Collaborative Approach to Management of Patients With Circadian Rhythm Disorders

Richard K. Bogan, MD; Melissa H. Hummel, MD; Jo Anne Turner, RN, MN, APRN
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Jointly sponsored by Albert Einstein College of Medicine, Montefiore Medical Center, and
Asante Communications, LLC.

This activity is made possible by an independent educational grant from Cephalon, Inc.


Activity Goal

This activity is designed to improve the recognition, continuous assessment, and multi-specialty treatment of patients with circadian rhythm disorders. This concerted educational effort is structured to demonstrate the enduring value of education and its effects on clinician management of sleep/wake disorders symptoms and patient care.

Intended Audience

This activity is intended for sleep clinicians, primary care physicians, physician assistants, nurse practitioners, and other healthcare providers interested in improving their knowledge base and skill sets in circadian rhythm disorders. There are no prerequisites for this educational activity.

Statement of Need

Developed for primary care clinicians and designed to provide a scientific rationale for collaborative management and treatment of patients with circadian rhythm disorders, this program serves as an educational consortium dedicated to improving sleep/wake education to improve patient care.

Learner’s Gap

CRDs significantly reduce the restorative value of sleep.(1) Characterized by the heterogeneity and profound effects on patient function, the disorders are often prevalent, underrecognized, and undertreated.(2,3) Inadequate treatment is associated with significant morbidity and mortality, an association gaining increased attention among clinical researchers.(4) Healthcare-associated costs are prohibitively burdensome, estimated at nearly $100 billion (US dollars) per annum.(5) Data from numerous epidemiologic and randomized, controlled studies clearly demonstrate that patients with disrupted sleep/wake patterns have significantly impaired daytime function and experience excessive sleepiness, a debilitating symptom with far-reaching consequences.(6,7) Primary care physicians need to improve their understanding of the morbidity associated with CRDs to communicate the issues to their colleagues and patients, and tailor therapies accordingly.

  1. Lavie P. Sleep-wake as a biological rhythm. Annu Rev Psychol. 2001;52:277-303.
  2. Sack RL, Auckley D, Auger RR, et al. Circadian rhythm sleep disorders: part I, basic principles, shift work and jet lag disorders. An American Academy of Sleep Medicine review. Sleep. 2007;30(11):1460-1483.
  3. Sack RL, Auckley D, Auger RR, et al. 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. 2007;30(11):1484-1501.
  4. Klerman EB. Clinical aspects of human circadian rhythms. J Biol Rhythms. 2005;20(4):375-386.
  5. Parambil JG, Olson EJ, Shepard JW Jr, et al. Effect of shifting costs to patients on specialty evaluation for sleep disorders. Mayo Clin Proc. 2006;81(2):185-189.
  6. American Academy of Sleep Medicine. International Classification of Sleep Disorders, 2nd ed.: Diagnostic and Coding Manual. Westchester, IL: American Academy of Sleep Medicine; 2005.
  7. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, 4th ed. Washington, DC: American Psychiatric Association; 2000.

Learning Objectives

Upon completion of this activity, 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 SWD and other CRDs based on their telltale symptomatology in the context of an initial assessment 
  • Diagnose SWD and other CRDs based on patient history, physical exam, comorbidities, and a thorough sleep history addressing sleep hygiene, symptoms, and diaries as appropriate
  • Formulate initial treatments for SWD, advanced sleep phase disorder (ASPD), and delayed sleep phase disorder (DSPD )via assessment of etiology, pathophysiology, patient comorbidities, age, medical history, and level of impairment
  • Improve ongoing management of patients with SWD and other CRDs 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 1.0 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.

Richard K. Bogan, MD, FCCP, FAASM
Actelion Pharmaceuticals US, Inc. (Grant/Research); Addrenex Pharmaceuticals (Consultant); Alza Corporation (Grant/Research); Apnicure Inc. (Consultant, Grant/Research); Arena Pharmaceuticals (Grant/Research); Boehringer Ingelheim (Grant/Research); Cephalon, Inc.(Consultant, Grant/Research, Speakers Bureau); Eli Lilly and Company (Grant/Research); Evotec AG (Grant/Research); GlaxoSmithKline PLC (Consultant, Grant/Research); Jazz Pharmaceuticals, Inc. (Consultant, Grant/Research, Speakers Bureau); Johnson & Johnson Pharmaceutical Research and Development, LLC (Grant/Research); Merck & Co., Inc. (Grant/Research); Neurogen Corporation (Grant/Research); Novartis US (Grant/Research); Pfizer Inc. (Grant/Research); Philips (Grant/Research); ResMed Inc. (Grant/Research); Sanofi-Aventis (Grant/Research, Speakers Bureau); Schwarz Pharma AG (Grant/Research); Sensory Medical, Inc. (Grant/Research); Sepracor Inc. (Grant/Research, Speakers Bureau); SleepMed, Inc. (Employee, Stock Shareholder); UCB (Consultant); Vanda Pharmaceuticals, Inc. (Grant/Research); Ventus Medical, Inc. (Grant/Research); Xenoport, Inc (Grant/Research)

Melissa H. Hummel, MD
Dr. Hummel has no relevant financial interests to disclose.

JoAnne Turner, APRN
Ms. Turner has no relevant financial interests to disclose.

The staff at Albert Einstein College of Medicine has 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.

Chris Ontiveros, PhD, (senior scientific associate, Asante Communications) has no relevant financial interests to disclose.

Method of Participation

There are no fees for participating in and receiving credit for this activity. Prior to viewing the webcasts, each participant must read the learning objectives and acknowledge receipt of the CME information. Additionally, each participant must also complete a prequestionnaire before beginning the activity. Upon completion of this prequestionnaire, the activity will commence. Once the final webcast is viewed, credit may be obtained by completing the posttest, program evaluation, and the attestation statement. Credit is available through November 5, 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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