Actigraphy

{{short description|Non-invasive method of monitoring human rest/activity cycles}} {{More citations needed|date=January 2010}} {{Infobox diagnostic | name = Actigraphy | image = | alt = | caption = | pronounce = | purpose =monitoring human rest/activity cycles | test of = | based on = | synonyms = | reference_range = | calculator = | DiseasesDB =  | ICD10 =  | ICD9 = | ICDO = | MedlinePlus =  | eMedicine =  | MeshID = | OPS301 =  | LOINC =  }} '''Actigraphy''' is a non-invasive method<ref>{{Cite journal|last1=Ibáñez|first1=Vanessa|last2=Silva|first2=Josep|last3=Cauli|first3=Omar|date=2018-05-25|title=A survey on sleep assessment methods|journal=PeerJ|volume=6|article-number=e4849|doi=10.7717/peerj.4849|pmid=29844990|pmc=5971842|issn=2167-8359 |doi-access=free }}</ref> of monitoring human rest/activity cycles. A small actigraph unit, also called an actimetry sensor,<ref>{{citation |last=Pigot |first=Hélène |author2=Bernard Lefebvre |author3=Jean-Guy Meunier |author4=Brigitte Kerhervé |author5=André Mayers |author6=Sylvain Giroux |year=2003 |title=The role of intelligent habitats in upholding elders in residence |publisher=Département de mathématiques et d'informatique, Université de Sherbrooke |location=Canada |url=http://www.dmi.usherb.ca/~sgiroux/Publications/2003/2003-Biomedecine-Pigot-01.pdf |access-date=2008-01-22 |journal= |archive-date=2007-10-01 |archive-url=https://web.archive.org/web/20071001030213/http://www.dmi.usherb.ca/~sgiroux/Publications/2003/2003-Biomedecine-Pigot-01.pdf }}</ref> 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.

==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."<ref name=":0">{{Cite journal|title = Comparison of Sleep Parameters from Actigraphy and Polysomnography in Older Women: The SOF Study|author = Terri Blackwell MA|author2=Susan Redline MD MPH|author3=Sonia Ancoli-Israel PhD|author4=Jennifer L. Schneider MPH|author5=Susan Surovec BA|author6=Nathan L. Johnson MS|author7=Jane A. Cauley, DrPH|author8=Katie L. Stone, PhD|others=and for the Study of Osteoporotic Fractures Research Group|date = 2008-02-01|journal = Sleep|doi = 10.1093/sleep/31.2.283| pmc=2225568 |pmid=18274276 |volume=31 |issue = 2|pages=283–91}}</ref> Since the 1990s, however, actigraphy has increasingly been used to assess sleep/wake behavior; especially for young children.<ref>{{Cite journal |last1=Bucko |first1=Agnes G. |last2=Dowda |first2=Marsha |last3=Frongillo |first3=Edward A. |last4=Torres |first4=Myriam E. |last5=Pate |first5=Russell R. |date=2021-11-01 |title=Nighttime sleep and physical activity in 6-7 month-old infants |journal=Infant Behavior and Development |language=en |volume=65 |article-number=101628 |doi=10.1016/j.infbeh.2021.101628 |issn=0163-6383 |pmc=8627435 |pmid=34392076}}</ref><ref>{{Cite journal |last1=Meltzer |first1=Lisa J. |last2=Montgomery-Downs |first2=Hawley E. |last3=Insana |first3=Salvatore P. |last4=Walsh |first4=Colleen M. |date=2012-10-01 |title=Use of actigraphy for assessment in pediatric sleep research |journal=Sleep Medicine Reviews |language=en |volume=16 |issue=5 |pages=463–475 |doi=10.1016/j.smrv.2011.10.002 |issn=1087-0792 |pmc=3445439 |pmid=22424706}}</ref> Studies have found actigraphy to be helpful for sleep research because it tends to be less expensive and cumbersome than polysomnography.<ref name=":0" /><ref>{{Cite journal |last=Sadeh |first=Avi |date=2015-03-01 |title=III. Sleep Assessment Methods: Sleep Assessment |url=https://onlinelibrary.wiley.com/doi/10.1111/mono.12143 |journal=Monographs of the Society for Research in Child Development |language=en |volume=80 |issue=1 |pages=33–48 |doi=10.1111/mono.12143|pmid=25704734 |url-access=subscription }}</ref><ref>{{Cite journal |last1=Bucko |first1=Agnes G. |last2=Dowda |first2=Marsha |last3=Frongillo |first3=Edward A. |last4=Torres |first4=Myriam E. |last5=Pate |first5=Russell R. |date=2021-11-01 |title=Nighttime sleep and physical activity in 6-7 month-old infants |journal=Infant Behavior and Development |language=en |volume=65 |article-number=101628 |doi=10.1016/j.infbeh.2021.101628 |issn=0163-6383 |pmc=8627435 |pmid=34392076}}</ref> 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.<ref name="CDP">{{cite journal |last1=Tang |first1=Nicole K.Y.|last2=Harvey |first2=Allison G.|year=2004 |title=Correcting distorted perception of sleep in insomnia: a novel behavioural experiment? |journal=Behaviour Research and Therapy |volume=42 |issue=1|pages=27–39 |doi=10.1016/s0005-7967(03)00068-8|pmid=14744521}}</ref>

