Clinical Case Book: Recognizing and Managing Shift Work Disorder

Program Description:

This Clinical Case Book on shift work disorder features 3 animated case studies with brief videos of expert faculty commentary, case study vignettes, and assessment questions. It includes diagnostic approaches and management strategies that optimize sleep, alertness, and circadian rhythm alignment.

Click here to see related programs in this series.

Click here for the Sleep/Wake Disorders Video Q&A.

NEEDS ASSESSMENT
Shift Work Disorder (SWD) is among the most commonly undiagnosed and undertreated sleep/wake disorders.^1-3 About 22 million Americans perform some type of nonstandard shift work⁴ and are at risk for SWD⁵—the presence of excessive sleepiness and/or insomnia for at least 1 month, in association with a shift work schedule, provided other sleep/wake disorders can be excluded.^3,6

SWD can increase the risk of gastrointestinal disorders, cardiovascular disease, cancer, diabetes, other metabolic disturbances, irritability, or depressed mood.⁷ Persons with SWD may also have higher rates of ulcers, accidents related to drowsiness, absenteeism, missed family and social activities, and poorer job performance.^8,9 Attempts to improve sleep may lead to drug and alcohol dependency.

SWD may develop when the physical environment requires a sleep schedule that is different from the individual’s internal circadian rhythms. SWD diagnosis is based on the patient history and may include use of a sleep diary/log.^3,6 The differential diagnosis should exclude other potentially causative conditions, such as mood disorders, especially depression, and other sleep/wake disorders.

Managing SWD symptoms includes using bright lights during awake hours to help combat drowsiness, medication to treat excessive sleepiness or insomnia, and proper sleep/wake hygiene measures. Patient education about quality-of-life improvement with SWD management can help raise patient awareness and facilitate treatment success.

References
1. Colten HR, Altevogt BM, eds. Committee on Sleep Medicine and Research. Sleep Disorders and Sleep Deprivation: An Unmet Public Health Problem. Washington, DC: National Academies Press; 2006. http://books.nap.edu/openbook.php?record_id=11617&page=20#p2000f7ef896002 0002. Accessed Sept. 16, 2009.
2. National Sleep Foundation. 2005 Sleep in America Poll. Summary of findings. March 2005. http://www.sleepfoundation.org/_content/hottopics/2005_summary_of_findings.pdf. Accessed Aug. 7, 2009.
3. American Academy of Sleep Medicine. The International Classification of Sleep Disorders: Diagnostic & Coding Manual, revised. Westchester, IL: American Academy of Sleep Medicine; 2005.
4. McMenamin TM. A time to work: recent trends in shift work and flexible schedules. Monthly Labor Review. Dec 2007:3-15. www.bls.gov/opub/mlr/2007/12/art1full.pdf. Accessed April 2, 2009.
5. US Department of Labor, Bureau of Labor Statistics. Workers on flexible and shift schedules. Bureau of Labor Statistics Web site. http://www.bls.gov/news.release/pdf/fl ex.pdf. Accessed May 11, 2009.
6. Morgenthaler TI, Lee-Chiong T, Alessi C, et al. Practice parameters for the clinical evaluation and treatment of circadian rhythm sleep disorders. An American Academy of Sleep Medicine Report. Sleep. 2007;30:1445-1459.
7. Knutsson A. Health disorders of shift workers. Occup Med (Lond). 2003;53:103-108.
8. American Academy of Sleep Medicine. American Academy of Sleep Medicine Diagnostic and Coding Manual. 2001. http://www.esst.org/adds/ICSD.pdf. Accessed July 28, 2010.
9. Drake CL, Roehrs T, Richardson G, et al. Shift work sleep disorder: prevalence and consequences beyond that of symptomatic day workers. Sleep. 2004;27:1453-1462.

Activity Objectives:

Upon completion of this educational activity, participants should be better able to:

• Explain the role of circadian rhythms in sleep/wake function


• Describe the pathophysiology and morbidity of shift work disorder (SWD)


• Improve the recognition and diagnosis of SWD, using screening questions, diagnostic tools, and criteria to aid differential diagnosis


• Describe strategies for the management of patients with SWD that optimize sleep, alertness, and circadian rhythm alignment


• Implement techniques to provide patient education, and clarify roles and responsibilities in managing SWD

Faculty:

Introductions by:
Thomas Roth, PhD
Clinical Professor of Psychiatry
University of Michigan School of Medicine
Director, Sleep Disorders and Research Center
Henry Ford Health System
Detroit, Michigan

Cases presented by:
Teresa D. Valerio, MSA, MSN, APN, FNP-BC
Advanced Practice Nurse, Certified Nurse Practitioner
Illinois Neurological Institute Sleep Center at OSF Saint Francis Medical Center
Peoria, Illinois

Marc B. Landau, PA-C
Gaylord Sleep Medicine
North Haven, Connecticut

Paul P. Doghramji, MD, FAAFP
Family Physician
Collegeville Family Practice
Collegeville, Pennsylvania

Program Consultant
Richard K. Bogan, MD, FCCP, FAASM
Chairman, Chief Medical Officer
SleepMed, Inc.
Associate Clinical Professor of Medicine
University of South Carolina
Columbia, South Carolina

