It's About Time: Recognizing Circadian Rhythm Disorders in Alertness and Sleep Pressure
- Credit Type
- AMA
- Credit Amount
- 0.5
- Release Date
- 01/03/2011
- Expiration Date
- 01/02/2012
- Activity Type
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
Guided by comprehensive assessment of clinical knowledge gaps and needs, this educational activity is intended to improve the assessment, recognition, treatment, and ongoing management of patients with circadian rhythm sleep disorders (CRSDs).
Intended Audience
This activity is intended for primary care clinicians.
There are no prerequisites for this educational activity.
Statement of Need
Circadian Rhythm Sleep Disorders (CRSDs) are prevalent, underrecognized, and inadequately treated, owing in part to their varied symptomatology and lack of assessment skills among primary care physicians (PCPs). CRSDs 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.” Characterized by insomnia at bedtime and excessive sleepiness (ES) during wake time, circadian dyssynchrony is debilitating across numerous cognitive, affective, and physiologic domains. CRSDs comprise several distinct subtypes, including shift work sleep disorder (SWSD), the most clinically significant and prevalent, advanced sleep phase syndrome (ASPS), delayed sleep phase syndrome (DSPS), and others. Short-term consequences stemming from CRSDs can be severe, including impaired cognition, motor vehicle accidents, and—among healthcare professionals—medical errors. More alarmingly perhaps are recent studies among patients with CRSDs suggesting an important link to cancer, cardiovascular disease, depression, and gastrointestinal and metabolic disorders. There is a need for PCPs to provide an accurate diagnosis and initiate appropriate treatment for CRSDs in order to avoid the long-term health implications associated with these disorders, and to ascertain patient and public safety.
Learner’s Gap
CRSDs are underdiagnosed, underrecognized, and undertreated. Evidence-based discussions supported by expert clinical experience provide a scientific and clinical rationale for individualized assessment and treatment of patients with CRSDs. 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 program, participants will be better prepared to:
- Describe the pathophysiologic basis of circadian rhythm dyssynchrony and its downstream consequences on sleep, metabolism, cardiac function, cognition, and mood
- Identify SWSD and other CRSDs based on their telltale symptomatology in the context of an initial assessment
- Diagnose SWSD and other CRSDs based on patient history, physical exam, comorbidities, and a thorough sleep history addressing sleep hygiene, symptoms, and diaries as appropriate
- Formulate initial treatments for SWSD, advanced sleep phase syndrome (ASPS), and delayed sleep phase syndrome (DSPS) via assessment of etiology, pathophysiology, patient comorbidities, age, medical history, and level of impairment
- Improve ongoing management of patients with SWSD and other CRSDs by monitoring treatment responsiveness and patient affect, cognition, and function
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 0.5 AMA PRA Category 1 Credits™. 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. Any presenter whose disclosed relationships prove to create a conflict of interest with regard to their contribution to the activity will not be permitted to present.
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.
Melissa H. Hummel, MD
Dr. Hummel has no relevant financial interests to disclose.
Method of Participation
There are no fees for participating in and receiving credit for this activity. Participants must read the objectives and enduring material, and answer the multiple-choice posttest. Please complete the evaluation form, which enables you to comment on the quality of the instructional process, the perception of enhanced professional effectiveness and commercial bias, and express your views on future educational needs. A score of at least 70% is required to successfully complete this activity. Credit is available through January 2, 2011.
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Copyright Information
© 2010 Albert Einstein College of Medicine and Montefiore Medical Center, and Asante Communications. 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 embodied in articles or reviews.
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