Parameters for the Use of Actigraphy in the Assessment of Sleep and Sleep Disorders

ACTIGRAPHY INVOLVES USE OF A PORTABLE DEVICE THAT RECORDS MOVEMENT OVER EXTENDED PERIODS OF TIME, AND HAS BEEN USED EXTENSIVELY IN the study of sleep and circadian rhythms. Since the publication of the last American Academy of Sleep Medicine (AASM) practice parameters on the use of actigraphy,1 there has been an explosion in the number of research articles utilizing actigraphy to estimate sleep and circadian rhythms. In response to this new literature, and the growing use of actigraphy in clinical sleep medicine, the AASM Standards of Practice Committee (SPC) undertook the development of these revised guidelines on the clinical use of this technology. Since the last review, additional literature has been published that addresses the use of actigraphy in the evaluation of insomnia, circadian rhythm sleep disorders, sleep related breathing disorders, determination of response to therapy, and in the evaluation of sleep patterns among special populations. This literature, in combination with growing clinical experience with actigraphy, led to the inclusion of actigraphy as a measure of sleep duration and sleep patterns in the diagnostic criteria for several specific sleep disorders in the second edition of the International Classification of Sleep Disorders.2 Actigraphy is listed as a diagnostic tool in the ICSD-2 primarily when sleep patterns must be assessed over time, making polysomnography impractical. For example, the ICSD-2 diagnostic criteria for most circadian rhythm disorders requires demonstration of abnormalities in the timing of the habitual sleep pattern using either actigraphy or sleep logs for seven days or more. The ICSD-2 also suggests that actigraphy may be used to document inconsistencies between objective and subjective measures of sleep timing in paradoxical insomnia, and as an aid in assessment of habitual sleep time and circadian pattern in patients with behaviorally induced insufficient sleep syndrome and idiopathic hypersomnia with and without long sleep times. Actigraphy is additionally recommended as an adjunct to the Multiple Sleep Latency Test to document a stable sleep pattern and adequate sleep times prior to the test. However, it should be noted that although the ICSD-2 reflects consensus among experts regarding disease classification and diPractice Parameters for the Use of Actigraphy in the Assessment of Sleep and Sleep Disorders: An Update for 2007