The Experts below are selected from a list of 159 Experts worldwide ranked by ideXlab platform
Phyllis C. Zee - One of the best experts on this subject based on the ideXlab platform.
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Clinical neurophysiology of circadian Rhythm Sleep-Wake disorders.
Handbook of clinical neurology, 2019Co-Authors: Yumna Saeed, Phyllis C. Zee, Sabra M. AbbottAbstract:Circadian Rhythms are the endogenous near-24-h oscillations in physiologic processes. In mammals the suprachiasmatic nucleus serves as the primary circadian pacemaker, and it maintains Rhythmicity at a genetic level through a complex transcription-translation feedback loop of core circadian clock genes. The circadian clock is entrained to the environment through daily exposure to light and melatonin. Disruption of these endogenous Rhythms or the ability to entrain to the surrounding environment results in the circadian Rhythm Sleep-Wake disorders (CRSWDs). Patients with CRSWDs can present with either late sleep/wake times (delayed Sleep-Wake phase disorder), early sleep/wake times (advanced Sleep-Wake phase disorder), inconsistent sleep/wake times (Irregular Sleep-Wake Rhythm disorder) or Sleep-Wake times that move progressively later each day (non-24-h Sleep-Wake Rhythm disorder). Diagnosis of these disorders relies on the use of sleep logs and/or actigraphy to demonstrate the daily patterns of rest and activity. Treatment of the CRSWDs focuses on sleep hygiene and strategically timed light and melatonin.
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Evaluation and Management of Circadian Rhythm Sleep Disorders
Sleep Disorders Medicine, 2017Co-Authors: Sabra M. Abbott, Phyllis C. ZeeAbstract:All individuals have an internal circadian pacemaker located in the suprachiasmatic nucleus (SCN) that maintains proper alignment of behaviors and physiological processes with the environment. The circadian Rhythm sleep disorders (CRSDs) result when this alignment is disrupted. In advanced (ASPD) and delayed sleep phase disorder (DSPD), an individual’s habitual sleep times fall much earlier or later than desired. In non-24-h sleep–wake disorder (N24SD), the sleep–wake period moves progressively later each day, while in Irregular sleep–wake Rhythm (ISWR), there is no clear pattern to the sleep–wake schedule. Shift work requires individuals to work during a time they would normally be sleeping, and jet lag results from changing time zones more rapidly than the internal clock is able to adapt. Treatment of all of these disorders depends on resetting the clock, primarily relying on the appropriate timing of administration of the two key regulators of the circadian clock: light and melatonin.
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Irregular Sleep-Wake Rhythm Disorder
Sleep medicine clinics, 2015Co-Authors: Sabra M. Abbott, Phyllis C. ZeeAbstract:Irregular Sleep-Wake Rhythm disorder is a circadian Rhythm disorder characterized by multiple bouts of sleep within a 24-hour period. Patients present with symptoms of insomnia, including difficulty either falling or staying asleep, and daytime excessive sleepiness. The disorder is seen in a variety of individuals, ranging from children with neurodevelopmental disorders, to patients with psychiatric disorders, and most commonly in older adults with neurodegenerative disorders. Treatment of Irregular Sleep-Wake Rhythm disorder requires a multimodal approach aimed at strengthening circadian synchronizing agents, such as daytime exposure to bright light, and structured social and physical activities. In addition, melatonin may be useful in some patients.
