Details

Autor(en) / Beteiligte

• Chen, Xuesong
• Alapat, Philip

Titel

1147 Non-24-hour Sleep-Wake Rhythm Disorder in a Sighted Patient

Ist Teil von

• Sleep (New York, N.Y.), 2018-04, Vol.41 (suppl_1), p.A424-A424

Ort / Verlag

US: Oxford University Press

Erscheinungsjahr

2018

Quelle

Oxford Journals 2020 Medicine

Beschreibungen/Notizen

• Abstract Introduction Non-24-hour sleep-wake rhythm disorder is characterized by inability to maintain stable entrainment to a 24h sleep-wake pattern. Non-24-hour sleep-wake rhythm disorder occurs more in blind individuals and is uncommon in sighted individuals. Report of Case Here we report a 57-y-old male with obstructive sleep apnea adequately controlled with CPAP therapy, who presented with a chief complaint of “sleep cycling” over the past year including intermittent insomnia. His usual bedtime was 21:00, but he noticed that his bedtime kept getting delayed every day to the extent that he had to “reset” his bedtime every two weeks. As his adherence to CPAP therapy was very good in that he used CPAP therapy whenever he slept, a sample of his sleep pattern was able to be obtained from his PAP download data (Figure 1). He reported that he was unemployed and rarely left the room he rented in a house, and that he kept his window blinds closed at all times. He denied signs/symptoms suggestive of untreated or under-treated obstructive sleep apnea, restless leg syndrome, depression, or anxiety. His other medical history and medications are noncontributory. His history and documented progressively delayed bedtime out of phase with 24-hour light-dark cycle as demonstrated on his PAP download pointed to a diagnosis of non-24-hour sleep-wake rhythm disorder. Conclusion Our patient’s non-24-hour sleep-wake rhythm disorder was most likely associated with his reclusive lifestyle with resultant lack of exposure to natural light and other zeitgebers. The regression line derived from his PAP download showed a daily bedtime delay of approximately 40 minutes (tau = 24.7 hr). To our knowledge, this is the first case of non-24-hour sleep-wake rhythm disorder that was diagnosed through PAP download. Given the prevalence of obstructive sleep apnea, PAP download can be utilized to facilitate the diagnose of circadian rhythm disorders in patients with good PAP adherence.