Elsevier

Sleep Medicine Reviews

Volume 15, Issue 4, August 2011, Pages 259-267
Sleep Medicine Reviews

Clinical Review
The role and validity of actigraphy in sleep medicine: An update

https://doi.org/10.1016/j.smrv.2010.10.001Get rights and content

Summary

Activity-based sleep-wake monitoring or actigraphy has gained a central role as a sleep assessment tool in sleep medicine. It is used for sleep assessment in clinical sleep research, and as a diagnostic tool in sleep medicine. This update indicates that according to most studies, actigraphy has reasonable validity and reliability in normal individuals with relatively good sleep patterns. The validity of actigraphy in special populations or with individuals with poor sleep or with other sleep-related disorders is more questionable. The most problematic validity issue is the low specificity of actigraphy in detecting wakefulness within sleep periods reported with certain devices or samples. Overall, the recent literature adds to previous reports in demonstrating that actigraphy is sensitive in detecting unique sleep patterns associated with specific sleep disorders as well as with other medical or neurobehavioral disorders. Furthermore, actigraphy is sensitive in detecting sleep changes associated with drug treatments and non-pharmacologic interventions. Recent developments include the development of devices specially tailored to detect periodic limb movement in sleep and the introduction of new devices and algorithms. Because of the limitations of actigraphy, it is recommended to use complementary assessment methods (objective and subjective) whenever possible.

Introduction

Over the last two decades actigraphy has become a major assessment tool in sleep research and sleep medicine. The rate of relative growth in number of scientific publications that include actigraphy (see Fig. 1) exceeds the rate of growth in publications that include polysomnography (PSG) (from an actigraphy-PSG ratio of about 1:10 in 1991 to a ratio of about 1:4 in 2009). This increase reflects the growing appeal of actigraphy to clinicians and researchers in sleep medicine. Earlier reviews and guidelines introduced by the American Sleep Disorders Association (ASDA) have established the use of actigraphy as a reliable and valid sleep assessment method in specific domains of sleep research and sleep medicine.1, 2, 3, 4, 5, 6 The current review is an update based on the literature published after the previous review published in 2002 in Sleep Medicine Reviews.6 It is based on a literature search that included Pubmed, Social and Science Citation Index databases and covers only articles published in peer-reviewed journals (excluding meeting abstracts or proceedings). Because of the large number of papers published each year, this review covers only papers that address methodological issues related to the use of actigraphy in sleep medicine and those that are directly related to clinical applications in sleep medicine. Thus, dozens of papers, addressing the use of actigraphy in assessing sleep in specific conditions or populations were not included.

Actigraphy is based on small wrist-watch like devices that monitor movements for extended periods of time. The raw activity scores (e.g., in 1-min epochs) are translated to sleep-wake scores based on computerized scoring algorithms. There are different commercial devices in the market and each device has its own measurement characteristics and therefore requires appropriate sleep-wake scoring algorithms and validation studies. To avoid commercial pitfalls, this review will not address specific devices or comparisons, but the readers are strongly advised to consider the presented issues and their relevance to the specific device they are using or planning to use.

Section snippets

Reliability and validity issues

The strengths and limitations of actigraphy in sleep assessment have been repeatedly outlined.1, 2, 3, 4, 5, 6 In this section, additional information is provided with regard to the main established topics and some new ones.

Assessment of insomnia

The role of actigraphy in the evaluation of insomnia has been documented in earlier reports.1, 2, 3, 41 The main consistent conclusion has been that actigraphy overestimates sleep time (as manifested in shorter SOL and WASO) because of efforts of individuals with insomnia to fall asleep by lying in bed motionless for extended periods. New studies have replicated, challenged and extended these earlier reports.

Lichstein et al.42 conducted a PSG-Actigraphy validation study, based on one laboratory

Assessment of non-pharmacologic interventions for insomnia

Recent studies on insomnia treatment have replicated earlier findings and demonstrated that actigraphy is sensitive to intervention effects as reflected in improvement of actigraphic sleep measures.43, 44, 66, 67 For instance, Sivertsen et al.44 reported that actigraphy detected the changes in total sleep time and WASO, but failed to detect the PSG-identified improvement in SOL and SE. The authors concluded that the clinical utility of actigraphy in older adults with insomnia is still

Conclusions and recommendations

The following conclusions can be derived from this review:

  • In comparison to PSG, actigraphy has reasonable validity and reliability in assessing sleep-wake patterns in normal individuals with average or good sleep quality.

  • The validity of actigraphy in special populations (e.g., elderly people, individuals with other major health problems or individuals with poor sleep quality) is more questionable.

  • The main methodological problem associated with the validity of actigraphic sleep-wake scoring is

Conflict of interests

The author has no conflict of interests to disclose.

Acknowledgement

I thank Liat Tikotzky for her helpful review and comments.

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