Program Reviewer
Jo Anne Turner, APRN, BC
Adult Nurse Practitioner
SleepMed, Inc.
Columbia, South Carolina

CME Course Director
David W. Appel, MD
Associate Professor of Medicine
Albert Einstein College of Medicine
Montefiore Medical Center
Bronx, New York

Case Writer
Roxanne Nelson, RN
Bellingham, Washington

Video Script Writer
Margot Embree Fisher
Teaneck, New Jersey

Disclosures:

Accreditor Disclosure of Conflicts of Interest Policy:
The “Conflict of Interest Disclosure Policy” of Albert Einstein College of Medicine requires that faculty participating in any CME activity disclose to the audience any relationship(s) with a pharmaceutical or equipment company. Any presenter whose disclosed relationships prove to create a conflict of interest with regard to their contribution to the activity, or who refuses to provide all their conflict-of-interest information, will not be permitted to present.

Thomas Roth, PhD, receives grant/research support from Merck & Co., Inc., and serves as a consultant for Abbott Laboratories, Cephalon, Inc., Eisai Inc., Intec, Merck & Co., Inc., Ocera Therapeutics, Inc., Otsuka Pharmaceutical Co., Ltd., Pfizer Inc., sanofi-aventis, Shire, Somaxon Pharmaceuticals, Somnus Therapeutics, Takeda Pharmaceuticals North America, and TransOral Pharmaceuticals, Inc. Dr. Roth is on the speakers’ bureau for Cephalon, Inc.

Paul P. Doghramji, MD, FAAFP, serves as a consultant for Pfizer, Inc. Dr. Doghramji is on the speakers’ bureaus for Cephalon, Inc., AstraZeneca, Pfizer Inc., and Takeda Pharmaceuticals North America.

Teresa D. Valerio, MSA, MSN, APN, FNP-BC, has nothing to disclose.

Marc B. Landau, PA-C, has nothing to disclose.

Richard K. Bogan, MD, FCCP, FAASM, receives grant/research support for Actellion, Alza, Arena, Boehringer Ingelheim, Cephalon, Inc., GlaxoSmithKline, Jazz, Vanda, Neurogen, Evotec, Merck & Co., Inc., Lilly, Pfizer Inc., Novartis, sanofi aventis, Schwarz, Sepracor, and Xenoport. Dr. Bogan is a consultant for GlaxoSmithKline, Jazz, ApniCure, Addrenex, UCB, and is on the speakers’ bureaus for sanofi-aventis, Sepracor, Cephalon Inc., and Jazz. Dr. Bogan is also a shareholder and employee of SleepMed Inc.

David W. Appel, MD, has nothing to disclose.

PUBLISHING STAFF DISCLOSURES
Mary Jo Krey, Ana Maria Albino, Lynne Callea, and Jeff Gherman, Haymarket Medical Education, have nothing to disclose with regard to commercial support.

Disclosure of Unlabeled Use
This educational activity may contain discussion of published and/or investigational uses of agents that are not indicated by the FDA. Cephalon, Inc., Albert Einstein College of Medicine of Yeshiva University, and HME do not recommend the use of any agent outside of the labeled indications.

The opinions expressed in the educational activity are those of the faculty and do not necessarily represent the views of Cephalon, Inc., Albert Einstein College of Medicine of Yeshiva University, and HME. Please refer to the official prescribing information for each product for discussion of approved indications, contraindications, and warnings.

Disclaimer
Participants have an implied responsibility to use the newly acquired information to enhance patient outcomes and their own professional development. The information presented in this activity is not meant to serve as a guideline for patient management. Any procedures, medications, or other courses of diagnosis or treatment discussed or suggested in this activity should not be used by clinicians without evaluation of their patient’s conditions and possible contraindications on dangers in use, review of any applicable manufacturer’s product information, and comparison with recommendations of other authorities.

Sponsored by the Albert Einstein College of Medicine of Yeshiva University





Supported by an educational grant from Cephalon





Produced by Haymarket Medical Education





If you have any questions relating to the accreditation of this activity, please contact Albert Einstein College of Medicine at 718-920-6674, Ext. 231.

Instructions:

To obtain credit, a score of 70% or better is required. This CE is offered at no cost to participants. Please proceed with the activity until you have successfully completed this program, answered all test questions, completed the posttest survey, and have received your digital copy of your credit certificate. Your online certificate will be saved on myCME.com within your Profile/Exam History, which you can then access at any time.

SYSTEM REQUIREMENTS:

WINDOWS PC SYSTEM REQUIREMENTS:
266-MHz Pentium II; Windows 98 or higher; 64 MB RAM; 800 x 600 screen resolution set for “High Color (16-Bit)”; Macromedia Flash Player 6 or higher.

MACINTOSH^® SYSTEM REQUIREMENTS:
Power Mac g3 at 300 MHz; System 8.5 or higher (excluding Mac OSX); 96 MB RAM; 20 MB minimum hard disk space available; 800 x 600 screen resolution set to “Thousands of Colors”; Macromedia Flash Player 6 or higher.