Non-24–Hour Sleep-Wake Disorder: A Case-Based Discussion on Diagnosis and Treatment

Educational Objectives
Upon completion of this activity, participants will be better prepared to:

1. Diagnose non-24–hour sleep-wake disorder based on presenting symptoms, a comprehensive sleep history, and published diagnostic criteria

2. Tailor therapeutic regimens for patients with non-24–hour sleep-wake disorder, including appropriate combinations of nonpharmacologic and pharmacologic modalities

3. Educate patients with non-24–hour sleep-wake disorder on the deleterious effects of disrupted circadian rhythms, behavioral management strategies, and pharmacologic treatment options

Target Audience
The educational design of this activity addresses the needs of primary care providers (PCPs), sleep specialists, and other clinicians involved in the identification and ongoing treatment of patients with non-24–hour sleep-wake disorder (non-24 disorder).

Statement of Need/Program Overview
Non-24 disorder is characterized by complaints of insomnia and/or excessive daytime sleepiness that result from a progressive desynchronization of the earth’s usual 24-hour light/dark cycle and the individual’s endogenous circadian rhythms.1,2 As many as half of totally blind patients suffer from non-24 disorder, and the incidence of non-24 disorder also appears to be more common than previously appreciated in sighted individuals in their teens and 20s.3,4 Non-24 disorder is underdiagnosed, in part because patients do not proactively discuss sleep-related issues with their healthcare providers, and time-limited clinicians often do not regularly inquire about insomnia or excessive sleepiness.5,6 Moreover, until recently, treatment recommendations were largely based on case series and clinical experience rather than well-designed clinical trials.6,7 This case-based POC101 program will educate clinician-learners regarding the pathophysiologic basis of non-24 disorder, current diagnostic criteria, behavioral approaches to improving sleep hygiene and daily scheduling, and evidence-based pharmacologic interventions.

Physician Accreditation Statement
This activity has been planned and implemented in accordance with the accreditation requirements and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint providership of Global Education Group (Global) and Integritas Communications (Integritas). Global is accredited by the ACCME to provide continuing medical education for physicians.

Physician Credit Designation
Global designates this enduring material for a maximum of 0.5 AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Global Contact Information
For information about the accreditation of this program, please contact Global at 303-395-1782 or inquire@globaleducationgroup.com.

Instructions to Receive Credit
In order to receive credit for this activity, the participant must score 70% or better on the posttest and complete the program evaluation.

System Requirements
PC
Microsoft Windows 2000 SE or above.
Flash Player Plugin (v7.0.1.9 or greater)
Internet Explorer (v5.5 or greater), or Firefox
Adobe Acrobat Reader

MAC
MAC OS 10.2.8
Flash Player Plugin (v7.0.1.9 or greater)
Safari
Adobe Acrobat Reader
Internet Explorer is not supported on the Macintosh.

Fee Information & Refund/Cancellation Policy
There is no fee for this educational activity.

Disclosure of Conflicts of Interest
Global requires instructors, planners, managers, and other individuals and their spouse/life partner who are in a position to control the content of this activity to disclose any real or apparent conflict of interest they may have as related to the content of this activity. All identified conflicts of interest are thoroughly vetted by Global for fair balance, scientific objectivity of studies mentioned in the materials or used as the basis for content, and appropriateness of patient care recommendations.

The faculty reported the following financial relationships or relationships to products or devices they or their spouse/life partner have with commercial interests related to the content of this continuing medical education (CME) activity:

Karl Doghramji, MD Nothing to disclose

Paul P. Doghramji, MD, FAAFP Consultant (AstraZeneca, Merck & Co., Inc., Teva Pharmaceutical Industries Ltd.);Speakers Bureau (Merck & Co., Inc., Takeda Pharmaceuticals U.S.A., Inc., Teva Pharmaceutical Industries Ltd.)

The planners and managers reported the following financial relationships or relationships to products or devices they or their spouses/life partners have with commercial interests related to the content of this CME activity:

Lindsay Borvansky Nothing to disclose
Andrea Funk Nothing to disclose
Laura Gilsdorf Nothing to disclose
Jim Kappler, PhD Nothing to disclose

Disclosure of Unlabeled Use
This educational activity may contain discussion of published and/or investigational uses of agents that are not indicated by the FDA. Global Education Group (Global) and Integritas Communications do not recommend the use of any agent outside of the labeled indications.

The opinions expressed in the educational activity are those of the faculty and do not necessarily represent the views of any organization associated with this activity. Please refer to the official prescribing information for each product for discussion of approved indications, contraindications, and warnings.

Disclaimer
Participants have an implied responsibility to use the newly acquired information to enhance patient outcomes and their own professional development. The information presented in this activity is not meant to serve as a guideline for patient management. Any procedures, medications, or other courses of diagnosis or treatment discussed in this activity should not be used by clinicians without evaluation of patient conditions and possible contraindications on dangers in use, review of any applicable manufacturer’s product information, and comparison with recommendations of other authorities.