Actigraphy

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Actigraphy
Purposemonitoring human rest/activity cycles

Actigraphy is a non-invasive method [1] of monitoring human rest/activity cycles. A small actigraph unit, also called an actimetry sensor, [2] is worn for a week or more to measure gross motor activity. The unit is usually in a wristwatch-like package worn on the wrist. The movements the actigraph unit undergoes are continually recorded and some units also measure light exposure. The data can be later read to a computer and analysed offline; in some brands of sensors the data are transmitted and analysed in real time.

Contents

Purpose

Sleep

Sleep actigraphs are generally watch-shaped and worn on the wrist of the non-dominant arm for adults and usually on the ankle for children. They are useful for determining sleep patterns and circadian rhythms and may be worn for several weeks at a time. In the medical setting, traditional polysomnography has long been cited as "the 'gold standard' for sleep assessment." [3] Since the 1990s, however, actigraphy has increasingly been used to assess sleep/wake behavior; especially for young children. [4] [5] Studies have found actigraphy to be helpful for sleep research because it tends to be less expensive and cumbersome than polysomnography. [3] [6] [7] Unlike polysomnography, actigraphy allows the patient to be movable and to continue her or his normal routines while the required data are being recorded in his or her natural sleep environment; this may render the measured data more generally applicable. As sleep actigraphs are more affordable than polysomnographs, their use has advantages, particularly in the case of large field studies. [8]

However, actigraphy cannot be considered as a substitute to polysomnography. A full night sleep measured with polysomnography may be required for some sleep disorders. Indeed, actigraphy may be efficient in measuring sleep parameters and sleep quality, however it is not provided with measures for brain activity (EEG), eye movements (EOG), muscle activity (EMG) or heart rhythm (ECG). [9]

Actigraphy is useful for assessing daytime sleepiness in place of a laboratory sleep latency test. It is used to clinically evaluate insomnia, circadian rhythm sleep disorders, excessive sleepiness. It is not recommended for the diagnosis of restless legs syndrome. It is also used in assessing the effectiveness of pharmacologic, behavioural, phototherapeutic or chronotherapeutic treatments for such disorders. The data, recorded over time, is in some cases more relevant than the result of polysomnography, particularly in assessing circadian rhythms and disorders thereof as well as insomnia. [10]

With the actigraphy it is also possible to determine some general information related to the sleep and the sleep quality of the subject, such as his/her chronotype, the sleep onset latency, the total sleep duration, the sleep consolidation (sleep efficiency), the time spent in bed, movements, and the sleep cycle. [11]

Research showed that both sleep and wake are not equally assessed by actigraphy devices. When compared, data collected through polysomnographs and actigraphs defines sensitivity; which is the proportion of sleep correctly detected by both methods. Actigraphy reveals itself to be more likely to detect sleep than wake phases. [12]

Actigraphy has been actively used in sleep-related studies since the early 1990s. [13] It has not traditionally been used in routine diagnosis of sleep disorders, but technological advances in actigraph hardware and software, as well as studies verifying data validity, have made its use increasingly common. [3] The main reason for this development is the fact that, while retaining mobility, actigraphy offers reliable results with an accuracy that is close to those of polysomnography (above 90% for estimating total sleep time but dropping to 55% for a 4 - way sleep stage estimation problem). [14] The technique is increasingly employed in new drug clinical trials where sleep quality is seen as a good indicator of quality of life. The technique has also been used in studies with individuals in both health [15] and disease, e.g., Alzheimer's [16] and fibromyalgia, [17] conditions.

Activity

Activity actigraphs are worn and used similarly to a pedometer: around the waist, near the hip. They are useful for determining the amount of wake-time activity, and possibly estimating the number of calories burned, by the wearer. They are worn for a number of days to collect enough data for valid analysis.[ citation needed ]

Movement

Movement actigraphs are generally larger and worn on the shoulder of the dominant arm. They contain a 3D actigraph as opposed to a single dimension one, and have a high sample rate and a large memory. They are used for only a few hours, and can be used to determine problems with gait and other physical impairments.[ citation needed ]

The actigraph unit

The unit itself is an integrate electronic device which generally embeds:[ citation needed ]

