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Laboratory evaluation typically includes serum vitamin B12 levels, with values below 200 pg/mL generally indicating deficiency and levels between 200-300 pg/mL considered borderline, though laboratory reference ranges may vary

Comprehensive reviews of the existing evidence for evaluation and treatment of these disorders and practice parameters for evaluation and treatment of CRSD were published by the American Academy of Sleep Medicine (AASM) in 2007.29 31 In evaluating patients for suspected CRSD, the physician utilizes history, a sleep log for at least 7 days, and often actigraphy (Box 266)

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2 Types and sources of environmental endocrine disruptors Environmental endocrine disruptors represent a heterogeneous collection of chemical substances that fundamentally alter hormone signaling pathways, thereby compromising endocrine homeostasis and reproductive function

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