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Circadian Rhythm Abnormalities
CONTINUUM: Lifelong Learning in Neurology, 2013Co-Authors: Phyllis C. Zee, Hrayr Attarian, Aleksandar VidenovicAbstract:Purpose: This article reviews the recent advances in understanding of the fundamental properties of circadian Rhythms and discusses the clinical features, diagnosis, and treatment of circadian Rhythm sleep disorders (CRSDs). Recent Findings: Recent evidence strongly points to the ubiquitous influence of circadian timing in nearly all physiologic functions. Thus, in addition to the prominent sleep and wake disturbances, circadian Rhythm disorders are associated with cognitive impairment, mood disturbances, and increased risk of cardiometabolic disorders. The recent availability of biomarkers of circadian timing in clinical practice has improved our ability to identify and treat these CRSDs. Summary: Circadian Rhythms are endogenous Rhythms with a periodicity of approximately 24 hours. These Rhythms are synchronized to the physical environment by social and work schedules by various photic and nonphotic stimuli. CRSDs result from a misalignment between the timing of the circadian Rhythm and the external environment (eg, jet lag and shift work) or a dysfunction of the circadian clock or its afferent and efferent pathways (eg, delayed sleep-phase, advanced sleep-phase, non–24-hour, and Irregular Sleep-Wake Rhythm disorders). The most common symptoms of these disorders are difficulties with sleep onset and/or sleep maintenance and excessive sleepiness that are associated with impaired social and occupational functioning. Effective treatment for most of the CRSDs requires a multimodal approach to accelerate circadian realignment with timed exposure to light, avoidance of bright light at inappropriate times, and adherence to scheduled sleep and wake times. In addition, pharmacologic agents are recommended for some of the CRSDs. For delayed sleep-phase, non–24-hour, and shift work disorders, timed low-dose melatonin can help advance or entrain circadian Rhythms; and for shift work disorder, wake-enhancing agents such as caffeine, modafinil, and armodafinil are options for the management of excessive sleepiness.
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Circadian Rhythm abnormalities.
Continuum (Minneapolis Minn.), 2013Co-Authors: Phyllis C. Zee, Hrayr Attarian, Aleksandar VidenovicAbstract:This article reviews the recent advances in understanding of the fundamental properties of circadian Rhythms and discusses the clinical features, diagnosis, and treatment of circadian Rhythm sleep disorders (CRSDs). Recent evidence strongly points to the ubiquitous influence of circadian timing in nearly all physiologic functions. Thus, in addition to the prominent sleep and wake disturbances, circadian Rhythm disorders are associated with cognitive impairment, mood disturbances, and increased risk of cardiometabolic disorders. The recent availability of biomarkers of circadian timing in clinical practice has improved our ability to identify and treat these CRSDs. Circadian Rhythms are endogenous Rhythms with a periodicity of approximately 24 hours. These Rhythms are synchronized to the physical environment by social and work schedules by various photic and nonphotic stimuli. CRSDs result from a misalignment between the timing of the circadian Rhythm and the external environment (eg, jet lag and shift work) or a dysfunction of the circadian clock or its afferent and efferent pathways (eg, delayed sleep-phase, advanced sleep-phase, non-24-hour, and Irregular Sleep-Wake Rhythm disorders). The most common symptoms of these disorders are difficulties with sleep onset and/or sleep maintenance and excessive sleepiness that are associated with impaired social and occupational functioning. Effective treatment for most of the CRSDs requires a multimodal approach to accelerate circadian realignment with timed exposure to light, avoidance of bright light at inappropriate times, and adherence to scheduled sleep and wake times. In addition, pharmacologic agents are recommended for some of the CRSDs. For delayed sleep-phase, non-24-hour, and shift work disorders, timed low-dose melatonin can help advance or entrain circadian Rhythms; and for shift work disorder, wake-enhancing agents such as caffeine, modafinil, and armodafinil are options for the management of excessive sleepiness.
Sabra M. Abbott - One of the best experts on this subject based on the ideXlab platform.
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Clinical neurophysiology of circadian Rhythm Sleep-Wake disorders.
Handbook of clinical neurology, 2019Co-Authors: Yumna Saeed, Phyllis C. Zee, Sabra M. AbbottAbstract:Circadian Rhythms are the endogenous near-24-h oscillations in physiologic processes. In mammals the suprachiasmatic nucleus serves as the primary circadian pacemaker, and it maintains Rhythmicity at a genetic level through a complex transcription-translation feedback loop of core circadian clock genes. The circadian clock is entrained to the environment through daily exposure to light and melatonin. Disruption of these endogenous Rhythms or the ability to entrain to the surrounding environment results in the circadian Rhythm Sleep-Wake disorders (CRSWDs). Patients with CRSWDs can present with either late sleep/wake times (delayed Sleep-Wake phase disorder), early sleep/wake times (advanced Sleep-Wake phase disorder), inconsistent sleep/wake times (Irregular Sleep-Wake Rhythm disorder) or Sleep-Wake times that move progressively later each day (non-24-h Sleep-Wake Rhythm disorder). Diagnosis of these disorders relies on the use of sleep logs and/or actigraphy to demonstrate the daily patterns of rest and activity. Treatment of the CRSWDs focuses on sleep hygiene and strategically timed light and melatonin.