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).<ref name=":1">{{Cite journal|last1=Ancoli-Israel|first1=Sonia|last2=Martin|first2=Jennifer L.|last3=Blackwell|first3=Terri|last4=Buenaver|first4=Luis|last5=Liu|first5=Lianqi|last6=Meltzer|first6=Lisa J.|last7=Sadeh|first7=Avi|last8=Spira|first8=Adam P.|last9=Taylor|first9=Daniel J.|date=2015-07-17|title=The SBSM Guide to Actigraphy Monitoring: Clinical and Research Applications|journal=Behavioral Sleep Medicine|volume=13|issue=sup1|pages=S4–S38|doi=10.1080/15402002.2015.1046356|pmid=26273913|s2cid=205887315|issn=1540-2002}}</ref>

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.<ref name="Schutte-Rodin">{{cite web|last1=Schutte-Rodin|first1=Sharon|last2=Broch|first2=Lauren|last3=Buysse|first3=Daniel|last4=Dorsey|first4=Cynthia|last5=Sateia|first5=Michael|title=Clinical Guideline for the Evaluation and Management of Chronic Insomnia in Adults|url=http://www.aasmnet.org/Resources/clinicalguidelines/040515.pdf|website=Journal of Clinical Sleep Medicine|publisher=AASM|access-date=30 July 2015|page=488|date=2015|quote=Actigraphy is indicated as a method to characterize circadian patterns or sleep disturbances in individuals with insomnia, ...}}</ref>

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.<ref>Martin, J. L., & Hakim, A. D. (2011). Wrist actigraphy. ''Chest'', ''139''(6), 1514-1527.</ref><ref>{{Cite journal |last=Bazin |first=Thomas |last2=Micoulaud Franchi |first2=Jean-Arthur |last3=Terras |first3=Nathalie |last4=Taillard |first4=Jacques |last5=Laharie |first5=David |last6=Zerbib |first6=Frank |last7=Philip |first7=Pierre |date=2020-09-01 |title=Altered sleep quality is associated with Crohn's disease activity: an actimetry study |journal=Sleep and Breathing |language=en |volume=24 |issue=3 |pages=971–977 |doi=10.1007/s11325-019-01934-z |issn=1522-1709}}</ref>

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.<ref>{{Cite journal|last1=Ancoli-Israel|first1=Sonia|last2=Cole|first2=Roger|last3=Alessi|first3=Cathy|last4=Chambers|first4=Mark|last5=Moorcroft|first5=William|last6=Pollak|first6=Charles P.|date=May 2003|title=The Role of Actigraphy in the Study of Sleep and Circadian Rhythms|journal=Sleep|volume=26|issue=3|pages=342–392|doi=10.1093/sleep/26.3.342|pmid=12749557|issn=0161-8105|doi-access=free}}</ref>