Measurements

Devices used for actigraphy collect data generated by movements. In order to make the data usable for practice and sleep medicine, movements are translated into digital data by actigraphs. Several devices and computer software are available, and assessment can vary depending on combination of chosen device, procedure and software program. [18]

Actigraphs have a number of different ways of accumulating the values from the accelerometer in memory. ZCM (zero crossing mode) counts the number of times the accelerometer waveform crosses 0 for each time period. PIM (proportional integral mode) measures the area under the curve, and adds that size for each time period. TAT (time above threshold) uses a certain threshold, and measures the length of time that the wave is above a certain threshold. Literature shows that PIM provides most accurate measurements for both sleep and activity, though the difference with ZCM is marginal. [19]

Features

Actigraph units vary widely in size and features and can be expanded to include additional measurements. However, there are a number of limiting factors:[ citation needed ]

For some uses, the following are examples of additional features:[ citation needed ]

Advantages

One advantage of actigraphy methods over polysomnography methods is about duration. Recording is longer than laboratory settings, duration of collection of data may be adapted to each patient and highlight information that cannot be found through one-night measurements such as sleep habits. Actigraphy also captures daytime activity, which is not captured by polysomnography. Actigraphy turns out to be especially adapted to pediatric and elderly patients. [9]

Disadvantages

The actigraph is recorded at home, and therefore a high compliance is needed: [20] patients need to complete a sleep diary and always wear the watch. [20] Sometimes, the actigraph doesn't properly record sleep; for example, a nap during a car ride isn't always logged as sleep. [20] In contrast, showers close to the sleep period can be erroneously recorded as sleep. [20] These false positives are relatively common: while actigraphy is good at detecting sleep patterns (sensitivity: 0.965), it has its difficulties in detecting wake periods (specificity: 0.329). [21] As an electronic device, there can be unobserved technical malfunctions that detrimentally affect actigraphic measurement. [20]

Consumer electronics devices

Some consumer electronics devices, such as the Oura Ring and the Huawei Honor Band, employ actigraphy to estimate sleep patterns. [22] Other devices, such as the Fitbit Alta HR, have been found to provide equivalent estimates across all traditional sleep parameters, compared to more traditional actigraph units. [23]

Related Research Articles

<span class="mw-page-title-main">Sleep</span> Naturally recurring resting state of mind and body

Sleep is a state of reduced mental and physical activity in which consciousness is altered and sensory activity is inhibited to a certain extent. During sleep, there is a decrease in muscle activity, and interactions with the surrounding environment. While sleep differs from wakefulness in terms of the ability to react to stimuli, it still involves active brain patterns, making it more reactive than a coma or disorders of consciousness.

<span class="mw-page-title-main">Sleep disorder</span> Medical disorder of the sleep patterns of a person

A sleep disorder, or somnipathy, is a medical disorder of an individual's sleep patterns. Some sleep disorders are severe enough to interfere with normal physical, mental, social and emotional functioning. Polysomnography and actigraphy are tests commonly ordered for diagnosing sleep disorders.

<span class="mw-page-title-main">Insomnia</span> Inability to fall or stay asleep

Insomnia, also known as sleeplessness, is a sleep disorder where people have trouble sleeping. They may have difficulty falling asleep, or staying asleep for as long as desired. Insomnia is typically followed by daytime sleepiness, low energy, irritability, and a depressed mood. It may result in an increased risk of motor vehicle collisions, as well as problems focusing and learning. Insomnia can be short term, lasting for days or weeks, or long term, lasting more than a month. The concept of the word insomnia has two possibilities: insomnia disorder and insomnia symptoms, and many abstracts of randomized controlled trials and systematic reviews often underreport on which of these two possibilities the word insomnia refers to.

<span class="mw-page-title-main">Delayed sleep phase disorder</span> Chronic mismatch between a persons normal daily rhythm, compared to other people and societal norms

Delayed sleep phase disorder (DSPD), more often known as delayed sleep phase syndrome and also as delayed sleep–wake phase disorder, is the delaying of a person's circadian rhythm compared to those of societal norms. The disorder affects the timing of biological rhythms including sleep, peak period of alertness, core body temperature, and hormonal cycles.

