescent sleep patterns, circadian timing, and sleepiness at a transition to early school days. Sleep. 1998;21(8):871-81.
Carskadon MA, Wolfson AR, Acebo C, Tzischinsky O, Seifer R. Adolescent sleep patterns, circadian timing, and sleepiness at a transition to early school days. Sleep. 1998;21(8):871-81. DOI: https://doi.org/10.1093/sleep/21.8.871
Dagan Y, Stein D, Steinbock M, Yovel I, Hallis D. Frequency of delayed sleep phase syndrome among hospitalized adolescent psychiatric patients. J Psychos Res. 1998;45(1):15-20. DOI: https://doi.org/10.1016/S0022-3999(97)00299-7
Aoki H, Ozeki Y, Yamada N. Hypersensitivity of melatonin suppression in response to light in patients with delayed sleep phase syndrome. Chronobiol Int. 2001;18(2):263-71. DOI: https://doi.org/10.1081/CBI-100103190
Ozaki S, Uchiyama M, Shirakawa S, Okawa M. Prolonged interval from body temperature nadir to sleep offset in patients with delayed sleep phase syndrome. Sleep. 1996;19(1):36-40. DOI: https://doi.org/10.1093/sleep/19.8.637
Uchiyama M, Okawa M, Shibui K, Liu X, Hayakawa T, Kamei Y, et al. Poor compensatory function for sleep loss as a pathogenic factor in patients with delayed sleep phase syndrome. Sleep. 2000;23(4):553-8. DOI: https://doi.org/10.1093/sleep/23.4.1h
Wyatt JK, Stepanski EJ, Kirkby J. Circadian phase in delayed sleep phase syndrome: predictors and temporal stability across multiple assessments. Sleep. 2006;29(8):1075-80.
Thorpy MJ, Korman E, Spielman AJ, Glovinsky PB. Delayed sleep phase syndrome in adolescents. J Adoles Health Care. 1988;9(1):22-7. DOI: https://doi.org/10.1016/0197-0070(88)90014-9
Mistlberger RE. Circadian regulation of sleep-in mammals: role of the suprachiasmatic nucleus. Brain Res Rev. 2005;49(3):429-54. DOI: https://doi.org/10.1016/j.brainresrev.2005.01.005
Bliwise DL, Hughes M, McMahon PM, Kutner N. Observed sleep/wakefulness and severity of dementia in an Alzheimer's disease special care unit. J Gerontol Series Biol Sci Med Sci. 1995;50(6):303-6. DOI: https://doi.org/10.1093/gerona/50A.6.M303
Sack RL, Lewy AJ, Blood ML, Keith LD, Nakagawa HI. Circadian rhythm abnormalities in totally blind people: incidence and clinical significance. J Clin Endocrinol Metabol. 1992;75(1):127-34. DOI: https://doi.org/10.1210/jcem.75.1.1619000
Spitzer RL, Terman M, Williams JB, Terman JS, Malt UF, Singer F, Lewy AJ. Jet lag: clinical features, validation of a new syndrome-specific scale, and lack of response to melatonin in a randomized, double-blind trial. American J Psych. 1999;156(9):1392-6. DOI: https://doi.org/10.1176/ajp.156.9.1392
Sack RL, Auckley D, Auger RR, Carskadon MA, Wright KP, Vitiello MV, et al. Circadian rhythm sleep disorders: part I, basic principles, shift work and jet lag disorders. Sleep. 2007;30(11):1460-83. DOI: https://doi.org/10.1093/sleep/30.11.1460
Hossain JL, Reinish LW, Heslegrave RJ. Subjective and objective evaluation of sleep and performance in daytime versus nighttime sleep in extended-hours shift-workers at an underground mine. J Occup Environment Med. 2017;46(3):212-26. DOI: https://doi.org/10.1097/01.jom.0000117421.95392.31
Palmer CR, Kripke DF, Savage Jr HC, Cindrich LA, Loving RT, Elliott JA. Efficacy of enhanced evening light for advanced sleep phase syndrome. Behav Sleep Med. 2003;1(4):213-26.
