Circadian Rhythm Disorders: Recognition and Management in the Primary Care Setting
- Credit Type
- CME
- Credit Amount
- 2
- Release Date
- 11/11/2011
- Expiration Date
- 11/12/2012
- Activity Type
- Compendium
Jointly sponsored by Albert Einstein College of Medicine, Montefiore Medical Center, and Asante Communications
This activity is made possible by an independent educational grant from Cephalon, Inc.
Activity Goal
The goal of this activity is to improve the assessment, recognition, treatment, and ongoing management of patients with circadian rhythm disorders (CRDs), including shift work disorder (SWD).
Intended Audience
This activity is intended for primary care physicians (PCPs).
Statement of Need and Learner’s Gap
CRDs are prevalent, underrecognized, and inadequately treated. Patients with CRDs have a varied symptomatology, the complexity of which provides a challenge for many PCPs.1-5 The major feature of CRDs—such as SWD, jet lag disorder, and advanced and delayed sleep phase disorders—is a misalignment between the patient’s actual and desired sleep/wake pattern, often causing insomnia or excessive sleepiness (ES).5-7 These two cardinal symptoms, as well as the misalignment itself, can adversely affect patients across medical and psychosocial domains. For example, circadian misalignment often contributes to many gastrointestinal, cardiometabolic, and mood/affective disorders commonly encountered in primary care.2,8 Cognitive and behavioral processes, such as memory and alertness, are also impaired.9 A study of patients with SWD indicated higher rates of ulcers, absenteeism, depression, and missed family obligations and social activities.2 Similar studies among healthcare shift workers highlight greater prevalence of motor vehicle accidents and medical errors, demonstrating potential public safety issues.10,11 PCPs must recognize, assess, and manage CRDs in their patients to alleviate unfavorable effects on overall health, well-being, and function. Guided by the American Academy of Sleep Medicine’s Practice Parameters for the Clinical Evaluation and Treatment of Circadian Rhythm Sleep Disorders and expert guidance on the management of patients with CRDs, PCPs can help reduce the serious and often long-term consequences of circadian misalignment.5,12
References
1. National Sleep Foundation. 2005 Sleep in America Poll: Summary of Findings. Washington, DC: National Sleep Foundation; 2005.
2. Drake CL, et al. Sleep. 2004;27(8):1453-1462.
3. Ontiveros CS, et al. Sleep. 2011;34(abstract supplement):A336.
4. Sack RL, et al. Sleep. 2007;30(11):1460-1483.
5. Roth T, et al. Curr Med Res Opin. 2010;26(suppl 2):S3-S24; quiz S25-S27.
6. Arendt J. Occup Med (Lond). 2010;60(1):10-20.
7. American Academy of Sleep Medicine. The International Classification of Sleep Disorders. 2nd ed. Westchester, IL: American Academy of Sleep Medicine; 2005.
8. Scheer FA, et al. Proc Natl Acad Sci U S A. 2009;106(11):4453-4458.
9. Gumenyuk V, et al. Sleep. 2010;33(5):703-713.
10. Chen I, et al. Behav Sleep Med. 2008;6(1):1-15.
11. DeArmond S, Chen PY. Accid Anal Prev. 2009;41(5):976-984.
12. Morgenthaler TI, et al. Sleep. 2007;30(11):1445-1459.
Educational Objectives
At the conclusion of this educational activity, participants should be better prepared to:
- Describe the pathophysiologic basis of circadian dyssynchrony and its relationship to light/dark and sleep/wake cycles, metabolism, affect, activities of daily living, and overall health
- Assess the consequences of circadian dyssynchrony on sleep/wake timing, physiologic parameters, and patient behavior
- Identify and differentially diagnose SWD 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
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. 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 educational activity for a maximum of 2.0 AMA PRA Category 1 Credits™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.
Method of Participation
There are no fees for participating in and receiving credit for this activity.
Online Activity Instructions: To qualify for a certificate of CME credit for this activity, please follow the 5-step Activity Progress menu above:
- Review the accompanying CME information and activity instructions. Click “Continue Activity” below the faculty listings at right to proceed.