Advanced Sleep Phase Disorder (ASPD), also known as the advanced sleep-phase type (ASPT) of circadian rhythm sleep disorder, is a condition that is characterized by a recurrent pattern of early evening sleepiness and very early morning awakening. This sleep phase advancement can interfere with daily social and work schedules, and results in shortened sleep duration and excessive daytime sleepiness. The timing of sleep and melatonin levels are regulated by the body's central circadian clock, which is located in the suprachiasmatic nucleus in the hypothalamus.

Somnolence is a state of strong desire for sleep, or sleeping for unusually long periods. It has distinct meanings and causes. It can refer to the usual state preceding falling asleep, the condition of being in a drowsy state due to circadian rhythm disorders, or a symptom of other health problems. It can be accompanied by lethargy, weakness and lack of mental agility.

Hypersomnia is a neurological disorder of excessive time spent sleeping or excessive sleepiness. It can have many possible causes and can cause distress and problems with functioning. In the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), hypersomnolence, of which there are several subtypes, appears under sleep-wake disorders.

Non-24-hour sleep–wake disorder is one of several chronic circadian rhythm sleep disorders (CRSDs). It is defined as a "chronic steady pattern comprising [...] daily delays in sleep onset and wake times in an individual living in a society". Symptoms result when the non-entrained (free-running) endogenous circadian rhythm drifts out of alignment with the light–dark cycle in nature. Although this sleep disorder is more common in blind people, affecting up to 70% of the totally blind, it can also affect sighted people. Non-24 may also be comorbid with bipolar disorder, depression, and traumatic brain injury. The American Academy of Sleep Medicine (AASM) has provided CRSD guidelines since 2007 with the latest update released in 2015.

<span class="mw-page-title-main">Polysomnography</span> Multi-parameter study of sleep and sleep disorders

Polysomnography (PSG), a type of sleep study, is a multi-parameter study of sleep and a diagnostic tool in sleep medicine. The test result is called a polysomnogram, also abbreviated PSG. The name is derived from Greek and Latin roots: the Greek πολύς, the Latin somnus ("sleep"), and the Greek γράφειν.

Periodic limb movement disorder (PLMD) is a sleep disorder where the patient moves limbs involuntarily and periodically during sleep, and has symptoms or problems related to the movement. PLMD should not be confused with restless legs syndrome (RLS), which is characterized by a voluntary response to an urge to move legs due to discomfort. PLMD on the other hand is involuntary, and the patient is often unaware of these movements altogether. Periodic limb movements (PLMs) occurring during daytime period can be found but are considered as a symptom of RLS; only PLMs during sleep can suggest a diagnosis of PLMD.

<span class="mw-page-title-main">Somnology</span> Scientific study of sleep

Somnology is the scientific study of sleep. It includes clinical study and treatment of sleep disorders and irregularities. Sleep medicine is a subset of somnology.

Circadian rhythm sleep disorders (CRSD), also known as circadian rhythm sleep-wake disorders (CRSWD), are a family of sleep disorders which affect the timing of sleep. CRSDs arise from a persistent pattern of sleep/wake disturbances that can be caused either by dysfunction in one's biological clock system, or by misalignment between one's endogenous oscillator and externally imposed cues. As a result of this mismatch, those affected by circadian rhythm sleep disorders have a tendency to fall asleep at unconventional time points in the day. These occurrences often lead to recurring instances of disturbed rest, where individuals affected by the disorder are unable to go to sleep and awaken at "normal" times for work, school, and other social obligations. Delayed sleep phase disorder, advanced sleep phase disorder, non-24-hour sleep–wake disorder and irregular sleep–wake rhythm disorder represents the four main types of CRSD.

Shift work sleep disorder (SWSD) is a circadian rhythm sleep disorder characterized by insomnia, excessive sleepiness, or both affecting people whose work hours overlap with the typical sleep period. Insomnia can be the difficulty to fall asleep or to wake up before the individual has slept enough. About 20% of the working population participates in shift work. SWSD commonly goes undiagnosed, so it's estimated that 10–40% of shift workers have SWSD. The excessive sleepiness appears when the individual has to be productive, awake and alert. Both symptoms are predominant in SWSD. There are numerous shift work schedules, and they may be permanent, intermittent, or rotating; consequently, the manifestations of SWSD are quite variable. Most people with different schedules than the ordinary one might have these symptoms but the difference is that SWSD is continual, long-term, and starts to interfere with the individual's life.

