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Actigraphy (with Sleep Diary)
Please visit this website for more information about the instrument: Actigraphy (with Sleep Diary)
Established clinical practice guidelines for actigraphy can be found in the American Academy of Sleep Medicine (AASM) International Classification of Sleep Disorders (ICSD) - Third Edition. Please click the above link for more information or to purchase the AASM ICSD -3rd Edition.
Supplemental: Parkinson's Disease (PD)
Short Description of Instrument
A small device that records motor activity by using an actimeter sensor (i.e., actigraph, accelerometer), which is a piezoelectric sensor (the size of a wristwatch) that is placed on the wrist of the non-dominant hand. It collects data generated by movements of the upper limb. It can be worn for days or weeks and evaluates the activity and rest of the limb where the device is worn. Periods of activity estimate wakefulness and periods of rest estimate sleep. In addition to motor activity, it can also assess temperature and light. The main utility of actimetry is to determine the pattern of a subject's wake-sleep cycle, as it evaluates 24-hour (day and night) activity. In PD, circadian rhythm disturbance is common, especially in elderly subjects with depression and dementia (advanced sleep-wake phase disorder).
Comments/Special Instructions
Data recorded can be later downloaded into a specific program where dates and times are given, and a graph of the rest-activity pattern is shown. A minimum of 7 days is required, and 3-4 weeks of recording is advised to estimate an individual's sleep-wake pattern.
The American Academy of Sleep Medicine (AASM) have published practice guidelines. It is recommended to wear the device while the patient is filling in a daily sleep diary.
It can also be used on the ankles to estimate the presence of periodic leg movements in several consecutive nights.
Scoring and Psychometric Properties
Psychometric Properties: In PD is particularly useful as it may record resting tremor, taking into account that tremor disappears during sleep. There are many devices in the market, but it is recommended to use those that have been validated against polysomnography.
Provides estimation of sleep timing, sleep duration, sleep efficiency, sleep fragmentation, +sleep bout (number and duration), interdaily stability, intradaily variability, relative amplitude, sleep regularity index, ultradian rhythms in sleep.
Strengths: Less expensive and more comfortable than polysomnography and the multiple sleep latency test. No need to stay in a hospital or a sleep lab as it is worn in a patient's real life in his/her own environment not stopping or adjusting daily activities. It may estimate the sleep-wake cycle for several days and weeks and not a single night like polysomnography does. A sleep expert may use actigraphy to distinguish between sleep disorders seen in PD such as REM sleep behavior disorder, periodic leg movements in sleep, and obstructive sleep apnea.
Weaknesses: It is not required for the definition of any sleep disorder, as it only estimates a sleep-wake pattern. Requires patient wearing the device for the whole day except when taking a bath or a shower.
Key Reference:
Smith MT, McCrae CS, Cheung J, Martin JL, Harrod CG, Heald JL, Carden KA. 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. J Clin Sleep Med. 2018 Jul 15;14(7):1209-1230.
Additional References:
Bolitho SJ, Naismith SL, Salahuddin P, Terpening Z, Grunstein RR, Lewis SJ. Objective measurement of daytime napping, cognitive dysfunction and subjective sleepiness in Parkinson's disease. PLoS One. 2013 Nov 21;8(11):e81233.
Kataoka H, Saeki K, Kurumatani N, Sugie K, Obayashi K. Objective sleep measures between patients with Parkinson's disease and community-based older adults Sleep Med. 2020 Apr;68:110-114.
Obayashi K, Saeki K, Yamagami Y, Kurumatani N, Sugie K, Kataoka H. Circadian activity rhythm in Parkinson's disease: findings from the PHASE study Sleep Med. 2021 Sep;85:8-14.
Reid K.J., Zee P.C. (2022) Techniques for clinical assessment of circadian rhythm disorders. In Kryger M.H., Roth T., Goldstein C.A., Dement W.C. (Eds.), Principles and practice of sleep medicine (Seventh edition, 1974-1981). Elsevier.
Document last updated August 2022