Circadian rhythm sleep disorders: pathophysiology and treatment.

The prediction that abnormalities of circadian clock function in humans would manifest principally as sleep/wake disruption led to the description of the first circadian sleep/wake disorders almost 20 years ago. Since then, formal classification of sleep pathology has expanded this category to include six specific disorders. In this review, the physiology of mammalian circadian clocks is summarized with emphasis on the role of light and hormonal signals in circadian adjustment and entrainment. Each of the circadian sleep disorders-time zone change (jet lag) syndrome, shift work sleep disorder, irregular sleep/wake pattern, delayed sleep phase syndrome, advanced sleep phase syndrome, and non-24-h sleep wake disorder-is reviewed. Presenting characteristics, approaches to diagnosis, models of pathophysiology, and methods of treatment are summarized for each sleep disorder. Developments in the understanding of circadian physiology offer promise for important advances in the diagnosis and treatment of these sleep disorders.

[1]  C A Czeisler,et al.  Circadian timekeeping in health and disease. Part 1. Basic properties of circadian pacemakers. , 1983, The New England journal of medicine.

[2]  D F Kripke,et al.  Sleep of night workers: EEG recordings. , 1970, Psychophysiology.

[3]  R. Kronauer,et al.  Exposure to bright light and darkness to treat physiologic maladaptation to night work. , 1990, The New England journal of medicine.

[4]  M. Uchiyama,et al.  A Polysomnographic Study on Patients with Delayed Sleep Phase Syndrome (DSPS) , 1992, The Japanese journal of psychiatry and neurology.

[5]  R. Newcombe,et al.  Effect of melatonin on jet lag after long haul flights. , 1989, BMJ.

[6]  S. Daan,et al.  Scheduled exposure to daylight: a potential strategy to reduce "jet lag" following transmeridian flight. , 1984, Psychopharmacology bulletin.

[7]  R. F. Johnson,et al.  Loss of entrainment and anatomical plasticity after lesions of the hamster retinohypothalamic tract , 1988, Brain Research.

[8]  T. Åkerstedt,et al.  INCREASED RISK OF ISCHAEMIC HEART DISEASE IN SHIFT WORKERS , 1986, The Lancet.

[9]  M. Okawa,et al.  Morning bright light therapy for sleep and behavior disorders in elderly patients with dementia , 1994, Acta psychiatrica Scandinavica.

[10]  Peter Knauth,et al.  Re-entrainment of body temperature in field studies of shiftwork , 1981 .

[11]  J. Meijer,et al.  Glutamate phase shifts circadian activity rhythms in hamsters , 1988, Neuroscience Letters.

[12]  S. Reppert,et al.  Melatonin receptors in human hypothalamus and pituitary: implications for circadian and reproductive responses to melatonin. , 1993, The Journal of clinical endocrinology and metabolism.

[13]  A. Samel,et al.  Influence of Melatonin Treatment on Human Circadian Rhythmicity before and after a Simulated 9-Hr Time Shift , 1991, Journal of biological rhythms.

[14]  C. Pollak,et al.  Long-term ambulatory temperature monitoring in a subject with a hypernychthemeral sleep--wake cycle disturbance. , 1978, Sleep.

[15]  I. Zucker,et al.  Regulation by the pituitary gland of circadian rhythms in the hamster. , 1980, The Journal of endocrinology.

[16]  H. Morris,et al.  Traveler's amnesia. Transient global amnesia secondary to triazolam. , 1987, JAMA.

[17]  L. Wetterberg,et al.  Correction of non–24‐hour sleep/wake cycle by melatonin in a blind retarded boy , 1991, Annals of neurology.

[18]  G. Richardson,et al.  Medical implications of shift-work. , 1985, Annual review of medicine.

[19]  R. Kronauer,et al.  Circadian sleep regulation in the absence of light perception: chronic non-24-hour circadian rhythm sleep disorder in a blind man with a regular 24-hour sleep-wake schedule. , 1993, Sleep.

[20]  A. Thompson,et al.  The delayed sleep phase syndrome: clinical and investigative findings in 14 subjects. , 1992, Journal of neurology, neurosurgery, and psychiatry.

