Wrist actigraphy

Abstract

To record sleep, actigraph devices are worn on the wrist and record movements that can be used to estimate sleep parameters with specialized algorithms in computer software programs. With the recent establishment of a Current Procedural Terminology code for wrist actigraphy, this technology is being used increasingly in clinical settings as actigraphy has the advantage of providing objective information on sleep habits in the patient's natural sleep environment. Actigraphy has been well validated for the estimation of nighttime sleep parameters across age groups, but the validity of the estimation of sleep-onset latency and daytime sleeping is limited. Clinical guidelines and research suggest that wrist actigraphy is particularly useful in the documentation of sleep patterns prior to a multiple sleep latency test, in the evaluation of circadian rhythm sleep disorders, to evaluate treatment outcomes, and as an adjunct to home monitoring of sleep-disordered breathing. Actigraphy has also been well studied in the evaluation of sleep in the context of depression and dementia. Although actigraphy should not be viewed as a substitute for clinical interviews, sleep diaries, or overnight polysomnography when indicated, it can provide useful information about sleep in the natural sleep environment and/or when extended monitoring is clinically indicated.

Figure 1.

Example of a double-plot of actigraphy data. This plot shows nights of data aligned one above the next. This 5-day recording is from a 92-year-old female resident of an assisted-living facility and shows a pattern of abnormally increased activity during the nighttime hours (indicated by arrows).

Figure 2.

Sample instructions and daily patient log for use with wrist actigraphy.

Figure 3.

Seven-day recording of a 66-year-old woman during hospitalization following ankle injury. Arrows indicate periods when lights were left on after the patient indicated “trying to fall asleep” and occasions when lights were turned on at night. During the day, light levels reached no higher than 450 lux during the 1-week recording period, confirming that the patient did not go outdoors on any occasion.