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Evaluation and Management of Circadian Rhythm Sleep Disorders
Sleep Disorders Medicine, 2017Co-Authors: Sabra M. Abbott, Phyllis C. ZeeAbstract:All individuals have an internal circadian pacemaker located in the suprachiasmatic nucleus (SCN) that maintains proper alignment of behaviors and physiological processes with the environment. The circadian Rhythm sleep disorders (CRSDs) result when this alignment is disrupted. In advanced (ASPD) and delayed sleep phase disorder (DSPD), an individual’s habitual sleep times fall much earlier or later than desired. In non-24-h sleep–wake disorder (N24SD), the sleep–wake period moves progressively later each day, while in Irregular sleep–wake Rhythm (ISWR), there is no clear pattern to the sleep–wake schedule. Shift work requires individuals to work during a time they would normally be sleeping, and jet lag results from changing time zones more rapidly than the internal clock is able to adapt. Treatment of all of these disorders depends on resetting the clock, primarily relying on the appropriate timing of administration of the two key regulators of the circadian clock: light and melatonin.
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Irregular Sleep-Wake Rhythm Disorder
Sleep medicine clinics, 2015Co-Authors: Sabra M. Abbott, Phyllis C. ZeeAbstract:Irregular Sleep-Wake Rhythm disorder is a circadian Rhythm disorder characterized by multiple bouts of sleep within a 24-hour period. Patients present with symptoms of insomnia, including difficulty either falling or staying asleep, and daytime excessive sleepiness. The disorder is seen in a variety of individuals, ranging from children with neurodevelopmental disorders, to patients with psychiatric disorders, and most commonly in older adults with neurodegenerative disorders. Treatment of Irregular Sleep-Wake Rhythm disorder requires a multimodal approach aimed at strengthening circadian synchronizing agents, such as daytime exposure to bright light, and structured social and physical activities. In addition, melatonin may be useful in some patients.
Margaret Moline - One of the best experts on this subject based on the ideXlab platform.
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Evaluation of the CYP3A and CYP2B6 Drug‐Drug Interaction Potential of Lemborexant
Clinical pharmacology in drug development, 2021Co-Authors: Ishani Landry, G. Filippov, Jagadeesh Aluri, Kenya Nakai, Nancy Hall, Yukiko Miyajima, Takashi Ueno, Satish Dayal, Bojan Lalovic, Margaret MolineAbstract:Lemborexant is approved for treating insomnia and is under investigation for treating Irregular Sleep-Wake Rhythm disorder. Based on in vitro drug-drug interaction (DDI) characteristics, phase 1, open-label DDI studies were conducted to evaluate lemborexant's cytochrome P450 3A (CYP3A) and CYP2B6 interaction potential. Interactions between lemborexant 10 mg and strong and moderate CYP3A inhibitors (itraconazole and fluconazole), a strong CYP3A inducer (rifampin), and CYP3A (midazolam) and CYP2B6 substrates (bupropion) were evaluated. Coadministration of lemborexant with itraconazole or fluconazole resulted in 1.4- to 1.6-fold and 3.7- to 4-fold increases in lemborexant maximum observed concentration (Cmax ) and area under the concentration-time curve from zero time extrapolated to infinity (AUC0-inf ), respectively. Coadministration of lemborexant with rifampin resulted in >90% decreases in lemborexant Cmax and AUC0-inf . Midazolam exposure was not affected. Coadministration of lemborexant with bupropion resulted in 49.9% and 45.5% decreases in S-bupropion Cmax and AUC0-inf , respectively.Comparison of estimated exposures for patients in phase 3 trials who were/were not receiving concomitant weak CYP3A inhibitors substantiated the DDI pharmacokinetic findings. Lemborexant was generally well tolerated in the phase 1 studies. In summary, lemborexant does not affect the pharmacokinetics of CYP3A substrates and has potential to induce CYP2B6. Consistent with in vitro findings, moderate and strong CYP3A inhibitors and inducers affected the pharmacokinetics of lemborexant; hence, patients taking lemborexant 5 or 10 mg should avoid coadministration with moderate and strong CYP3A inhibitors and inducers.