[21]  C A Czeisler,et al.  Sleep and alertness in a 12-hour rotating shift work environment. , 1994, Journal of occupational medicine. : official publication of the Industrial Medical Association.

[22]  A. Lewy,et al.  Melatonin rhythms in night shift workers. , 1992, Sleep.

[23]  E. van Cauter,et al.  Effects of the short-acting benzodiazepine triazolam, taken at bedtime, on circadian and sleep-related hormonal profiles in normal men. , 1990, Sleep.

[24]  M. Okawa,et al.  Four congenitally blind children with circadian sleep-wake rhythm disorder. , 1987, Sleep.

[25]  C A Czeisler,et al.  Chronotherapy: resetting the circadian clocks of patients with delayed sleep phase insomnia. , 1981, Sleep.

[26]  P. Smith.  A study of weekly and rapidly rotating shiftworkers , 1979, International archives of occupational and environmental health.

[27]  R. Cohen,et al.  Disruption of human circadian and cognitive regulation following a discrete hypothalamic lesion: A case study , 1991, Neurology.

[28]  S. Daan,et al.  Circadian Oscillations in Rodents: A Systematic Increase of Their Frequency with Age , 1974, Science.

[29]  D.G.M. Dijk,et al.  Contribution of the circadian pacemaker and the sleep homeostat to sleep propensity, sleep structure, electroencephalographic slow waves, and sleep spindle activity in humans , 1995, The Journal of neuroscience : the official journal of the Society for Neuroscience.

[30]  R. Moore,et al.  A retinohypothalamic projection in the rat , 1972, The Journal of comparative neurology.

[31]  R. Allen,et al.  Phase-shifting effects of bright morning light as treatment for delayed sleep phase syndrome. , 1990, Sleep.

[32]  C A Czeisler,et al.  ENTRAINMENT OF HUMAN ORCADIAN RHYTHMS BY LIGHT‐DARK CYCLES: A REASSESSMENT , 1981, Photochemistry and photobiology.

[33]  R. Kronauer,et al.  Bright light induction of strong (type 0) resetting of the human circadian pacemaker. , 1989, Science.

[34]  D A Newsome,et al.  Light suppresses melatonin secretion in humans. , 1980, Science.

[35]  J. C. Zimmerman,et al.  Delayed Sleep Phase Syndrome: A Chronobiological Disorder With Sleep-Onset Insomnia , 1981 .

[36]  R. Rosa,et al.  Performance and alertness on 8 h and 12 h rotating shifts at a natural gas utility. , 1993, Ergonomics.

[37]  T. Åkerstedt,et al.  Sleepiness as a consequence of shift work. , 1988, Sleep.

[38]  J. Arendt,et al.  Alleviation of jet lag by melatonin: preliminary results of controlled double blind trial. , 1986, British medical journal.

[39]  S. Folkard,et al.  Melatonin stabilises sleep onset time in a blind man without entrainment of cortisol or temperature rhythms , 1990, Neuroscience Letters.

[40]  D Dawson,et al.  Timed exposure to bright light improves sleep and alertness during simulated night shifts. , 1991, Sleep.

[41]  P. Lavie,et al.  The importance of timing in melatonin administration in a blind man , 1992, Journal of pineal research.

[42]  J. Vanecek,et al.  Hypothalamic melatonin receptor sites revealed by autoradiography , 1987, Brain Research.

[43]  F. Speizer,et al.  Rotating shift work, sleep, and accidents related to sleepiness in hospital nurses. , 1992, American journal of public health.

[44]  C A Czeisler,et al.  The prevalence and health impact of shiftwork. , 1986, American journal of public health.

[45]  F. Turek,et al.  Stimulated activity mediates phase shifts in the hamster circadian clock induced by dark pulses or benzodiazepines , 1989, Nature.

[46]  S. Strogatz,et al.  Bright light resets the human circadian pacemaker independent of the timing of the sleep-wake cycle. , 1986, Science.

[47]  A. Satlin,et al.  Bright light treatment of behavioral and sleep disturbances in patients with Alzheimer's disease. , 1992, The American journal of psychiatry.

[48]  C. Czeisler,et al.  Association of sleep-wake habits in older people with changes in output of circadian pacemaker , 1992, The Lancet.

