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Circadian Rhythm Disturbances in the Blind

  • Sleep (M Thorpy and M Billiard, Section Editors)
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Abstract

Purpose of Review

Sleep timing, quantity, and quality are controlled by homeostatic and circadian systems. Circadian clock systems are present in all cells and organs and their timing is determined by a transcriptional-translational feedback loop of circadian genes. Individual cellular clocks are synchronized by the central body clock, situated in the suprachiasmatic nucleus, which communicates with them through humoral and neural signals including melatonin. The circadian system controls both the circadian period: (i.e., the length of the intrinsic clock), but also the circadian phase (i.e., the clock timing). An important determinant of the circadian system is light exposure. In most humans, the circadian period is slightly longer than 24 h and without regular resetting it tends to drift, leading to progressively later bedtimes and wake times and a tendency to cycle though periods of normal and abnormal sleep. Blind patients are thus at an increased risk of abnormal circadian function. The purpose of this article is to review recent research and clinical management of circadian rhythm disorders in blind patients.

Recent Findings

Blind patients can present delayed and advanced sleep phase disorders but the most common abnormality in totally blind patients without light perception is non-24-hour sleep-wake disorder (N24SWD). This is rare in the general population but may affect up to 50% of blind patients without light perception. The diagnosis of a circadian rhythm disorder in the blind is complex. New screening tools have been developed but actigraphy and repeated melatonin profiles over 24 h remain essential.

Summary

Circadian disorders in the blind are frequent, especially in the patients without light perception. They require accurate diagnosis in order to target treatment. Determining the precise nature of a sleep disorder in blind patients with a suspected circadian rhythm abnormality is complex and requires a detailed clinical history with sleep diaries and the use of actigraphy and melatonin profiles.

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Authors and Affiliations

  1. Sleep Unit, Physiology Department, AP-HP Hôpital Raymond Poincaré, EA 4047 Versailles-St Quentin en Yvelines University, 104 bvd Poincaré, 92380, Garches, France

    Sarah Hartley & Maria-Antonia Quera-Salva

  2. Sleep-Wake Disorders Center, Department of Neurology, Gui-de-Chauliac Hospital, National Reference Network for Narcolepsy, INSERM U1061, Montpellier, France

    Yves Dauvilliers

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  1. Sarah Hartley
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Correspondence to Sarah Hartley.

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Conflict of Interest

Sarah Hartley and Yves Dauvilliers have received a grant from Vanda (investigator for tasimelteon study in totally blind patients).

Maria-Antonia Quera-Salva has received a grant from Vanda (investigator for tasimelteon study in totally blind patients), grants from Les gueules cassées, Fondation Vinci pour une conduite responsable, and Bioprojet, and personal fees from Journal l’ encephale.

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Hartley, S., Dauvilliers, Y. & Quera-Salva, MA. Circadian Rhythm Disturbances in the Blind. Curr Neurol Neurosci Rep 18, 65 (2018). https://doi.org/10.1007/s11910-018-0876-9

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