Actigraphy has been actively used in sleep-related studies since the early 1990s.<ref>Google Scholar; keyword: actigraph+sleep; 10.3k results as of September 2011</ref> 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.<ref name=":0" />''' '''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).<ref>Jean-Louis, Girardin, von Gizycki, H., Zizi, F., Spielman, A., Hauri, P., & Taub, H. (1997) The actigraph data analysis software: I. A novel approach to scoring and interpreting sleep–wake activity. Perceptual and Motor Skills, 85, 207–216.</ref> 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<ref>{{Cite journal|last1=Hu|first1=Kun|last2=Ivanov|first2=Plamen Ch.|last3=Chen|first3=Zhi|last4=Hilton|first4=Michael F.|last5=Stanley|first5=H.Eugene|last6=Shea|first6=Steven A.|date=2004|title=Non-random fluctuations and multi-scale dynamics regulation of human activity|journal=Physica A: Statistical Mechanics and Its Applications|volume=337|issue=1–2|pages=307–318| arxiv=physics/0308011|doi=10.1016/j.physa.2004.01.042|issn=0378-4371|pmc=2749944|pmid=15759365|bibcode=2004PhyA..337..307H }}</ref> and disease, e.g., Alzheimer's<ref>{{Cite journal|last1=Hu|first1=Kun|last2=Someren|first2=Eus J. W. Van|last3=Shea|first3=Steven A.|last4=Scheer|first4=Frank A. J. L.|date=2009-02-24|title=Reduction of scale invariance of activity fluctuations with aging and Alzheimer's disease: Involvement of the circadian pacemaker|journal=Proceedings of the National Academy of Sciences|volume=106|issue=8|pages=2490–2494|doi=10.1073/pnas.0806087106|issn=0027-8424|pmc=2650290|pmid=19202078|bibcode=2009PNAS..106.2490H |doi-access=free}}</ref> and fibromyalgia,<ref>{{Cite journal|last1=França|first1=Lucas Gabriel Souza|last2=Montoya|first2=Pedro|last3=Miranda|first3=José Garcia Vivas|date=2019|title=On multifractals: A non-linear study of actigraphy data|journal=Physica A: Statistical Mechanics and Its Applications|volume=514|pages=612–619|doi=10.1016/j.physa.2018.09.122|issn=0378-4371|arxiv=1702.03912|bibcode=2019PhyA..514..612F |s2cid=18259316}}</ref> 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|date=November 2018}}

===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|date=November 2018}}

==The actigraph unit== The unit itself is an integrate electronic device which generally embeds:{{Citation needed|date=November 2018}} * an accelerometer,<ref name=":0" /> * a real time clock or timer to start/stop the actigraph recording at specific times, and to record accumulate values for a specific time frame, * a non-volatile memory to store the resulting values, * an optional low-pass filter which filters out everything except the 2–3 Hz band, thereby ensuring external vibrations are ignored, and * an interface, usually USB, serial, or low-power wireless, to program the timer and download the data from memory.

===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.<ref>{{Cite journal|last1=Sadeh|first1=Avi|last2=Acebo|first2=Christine|date=May 2002|title=The role of actigraphy in sleep medicine|journal=Sleep Medicine Reviews|volume=6|issue=2|pages=113–124|doi=10.1053/smrv.2001.0182|pmid=12531147}}</ref>

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.<ref>Girardin, Jean-Louis et al. "Sleep estimation from wrist movement quantified by different actigraphic modalities." Journal of Neuroscience Methods 105.2 (2001): 185-191.</ref>

===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|date=November 2018}} * Fastest sample rate: 1-minute intervals provide adequate detail to measure sleep, but could be too slow for measuring other parameters. * Amount of memory: Together with sample rate, the amount of memory determines how long measurements can be taken. * Battery usage: Some actigraphs have a short battery life. * Weight: the heavier the actigraph, the more disruptive its use. * Water resistance: for proper measurements it is often desirable that the actigraph be worn in the shower, bathtub, or even while swimming/diving.