[49]  J. Arendt,et al.  SYNCHRONISATION OF A DISTURBED SLEEP-WAKE CYCLE IN A BLIND MAN BY MELATONIN TREATMENT , 1988, The Lancet.

[50]  P. Kincaid‐smith.  Quartan malarial nephrotic syndrome. , 1972, Lancet.

[51]  D Dawson,et al.  Improving adaptation to simulated night shift: timed exposure to bright light versus daytime melatonin administration. , 1995, Sleep.

[52]  Alexander G. Dawson,et al.  A double-blind trial of melatonin as a treatment for jet lag in international cabin crew , 1993, Biological Psychiatry.

[53]  R. Wever,et al.  Use of Light to Treat Jet Lag: Differential Effects of Normal and Bright Artificial Light on Human Circadian Rhythms , 1985, Annals of the New York Academy of Sciences.

[54]  D Minors,et al.  Circadian rhythms, jet lag, and chronobiotics: an overview. , 1994, Chronobiology international.

[55]  M. Muehlbach,et al.  Acute administration of triazolam for the daytime sleep of rotating shift workers. , 1984, Sleep.

[56]  F. Davis,et al.  Transplanted suprachiasmatic nucleus determines circadian period. , 1990, Science.

[57]  J K Walsh,et al.  Sleepiness/alertness on a simulated night shift following sleep at home with triazolam. , 1991, Sleep.

[58]  H M Wegmann,et al.  Transition between advance and delay responses to eastbound transmeridian flights. , 1989, Chronobiology international.

[59]  C A Czeisler,et al.  Rotating shift work schedules that disrupt sleep are improved by applying circadian principles. , 1982, Science.

[60]  J. Redman,et al.  Free-running activity rhythms in the rat: entrainment by melatonin. , 1983, Science.

[61]  K. Ando,et al.  Long‐Term Course of Adult Patients with Delayed Sleep Phase Syndrome , 1993, The Japanese journal of psychiatry and neurology.

[62]  S. Folkard,et al.  Can melatonin improve shift workers' tolerance of the night shift? Some preliminary findings. , 1993, Chronobiology international.

[63]  G. Sassolas,et al.  Melatonin and jet lag: Confirmatory result using a simplified protocol , 1992, Biological Psychiatry.

[64]  J. Walsh,et al.  Physiological sleep tendency on a simulated night shift: adaptation and effects of triazolam. , 1988, Sleep.

[65]  M. Koller,et al.  Health risks related to shift work , 1983, International archives of occupational and environmental health.

[66]  DM Edgar,et al.  Effect of SCN lesions on sleep in squirrel monkeys: evidence for opponent processes in sleep-wake regulation , 1993, The Journal of neuroscience : the official journal of the Society for Neuroscience.

[67]  Scott S. Campbell,et al.  Exposure to light in healthy elderly subjects and alzheimer's patients , 1988, Physiology & Behavior.

[68]  T. Åkerstedt,et al.  Shift work and cardiovascular disease. , 1984, Scandinavian journal of work, environment & health.

[69]  D. Welsh,et al.  Effect of age on the circadian pattern of sleep and wakefulness in the mouse. , 1986, Journal of gerontology.

[70]  R. Lydic,et al.  Suprachiasmatic region of the human hypothalamus: homolog to the primate circadian pacemaker? , 1980, Sleep.

[71]  D. Bliwise,et al.  Sleep in normal aging and dementia. , 1993, Sleep.

[72]  J. Rizzo,et al.  Suppression of melatonin secretion in some blind patients by exposure to bright light. , 1995, The New England journal of medicine.

[73]  T. Roth,et al.  Treatment of a 12-hour shift of sleep schedule with benzodiazepines. , 1984, Science.

[74]  A. Lewy,et al.  Melatonin Administration to Blind People: Phase Advances and Entrainment , 1991, Journal of biological rhythms.

[75]  A. Lewy,et al.  Different Types of Melatonin Circadian Secretory Rhythms in Some Blind Subjects , 1983 .

[76]  M. Wilson,et al.  Blind man living in normal society has circadian rhythms of 24.9 hours. , 1977, Science.