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Safety and Efficacy of Lemborexant in Patients With Irregular Sleep-Wake Rhythm Disorder and Alzheimer's Disease Dementia: Results From a Phase 2 Randomized Clinical Trial.
The journal of prevention of Alzheimer's disease, 2021Co-Authors: Margaret Moline, M. Bsharat, N. Rabbee, M. Kemethofer-waliczky, G. Filippov, N. Kubota, Stephen G. Thein, S. DhaddaAbstract:BACKGROUND Irregular Sleep-Wake Rhythm disorder (ISWRD) is a common sleep disorder in individuals with Alzheimer's disease dementia (AD-D). OBJECTIVES This exploratory phase 2 proof-of-concept and dose-finding clinical trial evaluated the effects of lemborexant compared with placebo on circadian Rhythm parameters, nighttime sleep, daytime wakefulness and other clinical measures of ISWRD in individuals with ISWRD and mild to moderate AD-D. DESIGN Multicenter, randomized, double-blind, placebo-controlled, parallel-group study. SETTING Sites in the United States, Japan and the United Kingdom. PARTICIPANTS Men and women 60 to 90 years of age with documentation of diagnosis with AD-D and Mini-Mental State Exam (MMSE) score 10 to 26. INTERVENTION Subjects were randomized to placebo or one of four lemborexant treatment arms (2.5 mg, 5 mg, 10 mg or 15 mg) once nightly at bedtime for 4 weeks. MEASUREMENTS An actigraph was used to collect subject rest-activity data, which were used to calculate sleep-related, wake-related and circadian Rhythm-related parameters. These parameters included least active 5 hours (L5), relative amplitude of the rest-activity Rhythm (RA) and mean duration of sleep bouts (MDSB) during the daytime. The MMSE and the Alzheimer's Disease Assessment Scale-Cognitive Subscale (ADAS-Cog) were used to assess for changes in cognitive function. RESULTS Sixty-two subjects were randomized and provided data for circadian, daytime and nighttime parameters (placebo, n = 12; lemborexant 2.5 mg [LEM2.5], n = 12; lemborexant 5 mg [LEM5], n = 13, lemborexant 10 mg [LEM10], n = 13 and lemborexant 15 mg [LEM15], n = 12). Mean L5 showed a decrease from baseline to week 4 for LEM2.5, LEM5 and LEM15 that was significantly greater than with placebo (all p < 0.05), suggesting a reduction in restlessness. For RA, LS mean change from baseline to week 4 versus placebo indicated greater distinction between night and day with all dose levels of lemborexant, with significant improvements seen with LEM5 and LEM15 compared with placebo (both p < 0.05). The median percentage change from baseline to week 4 in MDSB during the daytime indicated a numerical decrease in duration for LEM5, LEM10 and LEM15, which was significantly different from placebo for LEM5 and LEM15 (p < 0.01 and p = 0.002, respectively). There were no serious treatment-emergent adverse events or worsening of cognitive function, as assessed by the MMSE and ADAS-Cog. Lemborexant was well tolerated. No subjects discontinued treatment. CONCLUSIONS This study provides preliminary evidence of the potential utility of lemborexant as a treatment to address both nighttime and daytime symptoms in patients with ISWRD and AD-D.
