Circadian rhythm sleep disorders: part II, advanced sleep phase disorder, delayed sleep phase disorder, free-running disorder, and irregular sleep-wake rhythm. An American Academy of Sleep Medicine review.
OBJECTIVE
This the second of two articles reviewing the scientific literature on the evaluation and treatment of circadian rhythm sleep disorders (CRSDs), employing the methodology of evidence-based medicine. We herein report on the accumulated evidence regarding the evaluation and treatment of Advamced Sleep Phase Disorder (ASPD), Delayed Sleep Phase Disorder (DSPD), Free-Running Disorder (FRD) and Irregular Sleep-Wake Rhythm ISWR).


METHODS
A set of specific questions relevant to clinical practice were formulated, a systematic literature search was performed, and relevant articles were abstracted and graded.


RESULTS
A substantial body of literature has accumulated that provides a rational basis the evaluation and treatment of CRSDs. Physiological assessment has involved determination of circadian phase using core body temperature and the timing of melatonin secretion. Behavioral assessment has involved sleep logs, actigraphy and the Morningness-Eveningness Questionnaire (MEQ). Treatment interventions fall into three broad categories: 1) prescribed sleep scheduling, 2) circadian phase shifting ("resetting the clock"), and 3) symptomatic treatment using hypnotic and stimulant medications.


CONCLUSIONS
Circadian rhythm science has also pointed the way to rational interventions for CRSDs and these treatments have been introduced into the practice of sleep medicine with varying degrees of success. More translational research is needed using subjects who meet current diagnostic criteria.
Department of Psychiatry, Oregon Health Sciences University, Portland, OR, USA.
Robert L
RL
Sack
Dennis
D
Auckley
R Robert
RR
Auger
Mary A
MA
Carskadon
Kenneth P
KP
Wright
Michael V
MV
Vitiello
Irina V
IV
Zhdanova
D000328:Adult; D000975:Antioxidants / Q000627:therapeutic use; D000697:Central Nervous System Stimulants / Q000627:therapeutic use; D004358:Drug Therapy / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008550:Melatonin / Q000627:therapeutic use; D008875:Middle Aged; D010789:Phototherapy; D017286:Polysomnography; D012720:Severity of Illness Index; D020178:Sleep Disorders, Circadian Rhythm / Q000175:diagnosis* / Q000628:therapy*; D014805:Vitamin B 12 / Q000627:therapeutic use
D000975:Antioxidants; D000697:Central Nervous System Stimulants; D008550:Melatonin; D014805:Vitamin B 12