Sleep and circadian instability in delayed sleep-wake phase disorder

Apr 30, 2020Journal of clinical sleep medicine : JCSM : official publication of the American Academy of Sleep Medicine

Irregular sleep and body clock patterns in delayed sleep-wake phase disorder

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Abstract

Patients with delayed sleep-wake phase disorder (DSWPD) exhibited greater DLMO instability compared to healthy controls.

Patients with DSWPD had later sleep rhythm timing relative to clock time.
They also had earlier sleep rhythm timing relative to dim-light melatonin onset (DLMO).
The sleep regularity index was lower in patients with DSWPD compared to healthy controls.
Greater DLMO instability was associated with increased light sensitivity across all participants.
The findings suggest that less stable circadian timing and irregular sleep may contribute to the etiology of DSWPD.

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STUDY OBJECTIVES: In patients with delayed sleep-wake phase disorder (DSWPD), the circadian clock may be more easily affected by light at night. This creates a potential vulnerability, whereby individuals with irregular schedules may have less stable circadian rhythms. We investigated the stability of circadian timing and regularity of sleep in patients with DSWPD and healthy controls.

METHODS: Participants completed 2 dim-light melatonin onset (DLMO) assessments approximately 2 weeks apart while keeping their habitual sleep/wake schedule. After the second DLMO assessment, light sensitivity was assessed using the phase-resetting response to a 6.5-hour 150-lux stimulus. The change in DLMO timing (DLMO instability) was assessed and related to light sensitivity and the sleep regularity index.

RESULTS: Relative to healthy controls, patients with DSWPD had later sleep rhythm timing relative to clock time, earlier sleep rhythm timing relative to DLMO, lower sleep regularity index, and greater DLMO instability. Greater DLMO instability was associated with increased light sensitivity across all participants, but not within groups.

CONCLUSIONS: We find that circadian timing is less stable and sleep is less regular in patients with DSWPD, which could contribute to etiology of the disorder. Measures of light sensitivity may be informative in generating DSWPD treatment plans.

Sleep and circadian instability in delayed sleep-wake phase disorder

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