SHIFT WORK DISORDER - myCME.com

More documents

Recommendations

Info

Armodafinil for Treatment of Excessive Sleepiness Associated With Shift Work Disorder: A Randomized Controlled Study●Featured●GenBank●Reference Sequences●Map Viewer●Genome Projects●Human Genome●Mouse Genome●Influenza Virus●Primer-BLAST●Short Read Archive●NCBI Information●About NCBI●Research at NCBI●NCBI Newsletter●NCBI FTP Site●Contact UsNIH DHHS USA.govCopyright | Disclaimer | Privacy | Accessibility | ContactNational Center for Biotechnology Information , U.S. National Library of Medicine8600 Rockville Pike, Bethesda MD, 20894 USAhttp://www.ncbi.nlm.nih.gov/pmc/articles/PMC2770907/ (22 of 22)2/7/2010 3:40:42 PM
REPORTSThe Epidemiology and Diagnosisof InsomniaKarl Doghramji, MDAbstractMany questions remain unanswered with regardto our understanding of insomnia. Although it is generallybelieved that 10% to 15% of the adult populationsuffers from chronic insomnia, and an additional25% to 35% have transient or occasional insomnia,prevalence estimates vary because of inconsistentdefinitions and diagnostic criteria. The elderly in particularare affected by insomnia, and it has beenshown that women are more likely to have sleep difficultiesthan men. Although insomnia can be a primarycondition, and can coexist with other disordersor be considered secondary to these disorders, themechanisms producing it are not clearly defined.Additionally, the relationship between insomnia andother disease states is not always clear because it isoften not possible to determine the cause-and-effectrelationship between disorders. Epidemiologic studiesshow that abnormal sleep patterns predict lowerlife expectancy, and that people with insomnia aremore likely to develop affective disorders, substanceabuse, and other adverse health outcomes. This articlewill provide an overview of insomnia, its prevalenceand epidemiology, and guidelines for clinicalassessment.(Am J Manag Care. 2006;12:S214-S220)Sleep accounts for one third of humanlife, yet scientific inquiry in this area islimited compared with other aspectsof neuroscience. 1 Additionally, studies suggestthat poor sleep contributes to ill health.Epidemiologic studies show that abnormalsleep patterns predict lower life expectancy, 2and that insomnia frequently co-occurs withaffective disorders, substance abuse, andother physical and psychological comorbidities.3,4 However, research into the relationshipsbetween these findings is sorelylacking.The definition of insomnia is a complaintof disturbed sleep, manifested as difficultiesin sleep initiation or sleep maintenance,and/or as early awakenings. Many sourcesalso add the presence of associated daytimeimpairments, such as fatigue, irritability,decreased memory and concentration, andpervasive malaise affecting many aspects ofdaytime functioning. 5 Although all definitionsof insomnia rely on its symptomaticpresentation, a standard diagnostic definitiondoes not exist. Three separate textspresent diagnostic criteria for insomnia: TheDiagnostic and Statistical Manual ofMental Disorders (DSM) 6 ; The InternationalClassification of Sleep Disorders 7 ; and TheICD-10 Classification of Mental and BehaviouralDisorders. 8 Some definitions arebased solely on reports of nocturnal sleepdisturbances, 9 whereas others include featuressuch as associated daytime impairment(eg, fatigue, irritability, or reducedmemory or concentration), 10 self-reportedsleep dissatisfaction, 11 or other criteria. 