- Complete the 4-question pre-questionnaire by selecting the most accurate answers. These questions are not graded. Click “Continue” at page bottom to proceed.
- Review the written compendium (full-screen viewing available). Click “Continue” at page bottom to proceed.
- Complete the 4-question post-activity questionnaire by selecting the most accurate answers. These questions are not graded. Click “Continue” at page bottom to proceed.
- Complete the activity evaluation form and then indicate the total time required to complete the activity (maximum of 2.0 hours/credits is available) and generate/print your CME certificate for your records. A copy of your certificate will be retained in your online profile (accessible at upper right of webpage after logging on).
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 and anyone in a position to influence content disclose to the audience when discussing any unlabeled or investigational use of any commercial product, or device, not yet approved for use in the United States.
Faculty/Planning Committee Disclosures
Faculty/Planning Committee members of this program have indicated the following
disclosure information:
Richard K. Bogan, MD, FCCP, FAASM
Apnicure (Consultant, Grant/Research); Cephalon, Inc. (Consultant, Grant/Research, Speakers Bureau); GlaxoSmithKline (Consultant, Grant/Research, Speakers Bureau); Jazz Pharmaceuticals, Inc. (Consultant); Merck & Co., Inc. (Grant/Research); ResMed (Grant/Research); Respironics (Grant/Research); SleepMed Inc. (Stockholder); Sunovion Pharmaceuticals Inc. (Consultant, Speakers Bureau)
Larry Culpepper, MD, MPH
AstraZeneca (Advisory Board); Forest Laboratories, Inc. (Advisory Board); Lilly USA, LLC (Advisory Board); Merck & Co., Inc. (Advisory Board, Speakers Bureau); Pfizer Inc. (Advisory Board); Takeda Pharmaceutical Company Limited (Advisory Board)
Paul P. Doghramji, MD
AstraZeneca (Consultant, Speakers Bureau); Cephalon, Inc. (Speakers Bureau); MAP
Pharmaceuticals, Inc. (Consultant); PGxHealth (Consultant); Purdue Pharma L.P. (Consultant); URL Pharma, Inc. (Consultant, Speakers Bureau)
Melissa Hummel, MD
Has no relevant financial relationships to disclose.
Thomas Roth, PhD
Abbott Laboratories (Consultant); Cephalon, Inc. (Consultant, Speakers Bureau); Eisai Co., Ltd. (Consultant); Eli Lilly and Company (Consultant); Intec Pharma Ltd. (Consultant); Merck & Co., Inc. (Consultant); 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 Pharmaceutical Company Limited (Consultant); Transcept Pharmaceuticals, Inc. (Consultant)
Richard D. Simon, Jr, MD
Has no relevant financial relationships to disclose.
Adam J. Sorscher, MD
Has no relevant financial relationships to disclose.
Michael J. Thorpy, MD
Cephalon, Inc. (Speakers Bureau); Jazz Pharmaceuticals, Inc. (Speakers Bureau)
The staff of the Center for Continuing Medical Education (CCME) of Albert Einstein College of Medicine and Montefiore Medical Center, and the staff of Asante Communications, have no disclosures associated with any commercial interests to report other than the following:
Chris Ontiveros, PhD, of Asante Communications, has no conflict of interest with
commercial interests related directly or indirectly to this educational activity.
Steven Jay Feld of Albert Einstein College of Medicine, or a member of his household, owns securities in Bioheart, Inc., Chelsea Therapeutics, Inc., and Pharmacopeia, Inc.
Disclaimer
The opinions, ideas, recommendations, and perspectives expressed in this program and accompanying materials are those of the program faculty only and do not necessarily reflect the opinions, ideas, recommendations, or perspectives of their affiliated institutions, Albert Einstein College of Medicine and Montefiore Medical Center, Asante Communications, LLC, or the activity’s commercial supporters.
Copyright Information
Copyright © 2011 Albert Einstein College of Medicine and Montefiore Medical Center, and Asante Communications, LLC. All rights reserved. No part of this syllabus may be used or reproduced in any manner whatsoever without written permission except in the case of brief quotations embedded in articles or reviews.
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