Circadian Phase and Phase Angle Disorders in Primary Insomnia.

Circadian Phase and Phase Angle Disorders in Primary Insomnia.

Sleep. 2017 Oct 03;:

Authors: Flynn-Evans EE, Shekleton JA, Miller B, Epstein LJ, Kirsch D, Brogna LA, Burke LM, Bremer E, Murray JM, Gehrman P, Rajaratnam SMW, Lockley SW

Abstract
Objectives: We aimed to identify the prevalence of circadian phase and phase angle abnormalities in patients with insomnia.
Methods: We conducted a cross-sectional, multicenter study at three sleep laboratories in the United States and Australia. Patients with insomnia and healthy control participants completed a sleep log for seven days. Circadian phase was assessed from salivary Dim Light Melatonin Onset (DLMO) time during a 12-hour laboratory visit.
Results: Seventy-nine patients meeting the Research Diagnostic Criteria for Primary, Psychophysiological, Paradoxical, and/or Idiopathic Childhood Insomnia (46F, 35.5 ± 12.3 years (M SD)) and 21 controls (14F, 34.4 11.8 years). As compared to controls, patients with insomnia tried to initiate sleep on average at the same clock time (24:17 ± 1:17 h versus 24:13 ± 1:30 h, respectively; p=0.84), but had a later average DLMO times (20:56 ± 1:55 h, 18:17 - 01:21 versus 22:02 ± 2:02 h, 17:11 - 04:52, respectively; p=0.04). Consequently, patients with insomnia slept at an earlier circadian phase than controls (phase angle, bedtime-DLMO 2:13 h (± 1:43) versus 3:10 h (± 1:08), respectively; p=0.008), of whom 10% tried to sleep at or before DLMO (compared to 0 controls), and 22% tried to sleep before or within 1 hour after DLMO (compared to 6% of controls).
Conclusions: A substantial proportion (10-22%) of patients with insomnia initiate sleep at too early a circadian phase, implicating a circadian etiology for their insomnia. Outpatient circadian phase assessments should be considered to improve differential diagnoses in insomnia and to inform the development of appropriately timed circadian-based treatments.

PMID: 29029340 [PubMed - as supplied by publisher]

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