6,12-15Attempts have been made to subtypeinsomnia. One method is based on durationof symptoms, identifying insomnia as eitherchronic (long-term) or acute (transient). A2005 National Institutes of Health (NIH)State-of-the-Science statement pointed outthat time periods of various durations havebeen used to define chronic insomnia, rangingfrom 30 days to 6 months. 5 The transient/chronicdistinction can be clinicallyrelevant, inasmuch as transient insomniasoften result from specific environmental orsocial events, such as shift work, death of aloved one, air travel, and noise, and may bemore appropriately managed by addressingthese stressors and by managing the insom-Corresponding author: Karl Doghramji, MD, Director, Sleep DisordersCenter, Thomas Jefferson University, 1015 Walnut Street, Suite 319,Philadelphia, PA 19107. E-mail: karl.doghramji@jefferson.edu.Editorial assistance in the preparation of this manuscript was provided byGenevieve Belfiglio and Stephen Collins.S214 THE AMERICAN JOURNAL OF MANAGED CARE MAY 2006
Page 1 and 2:
Practice Management Tips ForSHIFT W
Page 3 and 4:
Patient QuestionnaireDo you often f
Page 5 and 6:
Sleep/Wake LogIn bedOut of bedLight
Page 7 and 8:
PHQ-9 QUICK DEPRESSION ASSESSMENTFo
Page 9 and 10:
Insomnia Severity IndexPlease answe
Page 11 and 12:
Take-Away PointsSHIFT WORK DISORDER
Page 13 and 14:
SHIFT WORKDISORDERBright Light Ther
Page 40 and 41:
PrimarycareScreeningfor depressioni
Page 42 and 43:
PrimarycareThescreening questionnai
Page 44 and 45:
Shift-work disorderContents and Fac
Page 46 and 47: Shift-work disorderThe diagnosis of
Page 48 and 49: Shift-work disorderas heightened le
Page 50 and 51: Shift-work disorderFigure 1 Risk ra
Page 52 and 53: Shift-work disorderare not function
Page 54 and 55: The characterization andpathology o
Page 56 and 57: Shift-work disorderFigure 2 Sleep/w
Page 58 and 59: Shift-work disorderFigure 3 Blood p
Page 60 and 61: Recognition of shift-workdisorder i
Page 62 and 63: Shift-work disorderThe timing of sh
Page 64 and 65: Shift-work disorderthe other potent
Page 66 and 67: Managing the patient withshift-work
Page 68 and 69: Shift-work disorderFigure 3 Optimal
Page 70 and 71: Shift-work disorderfor a motor vehi
Page 72 and 73: Shift-work disordermoderate caffein
Page 74 and 75: Supplement toAvailable at jfponline
Page 76 and 77: Armodafinil for Treatment of Excess
Page 98 and 99: The Epidemiology and Diagnosis of I
Page 120 and 121: CIRCADIAN RHYTHM SLEEP DISORDERSPra
Page 122 and 123: Table 2— AASM Levels of Recommend
Page 124 and 125: 3.2.1.1 Both the Morningness-Evenin
Page 126 and 127: Five studies used one of the newer
Page 128 and 129: as an indicator of phase in sighted
Page 130 and 131: 4.4 Advanced Sleep Phase DisorderBe
Page 132 and 133: 45. Walsh, JK, Randazzo, AC, Stone,
Page 134: 123. Van Someren, EJ, Kessler, A, M
Page 142 and 143: Table 1—Subject Demographicsn M:F
Page 144 and 145: Scale. 28 The simple reaction time
Page 146 and 147:
Median RT (msec)1600A14001200100080
Page 148 and 149:
10Mentally AExhaustedSharpScore8642
Page 150 and 151:
Current Treatment Options in Neurol
Page 152 and 153:
398 Sleep Disordersand sleep loss,
Page 154 and 155:
400 Sleep DisordersTable 1. Treatme
Page 156 and 157:
402 Sleep DisordersStandard dosageC
Page 158 and 159:
404 Sleep DisordersStandard procedu
Page 160 and 161:
406 Sleep DisordersCaffeineMelatoni
Page 162 and 163:
408 Sleep DisordersWake-promoting a
Page 164 and 165:
410 Sleep Disordersnight shift: ada
show all

SHIFT WORK DISORDER - myCME.com

You also want an ePaper? Increase the reach of your titles

Delete template?

Save as template?