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Safety and Efficacy of Lemborexant in Patients With Irregular Sleep-Wake Rhythm Disorder and Alzheimer’s Disease Dementia: Results From a Phase 2 Randomized Clinical Trial
The Journal of Prevention of Alzheimer's Disease, 2020Co-Authors: Margaret Moline, S. Thein, M. Bsharat, N. Rabbee, M. Kemethofer-waliczky, G. Filippov, N. Kubota, S. DhaddaAbstract:BACKGROUND Irregular Sleep-Wake Rhythm disorder (ISWRD) is a common sleep disorder in individuals with Alzheimer’s disease dementia (AD-D). OBJECTIVES This exploratory phase 2 proof-of-concept and dose-finding clinical trial evaluated the effects of lemborexant compared with placebo on circadian Rhythm parameters, nighttime sleep, daytime wakefulness and other clinical measures of ISWRD in individuals with ISWRD and mild to moderate AD-D. DESIGN Multicenter, randomized, double-blind, placebo-controlled, parallel-group study. SETTING Sites in the United States, Japan and the United Kingdom. PARTICIPANTS Men and women 60 to 90 years of age with documentation of diagnosis with AD-D and Mini-Mental State Exam (MMSE) score 10 to 26. INTERVENTION Subjects were randomized to placebo or one of four lemborexant treatment arms (2.5 mg, 5 mg, 10 mg or 15 mg) once nightly at bedtime for 4 weeks. MEASUREMENTS An actigraph was used to collect subject rest-activity data, which were used to calculate sleep-related, wake-related and circadian Rhythm-related parameters. These parameters included least active 5 hours (L5), relative amplitude of the rest-activity Rhythm (RA) and mean duration of sleep bouts (MDSB) during the daytime. The MMSE and the Alzheimer’s Disease Assessment Scale-Cognitive Subscale (ADAS-Cog) were used to assess for changes in cognitive function. RESULTS Sixty-two subjects were randomized and provided data for circadian, daytime and nighttime parameters (placebo, n = 12; lemborexant 2.5 mg [LEM2.5], n = 12; lemborexant 5 mg [LEM5], n = 13, lemborexant 10 mg [LEM10], n = 13 and lemborexant 15 mg [LEM15], n = 12). Mean L5 showed a decrease from baseline to week 4 for LEM2.5, LEM5 and LEM15 that was significantly greater than with placebo (all p > 0.05), suggesting a reduction in restlessness. For RA, LS mean change from baseline to week 4 versus placebo indicated greater distinction between night and day with all dose levels of lemborexant, with significant improvements seen with LEM5 and LEM15 compared with placebo (both p > 0.05). The median percentage change from baseline to week 4 in MDSB during the daytime indicated a numerical decrease in duration for LEM5, LEM10 and LEM15, which was significantly different from placebo for LEM5 and LEM15 (p > 0.01 and p = 0.002, respectively). There were no serious treatment-emergent adverse events or worsening of cognitive function, as assessed by the MMSE and ADAS-Cog. Lemborexant was well tolerated. No subjects discontinued treatment. CONCLUSIONS This study provides preliminary evidence of the potential utility of lemborexant as a treatment to address both nighttime and daytime symptoms in patients with ISWRD and AD-D.
Aleksandar Videnovic - One of the best experts on this subject based on the ideXlab platform.
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Circadian Rhythm Sleep-Wake Disorders: a Contemporary Review of Neurobiology, Treatment, and Dysregulation in Neurodegenerative Disease.
Neurotherapeutics : the journal of the American Society for Experimental NeuroTherapeutics, 2021Co-Authors: Tyler A. Steele, Aleksandar Videnovic, Erik K. St Louis, R. Robert AugerAbstract:Circadian Rhythms oscillate throughout a 24-h period and impact many physiological processes and aspects of daily life, including feeding behaviors, regulation of the Sleep-Wake cycle, and metabolic homeostasis. Misalignment between the endogenous biological clock and exogenous light-dark cycle can cause significant distress and dysfunction, and treatment aims for resynchronization with the external clock and environment. This article begins with a brief historical context of progress in the understanding of circadian Rhythms, and then provides an overview of circadian neurobiology and the endogenous molecular clock. Various tools used in the diagnosis of circadian Rhythm Sleep-Wake disorders, including sleep diaries and actigraphy monitoring, are then discussed, as are the therapeutic applications of strategically timed light therapy, melatonin, and other behavioral and pharmacological therapies including the melatonin agonist tasimelteon. Management strategies towards each major human circadian Sleep-Wake Rhythm disorder, as outlined in the current International Classification of Sleep Disorders - Third Edition, including jet lag and shift work disorders, delayed and advanced Sleep-Wake phase Rhythm disorders, non-24-h Sleep-Wake Rhythm disorder, and Irregular Sleep-Wake Rhythm disorder are summarized. Last, an overview of chronotherapies and the circadian dysregulation of neurodegenerative diseases is reviewed.
