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Practice Guideline
. 2015 Oct 15;11(10):1199-236.
doi: 10.5664/jcsm.5100.

Clinical Practice Guideline for the Treatment of Intrinsic Circadian Rhythm Sleep-Wake Disorders: Advanced Sleep-Wake Phase Disorder (ASWPD), Delayed Sleep-Wake Phase Disorder (DSWPD), Non-24-Hour Sleep-Wake Rhythm Disorder (N24SWD), and Irregular Sleep-Wake Rhythm Disorder (ISWRD). An Update for 2015: An American Academy of Sleep Medicine Clinical Practice Guideline

R Robert Auger  1 , Helen J Burgess  2 , Jonathan S Emens  3 , Ludmila V Deriy  4 , Sherene M Thomas  4 , Katherine M Sharkey  5
Affiliations
Practice Guideline

Clinical Practice Guideline for the Treatment of Intrinsic Circadian Rhythm Sleep-Wake Disorders: Advanced Sleep-Wake Phase Disorder (ASWPD), Delayed Sleep-Wake Phase Disorder (DSWPD), Non-24-Hour Sleep-Wake Rhythm Disorder (N24SWD), and Irregular Sleep-Wake Rhythm Disorder (ISWRD). An Update for 2015: An American Academy of Sleep Medicine Clinical Practice Guideline

R Robert Auger et al. J Clin Sleep Med. .

Abstract

A systematic literature review and meta-analyses (where appropriate) were performed and the GRADE approach was used to update the previous American Academy of Sleep Medicine Practice Parameters on the treatment of intrinsic circadian rhythm sleep-wake disorders. Available data allowed for positive endorsement (at a second-tier degree of confidence) of strategically timed melatonin (for the treatment of DSWPD, blind adults with N24SWD, and children/ adolescents with ISWRD and comorbid neurological disorders), and light therapy with or without accompanying behavioral interventions (adults with ASWPD, children/adolescents with DSWPD, and elderly with dementia). Recommendations against the use of melatonin and discrete sleep-promoting medications are provided for demented elderly patients, at a second- and first-tier degree of confidence, respectively. No recommendations were provided for remaining treatments/ populations, due to either insufficient or absent data. Areas where further research is needed are discussed.

Keywords: ASWPD; DSWPD; ISWRD; N24SWD; circadian rhythms.

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Figures

Figure 1
Figure 1. Guide for interpretation of clinical significance of the results.
Examples of (A) clinically significant improvement; (B) “serious” imprecision, grade one level down; (C) “very serious” imprecision, grade two levels down.
Figure 2
Figure 2. Meta-analysis of data for PSG determined TST in response to melatonin treatment of adult patients with DSWPD and comorbid depression.
Figure 3
Figure 3. Meta-analysis of data for PSG determined ISL in response to melatonin treatment of adult patients with DSWPD and comorbid depression.
Figure 4
Figure 4. Meta-analysis of data for DLMO in response to melatonin treatment of children/adolescents with DSWPD and comorbid psychiatric conditions.
Figure 5
Figure 5. Meta-analysis of data for actigraphically-determined SOT in response to melatonin treatment of children/ adolescents with DSWPD and comorbid psychiatric conditions.
Figure 6
Figure 6. Meta-analysis of evidence for entrainment as a result of melatonin treatment of blind adult patients with N24SWD.
See this image and copyright information in PMC

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