Appropriate therapeutic selection for patients with shift work disorder

摘要

Background: Shift work disorder (SWD) is characterized by symptoms of excessive sleepiness during work hours or insomnia during allotted daytime sleep hours, as well as by a disruption of the circadian rhythm. Many shift workers with SWD experience significant social, behavioral, and health problems as a result of this disorder. SWD is associated with a higher risk of occupational and motor vehicle accidents, and thus poses a public health risk. Methods: Currently there are both pharmacologic and non-pharmacologic treatments for this disorder that can be used to normalize the disruption of the circadian cycle or alleviate the symptoms of excessive sleepiness or insomnia. The American Academy of Sleep Medicine and the British Society of Psychopharmacology have developed guidelines for the diagnosis and treatment of patients with SWD. Results: Recommended therapies for altering the circadian cycle include chronobiotics such as melatonin or melatonin agonists and non-pharmacologic interventions such as timed light exposure. Other therapies, such as sedative hypnotics, target daytime insomnia, while pharmacologic agents such as modafinil, armodafinil, and caffeine and non-pharmacologic approaches such as napping promote nighttime alertness. Conclusions: While no therapies (pharmacological or nonpharmacological) can restore altered circadian cycles to baseline levels, proper identification and management of SWD will likely reduce its co-morbidities and improve the quality of life for individuals with this disorder.