Translating Evidence to the Clinic: Assessing and Managing Circadian Misalignment
- Credit Type
- CME
- Credit Amount
- 1
- Release Date
- 12/01/2011
- Expiration Date
- 01/01/2013
- Activity Type
Jointly sponsored by Albert Einstein College of Medicine of Yeshiva University and Montefiore Medical Center, and Asante Communications, LLC.
This activity is supported by an educational grant from Cephalon, Inc.
Intended Audience
This activity is intended for primary care clinicians. There are no prerequisites for this educational activity.
This interactive, self-directed case study titled Translating Evidence to the Clinic: Assessing and Managing Circadian Misalignment, allows clinicians to participate in the longitudinal management of a patient who presents to his primary care physician with a circadian rhythm disorder (CRD). Topics addressed range from recognition and assessment approaches to best practices in the initial treatment and ongoing management of patients with CRDs.
Learning Objectives
At the conclusion of this program, participants should be better able to:
- Assess the consequences of circadian dyssynchrony on sleep/wake timing, physiologic parameters, and patient behavior
- Identify and differentially diagnose shift work disorder and other CRDs based on symptomatology, patient history, and findings obtained from a thorough sleep history, sleep diaries/logs, and other tools
- Formulate initial and ongoing treatment plans for CRDs that incorporate evidence-based nonpharmacologic and pharmacologic modalities
- Improve ongoing management of patients with CRDs by monitoring treatment responsiveness (eg, sleepiness, affect, cognition) and establishing appropriate referral pathways to ensure continuity of care
Statement of Need/Learner's Gap
Despite their significant prevalence, CRDs are inadequately treated in the primary care setting in part because of their varied symptomatology and the lack of recognition and assessment among clinicians.1,5 CRDs reflect misalignment between the sleep/wake cycle and environmental demands, and/or between the biologic clock and conventional norms for bed and wake times.1 Circadian misalignment can be debilitating, with implications for several medical and psychosocial domains, including cardiometabolic, gastrointestinal, cognitive/behavioral, and social/occupational functioning.2,3,8 Among the telltale symptoms of CRDs are excessive sleepiness (ES) during desired wake time and insomnia.9 The most prevalent CRD, shift work disorder, affects approximately 2.2 million Americans.3,4 Other less prevalent, albeit serious CRDs, are advanced and delayed sleep phase disorder, which affect predominately older and younger adults, respectively.6,7
Although community-based PCPs needn’t keep abreast of the more arcane developments in sleep research, the proposed educational activities will highlight clinically relevant scientific advances, reinforcing the need for effective assessment and targeted management of CRDs, while simultaneously closing educational gaps to improve patient care. This activity provides knowledge about the importance of independently assessing sleep quality and characteristics to facilitate recognition of an underlying sleep disorder.
References:
1. 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.
2. Crowley SJ, Lee C, Tseng CY, Fogg LF, Eastman CI. Complete or partial circadian re-entrainment improves performance, alertness, and mood during night-shift work. Sleep. 2004;27(6):1077-1087.
3. Drake CL, et al. Shift work sleep disorder: prevalence and consequences beyond that of symptomatic day workers. Sleep. 2004;27(8):1453-1462.
4. McMenamin TM. A time to work: recent trends in shift work and flexible schedules. Monthly Labor Rev. 2007;130(12):3-15.
5. NSF (National Sleep Foundation). 2005 Sleep in America Poll. Washington, DC: NSF;2005:1-55.
6. Sack RL, Auckley D, Auger RR, et al; American Academy of Sleep Medicine. Circadian rhythm sleep disorders: part I, basic principles, shift work and jet lag disorders. An American Academy of Sleep Medicine review. Sleep. 2007a;30(11):1460-1483.
7. Sack RL, Auckley D, Auger RR, et al; American Academy of Sleep Medicine. 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. Sleep. 2007b;30(11):1484-1501.
8. Scheer FA, Hilton MF, Mantzoros CS, Shea SA. Adverse metabolic and cardiovascular consequences of circadian misalignment. Proc Natl Acad Sci U S A. 2009;106(11):4453-4458.
9. Schwartz JR. Recognition of shift-work disorder in primary care. J Fam Pract. 2010;59(1 suppl):S18-S23.
Accreditation 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 ACCME to provide continuing medical education for physicians.
Credit Designation
Albert Einstein College of Medicine designates this enduring material for a maximum of 1.0 AMA PRA Category 1 Credit™. Physicians should claim only the 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:
Joyce E. King, MD - Has no relevant financial relationships to disclose.
Thomas Roth, PhD (Course Director) - Abbott Laboratories (Consultant), Cephalon, Inc. (Consultant); Eisai Inc. (Consultant); Eli Lilly & Co. (Consultant); Intec Pharma ltd. (Consultant); Merck & Co., Inc. (Consultant, Grant/Research); Ocera Therapeutics, Inc. (Consultant); Pfizer Inc. (Consultant); sanofi-aventis U.S. LLC(Consultant); Sepracor Inc. (Consultant); Shire (Consultant); Somaxon Pharmaceuticals, Inc. (Consultant); Somnus Therapeutics, Inc. (Consultant); Steady Sleep Rx (Consultant); Takeda Pharmaceuticals North America, Inc. (Consultant); Transcept Pharmaceuticals, Inc. (Consultant)
Michael J. Thorpy, MD (CME Reviewer) - Cephalon, Inc. (Speakers Bureau); Jazz Pharmaceuticals, Inc. (Speakers Bureau)
The Center for Continuing Medical Education staff at Albert Einstein College of Medicine have no disclosures to report other than the following:
Steven Jay Feld, or a member of his household, owns securities in Bioheart, Inc.; Chelsea Therapeutics, Inc.; and Pharmacopeia, Inc.
All additional planning committee members, Asante Communications, LLC, staff, and Albert Einstein College of Medicine staff have 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 score at least 70% to successfully complete this activity. Credit is available through January 1, 2013.
Disclaimer
The opinions, ideas, recommendations, and perspectives expressed in this program are those of the program presenting faculty only and do not necessarily reflect 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 supporters.
Copyright Information
© 2012 Albert Einstein College of Medicine, Montefiore Medical Center, and Asante Communications, LLC. All rights reserved. No part of this program content may be used or reproduced in any manner whatsoever without written permission except in the case of brief quotations embedded in articles or reviews.
Faculty
