TY - JOUR
T1 - A Protocol to Determine Circadian Phase by At-Home Salivary Dim Light Melatonin Onset Assessment
AU - International Association of Circadian Health Clinics
AU - Murray, Jade M.
AU - Stone, Julia E.
AU - Abbott, Sabra M.
AU - Bjorvatn, Bjorn
AU - Burgess, Helen J.
AU - Cajochen, Christian
AU - Dekker, Jip J.
AU - Duffy, Jeanne F.
AU - Epstein, Lawrence J.
AU - Garbazza, Corrado
AU - Harsh, John
AU - Klerman, Elizabeth B.
AU - Lane, Jacqueline M.
AU - Lockley, Steven W.
AU - Pavlova, Milena K.
AU - Quan, Stuart F.
AU - Reid, Kathryn J.
AU - Scheer, Frank A.J.L.
AU - Sletten, Tracey L.
AU - Wright, Kenneth P.
AU - Zee, Phyllis C.
AU - Phillips, Andrew J.K.
AU - Czeisler, Charles A.
AU - Rajaratnam, Shantha M.W.
N1 - Publisher Copyright:
© 2024 The Author(s). Journal of Pineal Research published by John Wiley & Sons Ltd.
PY - 2024/8
Y1 - 2024/8
N2 - Internal circadian phase assessment is increasingly acknowledged as a critical clinical tool for the diagnosis, monitoring, and treatment of circadian rhythm sleep−wake disorders and for investigating circadian timing in other medical disorders. The widespread use of in-laboratory circadian phase assessments in routine practice has been limited, most likely because circadian phase assessment is not required by formal diagnostic nosologies, and is not generally covered by insurance. At-home assessment of salivary dim light melatonin onset (DLMO, a validated circadian phase marker) is an increasingly accepted approach to assess circadian phase. This approach may help meet the increased demand for assessments and has the advantages of lower cost and greater patient convenience. We reviewed the literature describing at-home salivary DLMO assessment methods and identified factors deemed to be important to successful implementation. Here, we provide specific protocol recommendations for conducting at-home salivary DLMO assessments to facilitate a standardized approach for clinical and research purposes. Key factors include control of lighting, sampling rate, and timing, and measures of patient compliance. We include findings from implementation of an optimization algorithm to determine the most efficient number and timing of samples in patients with Delayed Sleep−Wake Phase Disorder. We also provide recommendations for assay methods and interpretation. Providing definitive criteria for each factor, along with detailed instructions for protocol implementation, will enable more widespread adoption of at-home circadian phase assessments as a standardized clinical diagnostic, monitoring, and treatment tool.
AB - Internal circadian phase assessment is increasingly acknowledged as a critical clinical tool for the diagnosis, monitoring, and treatment of circadian rhythm sleep−wake disorders and for investigating circadian timing in other medical disorders. The widespread use of in-laboratory circadian phase assessments in routine practice has been limited, most likely because circadian phase assessment is not required by formal diagnostic nosologies, and is not generally covered by insurance. At-home assessment of salivary dim light melatonin onset (DLMO, a validated circadian phase marker) is an increasingly accepted approach to assess circadian phase. This approach may help meet the increased demand for assessments and has the advantages of lower cost and greater patient convenience. We reviewed the literature describing at-home salivary DLMO assessment methods and identified factors deemed to be important to successful implementation. Here, we provide specific protocol recommendations for conducting at-home salivary DLMO assessments to facilitate a standardized approach for clinical and research purposes. Key factors include control of lighting, sampling rate, and timing, and measures of patient compliance. We include findings from implementation of an optimization algorithm to determine the most efficient number and timing of samples in patients with Delayed Sleep−Wake Phase Disorder. We also provide recommendations for assay methods and interpretation. Providing definitive criteria for each factor, along with detailed instructions for protocol implementation, will enable more widespread adoption of at-home circadian phase assessments as a standardized clinical diagnostic, monitoring, and treatment tool.
KW - DLMO
KW - at-home DLMO
KW - circadian assessment
KW - circadian rhythm sleep−wake disorders
UR - http://www.scopus.com/inward/record.url?scp=85201528846&partnerID=8YFLogxK
U2 - 10.1111/jpi.12994
DO - 10.1111/jpi.12994
M3 - Review article
AN - SCOPUS:85201528846
SN - 0742-3098
VL - 76
JO - Journal of Pineal Research
JF - Journal of Pineal Research
IS - 5
M1 - e12994
ER -