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Circadian Rhythm Sleep–Wake Disorders: a Contemporary Review of Neurobiology, Treatment, and Dysregulation in Neurodegenerative Disease
Neurotherapeutics, 2021Co-Authors: Tyler A. Steele, Aleksandar Videnovic, Erik K. St Louis, R. Robert AugerAbstract:Circadian Rhythms oscillate throughout a 24-h period and impact many physiological processes and aspects of daily life, including feeding behaviors, regulation of the Sleep-Wake cycle, and metabolic homeostasis. Misalignment between the endogenous biological clock and exogenous light–dark cycle can cause significant distress and dysfunction, and treatment aims for resynchronization with the external clock and environment. This article begins with a brief historical context of progress in the understanding of circadian Rhythms, and then provides an overview of circadian neurobiology and the endogenous molecular clock. Various tools used in the diagnosis of circadian Rhythm sleep–wake disorders, including sleep diaries and actigraphy monitoring, are then discussed, as are the therapeutic applications of strategically timed light therapy, melatonin, and other behavioral and pharmacological therapies including the melatonin agonist tasimelteon. Management strategies towards each major human circadian sleep–wake Rhythm disorder, as outlined in the current International Classification of Sleep Disorders – Third Edition , including jet lag and shift work disorders, delayed and advanced sleep–wake phase Rhythm disorders, non-24-h sleep–wake Rhythm disorder, and Irregular sleep–wake Rhythm disorder are summarized. Last, an overview of chronotherapies and the circadian dysregulation of neurodegenerative diseases is reviewed.
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Irregular Sleep-Wake Rhythm Disorder.
Neurologic clinics, 2019Co-Authors: Temitayo O. Oyegbile, Aleksandar VidenovicAbstract:This article focuses on Irregular Sleep-Wake Rhythm disorder (ISWRD) and its associations with several other comorbidities. Irregular Sleep-Wake Rhythm disorder is a circadian disorder characterized by a lack of a clear Sleep-Wake pattern. The disorder has yet to be fully understood from pathophysiologic perspective. Treatments are available, but there is a need for development of novel interventions. The goal of this article is to focus on multiple aspects of ISWRD.
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Circadian Rhythm Abnormalities
CONTINUUM: Lifelong Learning in Neurology, 2013Co-Authors: Phyllis C. Zee, Hrayr Attarian, Aleksandar VidenovicAbstract:Purpose: This article reviews the recent advances in understanding of the fundamental properties of circadian Rhythms and discusses the clinical features, diagnosis, and treatment of circadian Rhythm sleep disorders (CRSDs). Recent Findings: Recent evidence strongly points to the ubiquitous influence of circadian timing in nearly all physiologic functions. Thus, in addition to the prominent sleep and wake disturbances, circadian Rhythm disorders are associated with cognitive impairment, mood disturbances, and increased risk of cardiometabolic disorders. The recent availability of biomarkers of circadian timing in clinical practice has improved our ability to identify and treat these CRSDs. Summary: Circadian Rhythms are endogenous Rhythms with a periodicity of approximately 24 hours. These Rhythms are synchronized to the physical environment by social and work schedules by various photic and nonphotic stimuli. CRSDs result from a misalignment between the timing of the circadian Rhythm and the external environment (eg, jet lag and shift work) or a dysfunction of the circadian clock or its afferent and efferent pathways (eg, delayed sleep-phase, advanced sleep-phase, non–24-hour, and Irregular Sleep-Wake Rhythm disorders). The most common symptoms of these disorders are difficulties with sleep onset and/or sleep maintenance and excessive sleepiness that are associated with impaired social and occupational functioning. Effective treatment for most of the CRSDs requires a multimodal approach to accelerate circadian realignment with timed exposure to light, avoidance of bright light at inappropriate times, and adherence to scheduled sleep and wake times. In addition, pharmacologic agents are recommended for some of the CRSDs. For delayed sleep-phase, non–24-hour, and shift work disorders, timed low-dose melatonin can help advance or entrain circadian Rhythms; and for shift work disorder, wake-enhancing agents such as caffeine, modafinil, and armodafinil are options for the management of excessive sleepiness.