Stewart KT, Hayes BC, Eastman CI. Light treatment for NASA shiftworkers. Chronobiol Internat. 1995;12(2):141-51. DOI: https://doi.org/10.3109/07420529509064509
Zavada A, Gordijn MC, Beersma DG, Daan S, Roenneberg T. Comparison of the Munich Chronotype Questionnaire with the Horne‐Östberg's morningness‐eveningness score. Chronobiol Int. 2005;22(2):267-78. DOI: https://doi.org/10.1081/CBI-200053536
Wittmann M, Dinich J, Merrow M, Roenneberg T. Social jetlag: misalignment of biological and social time. Chronobiology Int. 2006;23(1):497-509. DOI: https://doi.org/10.1080/07420520500545979
Kantermann T, Sung H, Burgess HJ. Comparing the morningness-eveningness questionnaire and munich chronotype questionnaire to the dim light melatonin onset. J Biol Rhyt. 2015;30(5):449-53. DOI: https://doi.org/10.1177/0748730415597520
Archer SN, Robilliard DL, Skene DJ, Smits M, Williams A, Arendt J, et al. A length polymorphism in the circadian clock gene Per3 is linked to delayed sleep phase syndrome and extreme diurnal preference. Sleep. 2003;26(4):413-5. DOI: https://doi.org/10.1093/sleep/26.4.413
Lockley SW, Skene DJ, Arendt J. Comparison between subjective and actigraphic measurement of sleep and sleep rhythms. J Sleep Res. 1999;8(3):175-83. DOI: https://doi.org/10.1046/j.1365-2869.1999.00155.x
Czeisler CA, Walsh JK, Roth T, Hughes RJ, Wright KP, Kingsbury L, et al. Modafinil for excessive sleepiness associated with shift-work sleep disorder. New England J Med. 2005;353(5):476-86. DOI: https://doi.org/10.1056/NEJMoa041292
Smith MT, McCrae CS, Cheung J, Martin JL, Harrod CG, Heald JL, Carden KA. Use of actigraphy for the evaluation of sleep disorders and circadian rhythm sleep-wake disorders: an American Academy of Sleep Medicine systematic review, meta-analysis, and GRADE assessment. J Clin Sleep Med. 2018;14(7):1209-30. DOI: https://doi.org/10.5664/jcsm.7228
Pickering L, Jennum P, Gammeltoft S, Poulsgaard L, Feldt-Rasmussen U, Klose M. Sleep–wake and melatonin pattern in craniopharyngioma patients. European J Endocrinol. 2014;170(6):873-84. DOI: https://doi.org/10.1530/EJE-13-1025
De Rui M, Middleton B, Sticca A, Gatta A, Amodio P, Skene DJ, Montagnese S. Sleep and circadian rhythms in hospitalized patients with decompensated cirrhosis: effect of light therapy. Neurochem Res. 2015;40(2):284-92. DOI: https://doi.org/10.1007/s11064-014-1414-z
Minors DS, Waterhouse JM. Separating the endogenous and exogenous components of the circadian rhythm of body temperature during night work using some ‘purification’ models. Ergonomics. 1993;36(5):497-507. DOI: https://doi.org/10.1080/00140139308967908
Lewy AJ, Sack RL. The dim light melatonin onset as a marker for orcadian phase position. Chronobiol Int. 1989;6(1):93-102. DOI: https://doi.org/10.3109/07420528909059144
Wyatt JK, Stepanski EJ, Kirkby J. Circadian phase in delayed sleep phase syndrome: predictors and temporal stability across multiple assessments. Sleep2006;29(8):1075-80. DOI: https://doi.org/10.1093/sleep/29.8.1075
Palmer CR, Kripke DF, Savage HC. Efficacy of enhanced evening light for advanced sleep phase syndrome. Behav Sleep Med. 2003;1(4):213-26. DOI: https://doi.org/10.1207/S15402010BSM0104_4
Kushida CA, Chang A, Gadkary C, Guilleminault C, Carrillo O, Dement WC. Comparison of actigraphic, polysomnographic, and subjective assessment of sleep parameters in sleep-disordered patients. Sleep Med. 2001;2(5):389-96. DOI: https://doi.org/10.1016/S1389-9457(00)00098-8
Downloads
Published
How to Cite
Issue
Section
