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Cited by 629Circadian rhythm and melatoninSleep and related disordersSleep and Work-Related Fatigue

Practice Parameters for the Clinical Evaluation and Treatment of Circadian Rhythm Sleep Disorders

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Morgenthaler, Timothy I., Lee-Chiong, Teofilo, Alessi, Cathy, Friedman, Leah, Aurora, R. Nisha, Boehlecke, Brian, Brown, Terry, Chesson, Andrew L. +6 more·2007·Sleep
DOI 10.1093/sleep/30.11.1445PMC PMC2082098
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Abstract

The expanding science of circadian rhythm biology and a growing literature in human clinical research on circadian rhythm sleep disorders (CRSDs) prompted the American Academy of Sleep Medicine (AASM) to convene a task force of experts to write a review of this important topic. Due to the extensive nature of the disorders covered, the review was written in two sections. The first review paper, in addition to providing a general introduction to circadian biology, addresses "exogenous" circadian rhythm sleep disorders, including shift work disorder (SWD) and jet lag disorder (JLD). The second review paper addresses the "endogenous" circadian rhythm sleep disorders, including advanced sleep phase disorder (ASPD), delayed sleep phase disorder (DSPD), irregular sleep-wake rhythm (ISWR), and the non-24-hour sleep-wake syndrome (nonentrained type) or free-running disorder (FRD). These practice parameters were developed by the Standards of Practice Committee and reviewed and approved by the Board of Directors of the AASM to present recommendations for the assessment and treatment of CRSDs based on the two accompanying comprehensive reviews. The main diagnostic tools considered include sleep logs, actigraphy, the Morningness-Eveningness Questionnaire (MEQ), circadian phase markers, and polysomnography. Use of a sleep log or diary is indicated in the assessment of patients with a suspected circadian rhythm sleep disorder (Guideline). Actigraphy is indicated to assist in evaluation of patients suspected of circadian rhythm disorders (strength of recommendation varies from "Option" to "Guideline," depending on the suspected CRSD). Polysomnography is not routinely indicated for the diagnosis of CRSDs, but may be indicated to rule out another primary sleep disorder (Standard). There is insufficient evidence to justify the use of MEQ for the routine clinical evaluation of CRSDs (Option). Circadian phase markers are useful to determine circadian phase and confirm the diagnosis of FRD in sighted and unsighted patients but there is insufficient evidence to recommend their routine use in the diagnosis of SWD, JLD, ASPD, DSPD, or ISWR (Option). Additionally, actigraphy is useful as an outcome measure in evaluating the response to treatment for CRSDs (Guideline). A range of therapeutic interventions were considered including planned sleep schedules, timed light exposure, timed melatonin doses, hypnotics, stimulants, and alerting agents. Planned or prescribed sleep schedules are indicated in SWD (Standard) and in JLD, DSPD, ASPD, ISWR (excluding elderly-demented/nursing home residents), and FRD (Option). Specifically dosed and timed light exposure is indicated for each of the circadian disorders with variable success (Option). Timed melatonin administration is indicated for JLD (Standard); SWD, DSPD, and FRD in unsighted persons (Guideline); and for ASPD, FRD in sighted individuals, and for ISWR in children with moderate to severe psychomotor retardation (Option). Hypnotic medications may be indicated to promote or improve daytime sleep among night shift workers (Guideline) and to treat jet lag-induced insomnia (Option). Stimulants may be indicated to improve alertness in JLD and SWD (Option) but may have risks that must be weighed prior to use. Modafinil may be indicated to improve alertness during the night shift for patients with SWD (Guideline).

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  • Traditionally, polysomnography (PSG), paired with clinical evaluation, has been the gold-standard and de-facto technique to study sleep in clinical and laboratory settings, as well as to diagnose a subset of sleep disorders.

    “Traditionally, polysomnography (PSG), paired with clinical evaluation, has been the gold-standard and de-facto technique to study sleep in clinical and laboratory settings, as well as to diagnose a subset of sleep disorders37.”

    From The future of sleep health: a data-driven revolution in sleep science and medicine (2020) · cites this paper as [37]

    Section 3.1.6 says PSG is indicated when a patient with suspected circadian rhythm sleep disorder may also have another primary sleep disorder, such as obstructive sleep apnea. Section 3.2.2.1 describes its use in laboratory studies of simulated jet lag. The paper does not establish PSG as the traditional gold-standard or de-facto technique for studying sleep across clinical and laboratory settings; it says PSG is not routinely indicated to diagnose circadian rhythm sleep disorders. (LLM, conf=0.84)

    Experimental — accuracy not yet measured

  • Multiple studies, opinions, and guidelines have suggested melatonin as primary therapy for improved health and sleep of shift workers.

    “Multiple studies, opinions, and guidelines have suggested melatonin as primary therapy for improved health and sleep of shift workers [69,70,71].”

    From Is Melatonin the “Next Vitamin D”?: A Review of Emerging Science, Clinical Uses, Safety, and Dietary Supplements (2022) · cites this paper as [71]

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Research works printed but not linked: 1

  1. [41]41. Monchesky, TC, Billings, BJ, Phillips, R, and Bourgouin, J. Zopi- clone in insomniac shiftworkers. Evaluation of its hypnotic properties and its effects on mood and work performance. International Archives of Occupational & Environmental Health 1989;61:255-259.

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Authors
Morgenthaler, T. I., Lee-Chiong, T., Alessi, C., Friedman, L., Aurora, R. N., Boehlecke, B., Brown, T., Chesson, A. L., Kapur, V., Maganti, R., Owens, J., Pancer, J., Swick, T. J., & Zak, R.
Affiliations
  • Mayo Clinic (US)
  • National Jewish Health (US)
  • University of California, Los Angeles (US)
  • Stanford Medicine (US)
  • Mount Sinai Hospital (US)
  • University of North Carolina at Chapel Hill (US)
  • Louisiana State University (US)
  • University of Washington (US)
  • Barrow Neurological Institute (US)
  • Rhode Island Hospital (US)
  • Houston Methodist (US)
ORCID
Venue
Sleep
Publisher
Oxford University Press (OUP)
Published
2007-11
Volume
30
Issue
11
Pages
1445-1459
ISSN
  • 0161-8105 (ISSN-L)
  • 1550-9109
DOI
10.1093/sleep/30.11.1445
PMC
PMC2082098
OpenAlex
W1480559618
Cited by
629
References
139
Citations by year
2026: 19 · 2025: 23 · 2024: 21 · 2023: 28 · 2022: 35 · 2021: 31 · 2020: 43 · 2019: 36 · 2018: 37 · 2017: 35 · 2016: 31 · 2015: 40 · 2014: 47 · 2013: 40 · 2012: 35
FWCI
11.02
Type
journal article
Language
en
Open access
Locations
  • SLEEP (publishedVersion)
  • PubMed Central (publishedVersion)
  • PubMed (publishedVersion)
Topics
  • Life Sciences › Neuroscience › Endocrine and Autonomic Systems › Circadian rhythm and melatonin
  • Social Sciences › Psychology › Experimental and Cognitive Psychology › Sleep and related disorders
  • Social Sciences › Psychology › Experimental and Cognitive Psychology › Sleep and Work-Related Fatigue
Keywords
circadian rhythm sleep disorders, shift work disorder, delayed sleep phase syndrome, actigraphy, sleep diary, sleep schedule, hypnotics, stimulants, circadian biology, diagnosis and treatment recommendations
MeSH terms
Antioxidants, Humans, Melatonin, Phototherapy, Surveys and Questionnaires, Sleep, Polysomnography, Sleep Disorders, Circadian Rhythm

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