For some uses, the following are examples of additional features:{{Citation needed|date=November 2018}} * Watch functionality: making the device more attractive to the user. * User input: most actigraphs now include a button so the user can indicate a specific event that occurs, for example lights out at bedtime. * Subjective user input: for example a query function to allow surveys at specific times. * Sensors which monitor: ** temperature ** ambient light ** sound levels ** Parkinsonian tremor ** skin resistance ** a full EEG data stream

=== 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.<ref name=":1" />

===Disadvantages=== The actigraph is recorded at home, and therefore a high compliance is needed:<ref name="Sadeh"/> patients need to complete a sleep diary and always wear the watch.<ref name="Sadeh"/> Sometimes, the actigraph doesn't properly record sleep; for example, a nap during a car ride isn't always logged as sleep.<ref name="Sadeh"/> In contrast, showers close to the sleep period can be erroneously recorded as sleep.<ref name="Sadeh"/> 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).<ref>Marino, M., Li, Y., Rueschman, M. N., Winkelman, J. W., Ellenbogen, J. M., Solet, J. M., … Buxton, O. M. (2013). Measuring Sleep: Accuracy, Sensitivity, and Specificity of Wrist Actigraphy Compared to Polysomnography. Sleep, 36(11), 1747–1755. https://doi.org/10.5665/sleep.3142</ref> As an electronic device, there can be unobserved technical malfunctions that detrimentally affect actigraphic measurement.<ref name="Sadeh">Sadeh, A., & Acebo, C. (2002). The role of actigraphy in sleep medicine. ''Sleep medicine reviews'', 6(2), 113–124.</ref>

==Consumer electronics devices==

Some consumer electronics devices, such as the Oura Ring and the Huawei Honor Band, employ actigraphy to estimate sleep patterns.<ref>{{cite web |author=Kaisa |title=How does Oura track sleep? |url=https://help.ouraring.com/sleep/how-does-oura-track-sleep |access-date=23 November 2018 |archive-url=https://web.archive.org/web/20181123112110/https://help.ouraring.com/sleep/how-does-oura-track-sleep |archive-date=23 November 2018 }}</ref> 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.<ref>{{cite journal |last1=Kahawage |first1=Piyumi |last2=Jumabhoy |first2=Ria |last3=Hamill |first3=Kellie |last4=de Zambotti |first4=Massimiliano |title=Validity, potential clinical utility, and comparison of consumer and research-grade activity trackers in Insomnia Disorder I: In-lab validation against polysomnography |journal=Journal of Sleep Research |date=2020 |volume=29 |issue=1 |article-number=e12931 |doi=10.1111/jsr.12931 |pmid=31626361 |doi-access=free }}</ref>

==References== {{reflist}}

==External links== * [http://www.aasmnet.org/Resources/PracticeParameters/PP_Actigraphy_Update.pdf American Academy of Sleep Medicine]—Parameters for the Use of Actigraphy in the Assessment of Sleep and Sleep Disorders: An Update for 2007 * [http://www.aasmnet.org/Resources/PracticeParameters/PP_Actigraphy_Circ.pdf American Academy of Sleep Medicine] – Practice parameters for the role of actigraphy in the study of sleep and circadian rhythms: An update for 2002 * [http://www.acsm-msse.org/pt/re/msse/abstract.00005768-200409000-00026.htm;jsessionid=EGV2oXf1VwE3h24pSzos7mnaSrNuqJu7tco1AuGHNjH4WGODCzwO!987057721!-949856145!9001!-1?index=1&results=1&count=10&searchid=1&nav=search%20 Reliability of Accelerometry-Based Activity Monitors: A Generalizability Study. Gregory J. Welk, Jodee A. Schaben, and James R. Morrow, Jr. Medicine & Science In Sports & Exercise, Vol. 36, No. 9, pp. 1637–1645, 2004.] – Medicine & Science in Sports & Medicine, the official Journal of the American College of Sports Medicine

Category:Measuring instruments Category:Neurology procedures Category:Circadian rhythm Category:Sleep