What are the guideline sources, guidelines and references for Circadian rhythm sleep disorders ?
Guideline sources The following summarized guidelines for the evaluation and management of circadian rhythm sleep disorders are prepared by our editorial team based on guidelines from the British Thoracic Society (BTS 2023), the British Association for Psychopharmacology (BAP 2019), and the American Academy of Sleep Medicine (AASM 2018; 2015). 1 2 3 4 Guidelines 1. Diagnostic investigations Clinical assessment: obtain clinical assessment in patients with delayed sleep-wake phase disorder and non-24-hour sleep rhythm disorder. A Actigraphy: consider obtaining actigraphy in the assessment of adult and pediatric patients with circadian rhythm sleep-wake disorder. C 2. Medical management Setting of care: manage patients with circadian rhythm disorders in a specialized sleep disorders center because of the necessity for careful timing of interventions. B Management of advanced SWPD: https://web.pathway.md/diseases/reczMgRmBZ2nQE5aj 1/3 6/23/23, 3:25 AM Circadian rhythm sleep disorders Pathway As per BAP 2019 guidelines, consider offering behavioral regimes and scheduled light exposure in patients with delayed sleep-wake phase disorder. C As per AASM 2015 guidelines: Consider offering evening light therapy in adult patients with advanced sleep-wake phase disorder. C Insufficient evidence to support the use of any of the following in patients with advanced sleep- wake phase disorder: prescribed sleep-wake scheduling strategic avoidance of light timed physical activity or exercise sleep-promoting medications melatonin or agonists wakefulness-promoting medications other somatic interventions combination treatments. I Management of delayed SWPD: As per BAP 2019 guidelines: Consider prescribing melatonin in patients with delayed sleep-wake phase disorder. C Consider offering behavioral regimes and scheduled light exposure in patients with delayed sleep-wake phase disorder. C As per AASM 2015 guidelines, consider prescribing strategically timed melatonin in adult patients with delayed sleep-wake phase disorder, with or without depression. C Show 3 more Management of non-24-hour SWRD: As per BAP 2019 guidelines, consider prescribing melatonin in blind patients with non-24-hour sleep-wake rhythm disorder. C As per AASM 2015 guidelines: Consider prescribing strategically timed melatonin in blind adult patients with non-24-hour sleep-wake rhythm disorder. C Insufficient evidence to support the use of any of the following in patients with non-24-hour sleep-wake rhythm disorder: prescribed sleep-wake scheduling strategic avoidance of light as monotherapy timed physical activity or exercise light therapy sleep-promoting medications melatonin in sighted patients wakefulness-promoting medications https://web.pathway.md/diseases/reczMgRmBZ2nQE5aj 2/3 6/23/23, 3:25 AM Circadian rhythm sleep disorders Pathway vitamin B12 supplementation alternate somatic interventions combination treatments. I Management of irregular SWRD: As per BAP 2019 guidelines, consider offering behavioral regimes and scheduled light exposure in patients with irregular sleep-wake rhythm disorder. C As per AASM 2015 guidelines, consider offering light therapy in elderly patients with irregular sleep-wake rhythm disorder and dementia. C Show 5 more Management of jet lag: consider prescribing melatonin in patients with jet lag. C 3. Specific circumstances Pediatric patients: Suspect other diagnoses, including narcolepsy, with possible coexistent cataplexy, sleep paralysis, hypnagogic and hypnopompic hallucinations, and circadian rhythm disorders, in pediatric patients with persisting excessive daytime sleepiness despite exclusion or effective treatment of sleep-disordered breathing. B Ask both the patient and parents/carers about sleep onset and wake-up times to elicit total sleep time and sleep latency to exclude a circadian rhythm disorder associated with excessive daytime sleepiness. B References 1. Auger RR, Burgess HJ, Emens JS et al. 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. J Clin Sleep Med. 2015 Oct 15;11 10 1199 236. Open 2. Sue Wilson, Kirstie Anderson, David Baldwin et al. British Association for Psychopharmacology consensus statement on evidence-based treatment of insomnia, parasomnias and circadian rhythm disorders: An update. J Psychopharmacol. 2019 Aug;33 8 923 947. Open 3. Hazel J Evans, Neil A Gibson, Joanna Bennett et al. British Thoracic Society guideline for diagnosing and monitoring paediatric sleep-disordered breathing. Thorax. 2023 Jun;78 Suppl 2):s1-s27. Open 4. Michael T Smith, Christina S McCrae, Joseph Cheung et al. Use of Actigraphy for the Evaluation of Sleep Disorders and Circadian Rhythm Sleep-Wake Disorders: An American Academy of Sleep Medicine Clinical Practice Guideline. J Clin Sleep Med. 2018 Jul 15;14 7 1231 1237. Open https://web.pathway.md/diseases/reczMgRmBZ2nQE5aj 3/3