SHIFT WORK DISORDER - myCME.com

408 Sleep DisordersWake-promoting agentspersistent sleep (-10.6 min, P=0.03) as compared with placebo. Whenfurther examining two subsets of the study (those exposed to naturallight and those kept in dim light conditions), the group exposed tonatural bright light and taking a placebo experienced sleep-promotingeffects similar to the effects on those in dim light who received 1 mg oframelteon. Therefore, ramelteon could be a treatment option duringtravel when bright light is less accessible (eg, during the winter). Therewere no significant differences between the ramelteon group the placebogroup in sleepiness scales during waking hours. At the 4-mg dose,significant improvements in subjective daytime function, alertness,concentration, sleep quality, and ease of awakening were seen. Adverseeffects were similar across all groups [65•, Class I].Tasimelteon is another MT 1 and MT 2 receptor agonist. In a phase 3,double-blind, randomized placebo-controlled trial, 411 individuals underwenta 5-hour advance of sleep-wake times and received tasimelteonat the new bedtime. Compared with placebo, all doses of tasimelteonwere followed by decreased latency to persistent sleep onset, decreasedwaking after sleep onset, increased total sleep time, and increased sleepefficiency. Results of neurocognitive testing the day after treatment wereno different with tasimelteon or placebo [66, Class I].Agomelatine (also an MT 1 and MT 2 receptor agonist, as well as aserotonin agonist) has been shown in a double-blind, placebo-controlledtrial to significantly phase-advance body temperature profiles [67].The clock-advancing properties of melatonin agonists may be effective intreating shift work disorder resulting from early morning shifts as well as jetlag resulting from eastward travel.Although approved for shift work disorder, armodafinil does not currentlyhave an indication in jet lag.In a recent double-blind, randomized, placebo-controlled study todetermine the efficacy of armodafinil in jet lag, 427 individuals traveledeastward over six time zones and were given armodafinil (50 mg or 150 mg)or placebo daily at 7 AM local time after arrival. Those receiving 150 mg ofarmodafinil had significant improvements in objective measures of sleepiness(mean sleep latency on the Multiple Sleep Latency Test of 11.7 min vs4.8 min with placebo, PG0.001) and less severe symptoms of jet lag [68•,Class I].Armodafinil may be an effective agent for combating daytime sleepinessassociated with jet lag.DisclosureDr. Zee has received consulting fees from Takeda, Cephalon, Philips, Sanofi-aventis, and Merck; honorariafrom Sanofi-aventis; and a sleep fellowship education grant from Takeda. She also has been paid todevelop educational materials for Cephalon. No other potential conflicts of interest relevant to this article werereported.