Circadian Rhythm Disorders in Primary Care: Causes, Consequences, and Clinical Management
- Credit Type
- CME
- Credit Amount
- 1
- Release Date
- 03/15/2011
- Expiration Date
- 03/14/2012
- Activity Type
- Webcast
Jointly sponsored by Albert Einstein College of Medicine, Montefiore Medical Center, and Asante Communications
This activity is supported by an educational grant from Cephalon, Inc.
Activity Goal
This continuing medical education (CME) activity is intended to improve the recognition, continuous assessment, and multimodal treatment of patients with circadian rhythm disorders (CRDs).
Intended Audience
This activity is intended for primary care providers.
Statement of Need
CRDs are prevalent, underrecognized, and inadequately treated, due in part to their varied symptomatology and to the lack of assessment skills among clinicians in the primary care setting (AASM, 2005; Drake et al, 2004; NSF, 2005; Schwartz and Roth, 2006). CRDs reflect misalignment between the biologic sleep/wake cycle and environmental demands, and/or between the biologic clock and societal norms for bedtime and wake time (AASMM, 2005). Characterized by excessive sleepiness and insomnia, circadian dyssynchrony is debilitating across numerous cognitive, affective, and physiologic domains (Culpepper, 2010). CRDs comprise several distinct subtypes, including shift work disorder (SWD, the most clinically significant and prevalent), jet lag disorder (JLD), delayed sleep phase disorder (DSPD), and advanced sleep phase disorder (ASPD) (AASM, 2005). short-term consequences stemming from CRDs can be severe, including impaired cognition, motor vehicle accidents, and medical errors among healthcare professionals (Chen et al, 2008; DeArmond and Chen, 2009; NSF, 2008). More alarming perhaps are findings from several studies suggesting a link between CRDs and cardiometabolic dysfunction, gastrointestinal disturbances, and/or mood/affective disorders (Drake et al, 2004; Scheer et al, 2009). Primary care clinicians are faced with the need to provide an accurate diagnosis and initiate appropriate treatment for CRDs to avoid the long-term health implications associated with these disorders, and to ascertain patient and public safety.
References
AASM (American Academy of Sleep Medicine). International Classification of Sleep Disorders: Diagnostic and Coding Manual. 2nd ed. Westchester, Il: American Academy
of Sleep Medicine; 2005.
Chen I, et al. Behav Sleep Med. 2008;6:1-15.
Culpepper l. J Fam Pract. 2010;59(suppl):S3-S11.
DeArmond S, Chen PY. Accid Anal Prev. 2009;41:976-984.
Drake CL, et al. Sleep. 2004;27:1453-1462.
NSF (National Sleep Foundation). 2005 Sleep in America Poll. Washington, DC:
NSF; 2005:1-55.
NSF. National Sleep Foundation: State of the States Report on Drowsy Driving.
Washington, DC: NSF; 2008:1-24.
Scheer FA, et al. Proc Natl Acad Sci U S A. 2009;106:4453-4458.
Schwartz JR, Roth T. Drugs. 2006;66:2357-2370.
Learner's Gap
Evidence-based discussions supported by expert clinical experience provide a scientific and clinical rationale for individualized assessment and treatment of patients with CRDs. Emphasizing the biopsychosocial and potentially irreversible consequences of untreated disturbances in sleep/ wake consolidation enables clinicians to better assess and manage sleep/wake disorders, thereby improving patient outcomes.
Learning Objectives
At the conclusion of this activity, participants will be better prepared to:
- Formulate a comprehensive and accurate approach to initial assessment of CRDs based on the pathophysiology of circadian rhythm dyssynchrony and its consequences on sleep symptoms, as well as on metabolism, cardiac function, cognition, and mood
- Perform focused initial assessments in patients identifi ed to have SWD and other CRDs based on their telltale symptomatology
- Formulate initial treatment plans for SWD, JLD, DSPD, and ASPD based on etiology, pathophysiology, and assessment of patient comorbidities, age, medical history, and level of functional impairment
- Monitor treatment responsiveness (improved ess score and/or sleep log, affect, cognition, and function) for patients with sWd and other CRDs at 1-month follow-up from initial visit, and as needed, for improved long-term management and patient outcomes
Accrediation Statement
This activity has been planned and implemented in accordance with the essential areas and Policies of the accreditation Council for Continuing Medical education (ACCME) through the joint sponsorship of Albert Einstein College of Medicine and Montefiore Medical Center, and Asante Communications, LLC. Albert Einstein College of Medicine is accredited by the AACME to provide continuing medical education for physicians.
Credit Designation
Albert Einstein College of Medicine designates this educational activity for a maximum of 1.0 AMA PRA Category 1 Credit™. Physicians should only claim credit commensurate with the extent of their participation in the activity.
Conflict of Interest Statement
The conflict of interest disclosure Policy of Albert Einstein College of Medicine requires that faculty participating in any CME activity disclose to the audience any relationship(s) with a pharmaceutical, product, or device company. Faculty whose disclosed relationships prove to create a conflict of interest with regard to their contribution to the activity will not be permitted to participate. Albert Einstein College of Medicine also requires that faculty participating in any CME activity disclose to the audience when discussing any unlabeled or investigational use of any commercial product or device not yet approved for the use in the United States.
Course Director/Authors and Planning Committee Disclosures
Course director/authors and planning committee members of this program have indicated the following disclosure information:
Thomas Roth, PhD—Abbott Laboratories (Consultant); Cephalon, Inc. (Consultant, Speakers Bureau); Eisai Inc. (Consultant); Eli Lilly and Company (Consultant); GlaxoSmithKline PlC (Consultant); Merck & Co., inc. (Advisory Board, Consultant, Grant/Research); Novartis (Consultant); Ortho-Mcneil-Janssen Pharmaceuticals, Inc. (advisory Board, Consultant); Otsuka America Pharmaceutical, Inc. (Consultant); Sanofi -Aventis (advisory Board, Consultant, Grant/Research); Schering-Plough Pharmaceuticals (Consultant); Sepracor Inc. (Advisory Board, Consultant, Speakers Bureau); Shire Specialty Pharmaceuticals (Consultant); Takeda Pharmaceuticals North America, Inc. (Consultant)
Larry Culpepper, MD, MPH—AstraZeneca US; Eli Lilly and Company; LaboPharm USA, Inc.; Merck & Co., Inc.; Pfizer Inc.; Takeda Pharmaceuticals North America, Inc. (Advisory Board)
Daniel I. Silvershein, MD, FACP—Forest Laboratories, Inc. (Speakers Bureau); King Pharmaceuticals, Inc. (Speakers Bureau); Pfizer Inc. (Stock Shareholder)
Michael J. Thorpy, MD—Cephalon, Inc. (Consultant, Speakers Bureau)
Chris Ontiveros, PhD—Has no relevant financial relationships to disclose.
Method of Participation
There are no fees for participating in and receiving credit for this activity. The participant will have two opportunities to a score of atleast 70% to successfully complete this activity. Credit is available through March 14, 2012.
Disclaimer
The opinions, ideas, recommendations, and perspectives expressed in the accompanying materials are those of the course director and authors only and do not necessarily refl ect the opinions, ideas, recommendations, or perspectives of their affiliated institutions, Albert Einstein College of Medicine, Montefiore Medical Center, Asante Communications, LLC, or the activity’s commercial supporter.
Copyright Information
© 2011 Albert Einstein College of Medicine, Montefiore Medical Center, and Asante Communications, LLC. all rights reserved. no part of this report may be used or reproduced in any manner whatsoever without written permission except in the case of brief quotations embodied in articles or reviews.
Faculty
