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Non-24-Hour Sleep-Wake Disorder Revisited - A Case Study
Corrado Garbazza1, Vivien Bromundt2, Anne Eckert3
1Centre for Chronobiology, Psychiatric Hospital of the University of Basel, Basel, Switzerland; Transfaculty Research Platform Molecular and Cognitive Neurosciences, University of Basel, Basel, Switzerland.
Frontiers in Neurology
|March 15, 2016
Summary
This case study explores non-24-hour sleep-wake disorders (N24HSWD) in a sighted patient. Chemotherapy may have disrupted the circadian clock, causing a free-running rhythm resistant to standard treatments.
Area of Science:
- Chronobiology
- Sleep Medicine
- Neuroscience
Background:
- The human sleep-wake cycle is regulated by homeostatic (process S) and circadian (process C) processes.
- Circadian rhythms are generated by the suprachiasmatic nucleus and synchronized by external cues like the light-dark cycle.
- Disruptions in circadian rhythm can lead to sleep disorders, including non-24-hour sleep-wake disorders (N24HSWD).
Observation:
- A 40-year-old sighted male developed N24HSWD after chemotherapy for Hodgkin's lymphoma.
- Clinical assessment revealed a free-running circadian rhythm with a period (tau) of 25.27 hours.
- Standard treatments including bright light therapy and melatonin failed to entrain the circadian rhythm.
Findings:
- The patient exhibited a significantly prolonged circadian period, indicating a free-running rhythm.
- The chemotherapy regimen (ABVD and AVD) was temporally linked to the onset of N24HSWD.
- The failure of conventional therapies suggests a potential underlying molecular clock disruption.
Implications:
- Chemotherapy may induce molecular clock mutations, leading to circadian rhythm disturbances like N24HSWD in sighted individuals.
- This case highlights the potential for iatrogenic circadian rhythm disorders.
- Further research is needed to understand the mechanisms and develop effective treatments for chemotherapy-induced N24HSWD.
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