Circadian Rhythm Sleep-Wake Disorders

Phyllis C. Zee, MD, PhD; Sabra M. Abbott, MD, PhD Sleep Neurology p. 988-1002 August 2020, Vol.26, No.4 doi: 10.1212/CON.0000000000000884
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PURPOSE OF REVIEW This article provides an overview of circadian physiology and discusses common presentations and treatment strategies for the circadian rhythm sleep-wake disorders.

RECENT FINDINGS Circadian rhythms are present throughout the body, and appreciation for the role that circadian dysregulation plays in overall health is increasing, with mounting associations between circadian disruption and cardiometabolic disease risk.

SUMMARY It is important to recognize the ubiquitous role that circadian rhythms play throughout the brain and body. An understanding of circadian neurophysiology will provide insight into the means by which patients with a variety of neuropathologies at the level of the retina, optic nerve, or hypothalamus may also be at risk for circadian dysfunction.

Address correspondence to Dr Sabra M. Abbott, 710 N Lake Shore Dr, Abbott Hall 524, Chicago, IL 60611,

RELATIONSHIP DISCLOSURE: Dr Zee has received personal compensation for serving on scientific advisory boards for Eisai Co, Ltd, Jazz Pharmaceuticals, Inc, and Koninklijke Philips NV; on the editorial board for Sleep Medicine; for providing live and web-based CME lectures for Accredit Education, LLC, Impact Education, LLC, and WebMD LLC; for providing research and educational programs for Eisai Co, Ltd, Jazz Pharmaceuticals, Inc, Koninklijke Philips NV, Merck & Co, Inc, Pear Therapeutics, Inc, Sanofi-Adventis US LLC, and Takeda Pharmaceutical Company Limited; and research/grant support from Apnimed, Harmony Biosciences, LLC, Jazz Pharmaceuticals, Inc, Koninklijke Philips NV, and the National Institutes of Health (R01 HL140580-03, P01 AG011412-20, UG3HL140144-02, R01 AG059291-01, R01HL141881-02, R01HL134015-04, R21DK 118503-02, and R01HD097786). Dr Zee has received publishing royalties from Wolters Kluwer and has held stock in Teva Pharmaceutical Industries Ltd. Dr Abbott has received personal compensation for serving as a member of the American Board of Internal Medicine’s Sleep Medicine Exam Writing Committee, research/grant support from the American Sleep Medicine Foundation (155-JF-16), and publishing royalties from UpToDate, Inc.

UNLABELED USE OF PRODUCTS/INVESTIGATIONAL USE DISCLOSURE: Drs Zee and Abbott discuss the unlabeled/investigational use of melatonin for the treatment of circadian rhythm sleep-wake disorders.

© 2020 American Academy of Neurology.