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May 31, 2022; 98 (22) Resident & Fellow Section

Teaching NeuroImage: Non–24-Hour Sleep-Wake Rhythm Disorder

Alan R. Tesson, Mir Mustafa Ali, View ORCID ProfileAndrew R. Spector
First published March 29, 2022, DOI: https://doi.org/10.1212/WNL.0000000000200570
Alan R. Tesson
From the Department of Neurology (A.R.T., M.M.A., A.R.S.), Duke University, Durham, NC.
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Mir Mustafa Ali
From the Department of Neurology (A.R.T., M.M.A., A.R.S.), Duke University, Durham, NC.
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Andrew R. Spector
From the Department of Neurology (A.R.T., M.M.A., A.R.S.), Duke University, Durham, NC.
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  • ORCID record for Andrew R. Spector
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Teaching NeuroImage: Non–24-Hour Sleep-Wake Rhythm Disorder
Alan R. Tesson, Mir Mustafa Ali, Andrew R. Spector
Neurology May 2022, 98 (22) 945-946; DOI: 10.1212/WNL.0000000000200570

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A 77-year-old woman with obstructive sleep apnea reported a lifelong difficulty with periods of severe nocturnal insomnia and daytime sleepiness. Wrist actigraphy, the diagnostic method of choice for circadian rhythm disorders, was not covered by insurance. A review of her CPAP data (Figure) demonstrated progressively later bedtimes with a period of greater than 24 hours, revealing the diagnosis of non–24-hour sleep-wake rhythm disorder. While common in unsighted individuals, non–24-hour sleep-wake rhythm disorder can occur in sighted people,1,2 as was the case here. For patients on PAP therapy, adherence data can provide evidence of circadian rhythm disorders.

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Figure CPAP Adherence Report Demonstrating a Sleep Period That Begins Later Each Day

Each green bar represents 1 day of CPAP use with the top representing CPAP initiation, approximating sleep onset, and the bottom representing CPAP discontinuation, approximating end of sleep. The image produces a unique diagonal band appearance.

Study Funding

The authors report no targeted funding.

Disclosure

The authors report no disclosures relevant to the manuscript. Go to Neurology.org/N for full disclosures.

Acknowledgment

The authors thank Onyinye Iweala, MD, PhD for reviewing the manuscript.

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Table

Footnotes

  • Go to Neurology.org/N for full disclosures.

  • ↵* These authors contributed equally to this work.

  • Submitted and externally peer reviewed. The handling editor was Roy Strowd III, MD, Med, MS.

  • Teaching slides links.lww.com/WNL/B906.

  • Received November 29, 2021.
  • Accepted in final form March 4, 2022.
  • © 2022 American Academy of Neurology

References

  1. 1.↵
    1. Malkani RG,
    2. Abbott SM,
    3. Reid KJ,
    4. Zee PC
    . Diagnostic and treatment challenges of sighted non–24-hour sleep-wake disorder. J Clin Sleep Med. 2018;14(04):603-613.
    OpenUrl
  2. 2.↵
    1. Hayakawa T,
    2. Uchiyama M,
    3. Kamei Y, et al.
    Clinical analyses of sighted patients with non-24-hour sleep-wake syndrome: a study of 57 consecutively diagnosed cases. Sleep. 2005;28(8):945-952.
    OpenUrlPubMed

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