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.
Study Goal
The researchers aimed to evaluate the effectiveness of light therapy, with or without behavioral interventions, for treating intrinsic circadian rhythm sleep-wake disorders in specific populations.
Results Summary
The study found positive endorsement for light therapy in adults with ASWPD, children/adolescents with DSWPD, and elderly with dementia, indicating its efficacy when used with or without behavioral interventions. No recommendations were provided for other treatments or populations due to insufficient data.
Population
Adults with advanced sleep-wake phase disorder (ASWPD), children/adolescents with delayed sleep-wake phase disorder (DSWPD), and elderly with dementia.
Effective Dosage
Not specified
Duration
Not specified
Interactions
None mentioned
| Intervention | Direction | Endpoint | Population | Dosage | Impact | Claim # |
|---|---|---|---|---|---|---|
strategically timed melatonin | increase | treatment of intrinsic circadian rhythm sleep-wake disorders | adults with DSWPD, blind adults with N24SWD, and children/adolescents with ISWRD and comorbid neurological disorders | - | positive endorsement (at a second-tier degree of confidence) | #1 |
light therapy with or without accompanying behavioral interventions | increase | treatment of intrinsic circadian rhythm sleep-wake disorders | adults with ASWPD, children/adolescents with DSWPD, and elderly with dementia | - | positive endorsement (at a second-tier degree of confidence) | #2 |
melatonin | decrease | treatment of intrinsic circadian rhythm sleep-wake disorders | demented elderly patients | - | recommendations against the use | #3 |
discrete sleep-promoting medications | decrease | treatment of intrinsic circadian rhythm sleep-wake disorders | demented elderly patients | - | recommendations against the use | #4 |
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.