What is actigraphy (activity monitoring)?

From the Guidelines

Actigraphy is a valuable diagnostic tool for assessing sleep disorders and circadian rhythm sleep-wake disorders, and clinicians should use it to estimate sleep parameters in adult and pediatric patients with suspected sleep disorders, as recommended by the American Academy of Sleep Medicine 1.

Key Points

• Actigraphy is a non-invasive method that involves wearing a small device on the wrist to record movement data over extended periods, typically days to weeks.
• It is particularly useful for assessing sleep patterns, circadian rhythms, and physical activity levels in real-world settings.
• Actigraphy provides objective data about sleep duration, efficiency, and fragmentation that subjective reports might miss.
• The typical monitoring period is 1-2 weeks, which allows for detection of patterns that might not be apparent in a single night's observation.
• Actigraphy is not a substitute for in-laboratory polysomnography (PSG) when there is an indication for in-laboratory testing, but it can provide useful objective metrics across a variety of sleep-wake disorders to assist in the assessment and monitoring of treatment response 1.

Recommendations

• Clinicians should use actigraphy to estimate sleep parameters in adult patients with insomnia disorder, circadian rhythm sleep-wake disorder, and insufficient sleep syndrome 1.
• Actigraphy should be used to monitor total sleep time prior to testing with the Multiple Sleep Latency Test in adult and pediatric patients with suspected central disorders of hypersomnolence 1.
• Actigraphy is not recommended to be used in place of electromyography for the diagnosis of periodic limb movement disorder in adult and pediatric patients 1.

Benefits and Limitations

• Actigraphy provides objective data that is unique from patient-reported data and may be useful in the assessment of sleep disorders.
• The potential benefits of actigraphy include increased sensitivity over sleep logs in identifying short sleep duration and the objective nature of the data.
• Potential harms of actigraphy are negligible and rare, and include skin irritation.
• The overall quality of evidence for actigraphy is moderate to very low due to imprecision, heterogeneity, and small sample sizes in some studies 1.

From the Research

Actigraphy Overview

• Actigraphy is a tool used in sleep research and clinical care to assess sleep and sleep disorders 2, 3, 4, 5, 6
• It provides an estimate of sleep patterns, including sleep-wake schedules and sleep quality 2, 4, 6

Clinical Applications

• Actigraphy is indicated for use in evaluating patients with advanced sleep phase syndrome, delayed sleep phase syndrome, and shift work disorder 2
• It can also be used to estimate total sleep time in patients with obstructive sleep apnea when polysomnography is not available 2
• Actigraphy has been shown to be useful in characterizing sleep and circadian patterns in older adults and in patients with insomnia and hypersomnia 2, 4

Limitations and Pitfalls

• Actigraphy is less useful for documenting sleep-wake patterns in individuals with long motionless periods of wakefulness or disorders that involve altered motility patterns 3
• Potential users should be aware of the limitations of actigraphy, including the need for valid scoring algorithms and the potential for artifacts 3, 4
• Actigraphy may not be sufficient for diagnosis of sleep disorders in individuals with motor disorders or high motility during sleep 3, 4

Research and Development

• Recent research has utilized actigraphy in the assessment and management of sleep disorders, allowing for the development of evidence-based recommendations for its use 2
• Further research is warranted to refine and broaden the clinical value of actigraphy 2, 5
• Actigraphy may be more practical than polysomnography for some disorders, but it should not be held to the same expectations as polysomnography 4