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Circadian Rhythm abnormalities.
Continuum (Minneapolis Minn.), 2013Co-Authors: Phyllis C. Zee, Hrayr Attarian, Aleksandar VidenovicAbstract:This article reviews the recent advances in understanding of the fundamental properties of circadian Rhythms and discusses the clinical features, diagnosis, and treatment of circadian Rhythm sleep disorders (CRSDs). Recent evidence strongly points to the ubiquitous influence of circadian timing in nearly all physiologic functions. Thus, in addition to the prominent sleep and wake disturbances, circadian Rhythm disorders are associated with cognitive impairment, mood disturbances, and increased risk of cardiometabolic disorders. The recent availability of biomarkers of circadian timing in clinical practice has improved our ability to identify and treat these CRSDs. Circadian Rhythms are endogenous Rhythms with a periodicity of approximately 24 hours. These Rhythms are synchronized to the physical environment by social and work schedules by various photic and nonphotic stimuli. CRSDs result from a misalignment between the timing of the circadian Rhythm and the external environment (eg, jet lag and shift work) or a dysfunction of the circadian clock or its afferent and efferent pathways (eg, delayed sleep-phase, advanced sleep-phase, non-24-hour, and Irregular Sleep-Wake Rhythm disorders). The most common symptoms of these disorders are difficulties with sleep onset and/or sleep maintenance and excessive sleepiness that are associated with impaired social and occupational functioning. Effective treatment for most of the CRSDs requires a multimodal approach to accelerate circadian realignment with timed exposure to light, avoidance of bright light at inappropriate times, and adherence to scheduled sleep and wake times. In addition, pharmacologic agents are recommended for some of the CRSDs. For delayed sleep-phase, non-24-hour, and shift work disorders, timed low-dose melatonin can help advance or entrain circadian Rhythms; and for shift work disorder, wake-enhancing agents such as caffeine, modafinil, and armodafinil are options for the management of excessive sleepiness.
Akito Shimouchi - One of the best experts on this subject based on the ideXlab platform.
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Effects of long sleep time and Irregular sleep–wake Rhythm on cognitive function in older people
Scientific Reports, 2021Co-Authors: Masato Okuda, Seiko Miyata, Akiko Noda, Kunihiro Iwamoto, Norio Ozaki, Honoka Nakashima, Kozue Takeda, Fumihiko Yasuma, Akito ShimouchiAbstract:Sleep disturbances and cognitive decline are common in older adults. We aimed to investigate the effects of the total sleep time (TST) and sleep–wake Rhythm on executive function and working memory in older adults. In 63 older participants, we measured the TST, wake after sleep onset (WASO), and sleep timing (midpoint between bedtime and wake-up time) using actigraphy. Executive function was evaluated with the trail making test B (TMT-B) and Wisconsin card sorting test (WCST). The number of back task (N-back task) was used to measure working memory. Participants with a TST ≥ 8 h had a significantly lower percentage of correct answers (% correct) on the 1-back task than those with a TST
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Effects of long sleep time and Irregular Sleep-Wake Rhythm on cognitive function in older people.
Scientific reports, 2021Co-Authors: Masato Okuda, Seiko Miyata, Akiko Noda, Kunihiro Iwamoto, Norio Ozaki, Honoka Nakashima, Kozue Takeda, Fumihiko Yasuma, Akito ShimouchiAbstract:Sleep disturbances and cognitive decline are common in older adults. We aimed to investigate the effects of the total sleep time (TST) and Sleep-Wake Rhythm on executive function and working memory in older adults. In 63 older participants, we measured the TST, wake after sleep onset (WASO), and sleep timing (midpoint between bedtime and wake-up time) using actigraphy. Executive function was evaluated with the trail making test B (TMT-B) and Wisconsin card sorting test (WCST). The number of back task (N-back task) was used to measure working memory. Participants with a TST ≥ 8 h had a significantly lower percentage of correct answers (% correct) on the 1-back task than those with a TST