The International Classification of Sleep Disorders (ICSD) is "a primary diagnostic, epidemiological and coding resource for clinicians and researchers in the field of sleep and sleep medicine". The ICSD was produced by the American Academy of Sleep Medicine (AASM) in association with the European Sleep Research Society, the Japanese Society of Sleep Research, and the Latin American Sleep Society. The classification was developed as a revision and update of the Diagnostic Classification of Sleep and Arousal Disorders (DCSAD) that was produced by both the Association of Sleep Disorders Centers (ASDC) and the Association for the Psychophysiological Study of Sleep and was published in the journal Sleep in 1979. A second edition, called ICSD-2, was published by the AASM in 2005. The third edition, ICSD-3, was released by the AASM in 2014. A text revision of the third edition (ICSD-3-TR) was published in 2023 by the AASM.

<span class="mw-page-title-main">Sleep medicine</span> Medical specialty devoted to the diagnosis and therapy of sleep disturbances and disorders

Sleep medicine is a medical specialty or subspecialty devoted to the diagnosis and therapy of sleep disturbances and disorders. From the middle of the 20th century, research has provided increasing knowledge of, and answered many questions about, sleep–wake functioning. The rapidly evolving field has become a recognized medical subspecialty in some countries. Dental sleep medicine also qualifies for board certification in some countries. Properly organized, minimum 12-month, postgraduate training programs are still being defined in the United States. In some countries, the sleep researchers and the physicians who treat patients may be the same people.

<span class="mw-page-title-main">Sleep diary</span> Method of recording sleep patterns

A sleep diary is a record of an individual's sleeping and waking times with related information, usually over a period of several weeks. It is self-reported or can be recorded by a caregiver.

Sleep deprivation, also known as sleep insufficiency or sleeplessness, is the condition of not having adequate duration and/or quality of sleep to support decent alertness, performance, and health. It can be either chronic or acute and may vary widely in severity.

Irregular sleep–wake rhythm disorder (ISWRD) is a rare form of circadian rhythm sleep disorder. It is characterized by numerous naps throughout the 24-hour period, no main nighttime sleep episode, and irregularity from day to day. Affected individuals have no pattern of when they are awake or asleep, may have poor quality sleep, and often may be very sleepy while they are awake. The total time asleep per 24 hours is normal for the person's age. The disorder is serious—an invisible disability. It can create social, familial, and work problems, making it hard for a person to maintain relationships and responsibilities, and may make a person home-bound and isolated.

<span class="mw-page-title-main">Behavioral sleep medicine</span>

Behavioral sleep medicine (BSM) is a field within sleep medicine that encompasses scientific inquiry and clinical treatment of sleep-related disorders, with a focus on the psychological, physiological, behavioral, cognitive, social, and cultural factors that affect sleep, as well as the impact of sleep on those factors. The clinical practice of BSM is an evidence-based behavioral health discipline that uses primarily non-pharmacological treatments. BSM interventions are typically problem-focused and oriented towards specific sleep complaints, but can be integrated with other medical or mental health treatments. The primary techniques used in BSM interventions involve education and systematic changes to the behaviors, thoughts, and environmental factors that initiate and maintain sleep-related difficulties.

<span class="mw-page-title-main">Girardin Jean-Louis</span> American academic

Girardin Jean-Louis is an American academic who is a Professor in the Departments of Psychiatry and Neurology at the University of Miami, Miller School of Medicine. He serves as Director of the Translational Sleep and Circadian Sciences Program and the "Program to Increase Diversity among Individuals Engaged in Health-Related Research" Institute. Dr. Jean-Louis’ translational behavioral sleep and circadian research was recently featured in Science and NPR. In 2020, he was named ‘Pioneer in Minority Health and Health Disparities’ and one of the Community of Scholars' most inspiring Black scientists in America. In 2021, he received the Mary A. Carskadon Outstanding Educator Award from the Sleep Research Society, and in 2022 the Diversity, Equity, and Inclusion Leadership Award from the American Academy of Sleep Medicine.

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