Management of shift work disorder: an American Academy of Sleep Medicine systematic review, meta-analysis, and GRADE assessment

The purpose of this systematic review is to provide supporting evidence for a clinical practice guideline on the treatment of adults with shift work disorder (SWD). The American Academy of Sleep Medicine commissioned a task force of six experts in sleep and circadian medicine. A systematic review was conducted to identify randomized controlled trials, observational studies, and treatment trials in which treatments for the symptoms of excessive sleepiness and/or sleep disturbance/insomnia in adults with SWD, and for circadian adaptation to shift work schedules was tested. Evidence from controlled laboratory trials of simulated shift work and of field-based trials of shift workers with and without a diagnosis of SWD was included. Statistical analyses were performed to determine the significance of critical and important outcomes and clinically meaningful thresholds were set to determine the clinical relevance of treatments on the outcomes examined, where possible. Finally, the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) process was used to assess the evidence for making recommendations. The literature search resulted in 3,045 articles; 118 studies provided data suitable for statistical analyses. The task force provided a detailed summary of the evidence along with the quality of evidence, the balance of benefits and harms, patient values and preferences, and resource use considerations.