Use of Actigraphy for the Evaluation of Sleep Disorders and Circadian Rhythm Sleep-Wake Disorders: An American Academy of Sleep Medicine Systematic Review, Meta-Analysis, and GRADE Assessment

Abstract

Introduction: The purpose of this systematic review is to provide supporting evidence for a clinical practice guideline on the use of actigraphy.

Methods: The American Academy of Sleep Medicine commissioned a task force of experts in sleep medicine. A systematic review was conducted to identify studies that compared the use of actigraphy, sleep logs, and/or polysomnography. Statistical analyses were performed to determine the clinical significance of using actigraphy as an objective measure of sleep and circadian parameters. Finally, the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) process was used to assess the evidence for making recommendations.

Results: The literature search resulted in 81 studies that met inclusion criteria; all 81 studies provided data suitable for statistical analyses. These data demonstrate that actigraphy provides consistent objective data that is often unique from patient-reported sleep logs for some sleep parameters in adult and pediatric patients with suspected or diagnosed insomnia, circadian rhythm sleep-wake disorders, sleep-disordered breathing, central disorders of hypersomnolence, and adults with insufficient sleep syndrome. These data also demonstrate that actigraphy is not a reliable measure of periodic limb movements in adult and pediatric patients. 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.

Keywords: actigraphy; circadian rhythm; sleep disorders; systematic review.

© 2018 American Academy of Sleep Medicine.

Figures

Figure 1. Hypothetical mean difference of actigraphy versus sleep log measurements (clinically significant).

Figure 2. Hypothetical range of mean differences of actigraphy versus PSG measurements (clinically significant).

CI = confidence interval, PSG = polysomnography.

Figure 3. Evidence base flow diagram.

AASM = American Academy of Sleep Medicine, CRSWD = circadian rhythm sleep-wake disorder, PICO = Patient, Intervention, Comparison, and Outcomes.