Showing papers on "Actigraphy published in 2003"
TL;DR: It is suggested that in the clinical setting, actigraphy is reliable for evaluating sleep patterns in patients with insomnia, for studying the effect of treatments designed to improve sleep, in the diagnosis of circadian rhythm disorders (including shift work), and in evaluating sleep in individuals who are less likely to tolerate PSG, such as infants and demented elderly.
Abstract: In summary, although actigraphy is not as accurate as PSG for determining some sleep measurements, studies are in general agreement that actigraphy, with its ability to record continuously for long time periods, is more reliable than sleep logs which rely on the patients' recall of how many times they woke up or how long they slept during the night and is more reliable than observations which only capture short time periods Actigraphy can provide information obtainable in no other practical way It can also have a role in the medical care of patients with sleep disorders However, it should not be held to the same expectations as polysomnography Actigraphy is one-dimensional, whereas polysomnography comprises at least 3 distinct types of data (EEG, EOG, EMG), which jointly determine whether a person is asleep or awake It is therefore doubtful whether actigraphic data will ever be informationally equivalent to the PSG, although progress on hardware and data processing software is continuously being made Although the 1995 practice parameters paper determined that actigraphy was not appropriate for the diagnosis of sleep disorders, more recent studies suggest that for some disorders, actigraphy may be more practical than PSG While actigraphy is still not appropriate for the diagnosis of sleep disordered breathing or of periodic limb movements in sleep, it is highly appropriate for examining the sleep variability (ie, night-to-night variability) in patients with insomnia Actigraphy is also appropriate for the assessment of and stability of treatment effects of anything from hypnotic drugs to light treatment to CPAP, particularly if assessments are done before and after the start of treatment A recent independent review of the actigraphy literature by Sadeh and Acebo reached many of these same conclusions Some of the research studies failed to find relationships between sleep measures and health-related symptoms The interpretation of these data is also not clear-cut Is it that the actigraph is not reliable enough to the access the relationship between sleep changes and quality of life measures, or, is it that, in fact, there is no relationship between sleep in that population and quality of life measures? Other studies of sleep disordered breathing, where actigraphy was not used and was not an outcome measure also failed to find any relationship with quality of life Is it then the actigraph that is not reliable or that the associations just do not exist? The one area where actigraphy can be used for clinical diagnosis is in the evaluation of circadian rhythm disorders Actigraphy has been shown to be very good for identifying rhythms Results of actigraphic recordings correlate well with measurements of melatonin and of core body temperature rhythms Activity records also show sleep disturbance when sleep is attempted at an unfavorable phase of the circadian cycle Actigraphy therefore would be particularly good for aiding in the diagnosis of delayed or advanced sleep phase syndrome, non-24-hour-sleep syndrome and in the evaluation of sleep disturbances in shift workers It must be remembered, however, that overt rest-activity rhythms are susceptible to various masking effects, so they may not always show the underlying rhythm of the endogenous circadian pacemaker In conclusion, the latest set of research articles suggest that in the clinical setting, actigraphy is reliable for evaluating sleep patterns in patients with insomnia, for studying the effect of treatments designed to improve sleep, in the diagnosis of circadian rhythm disorders (including shift work), and in evaluating sleep in individuals who are less likely to tolerate PSG, such as infants and demented elderly While actigraphy has been used in research studies for many years, up to now, methodological issues had not been systematically addressed in clinical research and practice Those issues have now been addressed and actigraphy may now be reaching the maturity needed for application in the clinical arena
2,716 citations
1 Jan 2003
TL;DR: Wang et al. as discussed by the authors reviewed the current knowledge about the role of actigraphy in the evaluation of sleep disorders and concluded that actigraphys can provide useful information and that it may be a cost-effective method for assessing specific sleep disorders.
Abstract: 1.0 BACKGROUND ACTIGRAPHY HAS BEEN USED TO STUDY SLEEP/WAKE PATTERNS FOR OVER 20 YEARS. The advantage of actigraphy over traditional polysomnography (PSG) is that actigraphy can conveniently record continuously for 24-hours a day for days, weeks or even longer. In 1995, Sadeh et al.,1 under the auspices of the American Sleep Disorders Association (now called the American Academy of Sleep Medicine, AASM), reviewed the current knowledge about the role of actigraphy in the evaluation of sleep disorders. They concluded that actigraphy does provide useful information and that it may be a “cost-effective method for assessing specific sleep disorders...[but that] methodological issues have not been systematically addressed in clinical research and practice.” Based on that task force’s report, the AASM Standards of Practice Committee concluded that actigraphy was not indicated for routine diagnosis or for assessment of severity or management of sleep disorders, but might be a useful adjunct for diagnosing insomnia, circadian rhythm disorders or excessive sleepiness.2 Since that time, actigraph technology has improved, and many more studies have been conducted. Several review papers have concluded that wrist actigraphy can usefully approximate sleep versus wake state during 24 hours and have noted that actigraphy has been used for monitoring insomnia, circadian sleep/wake disturbances, and periodic limb movement disorder.3,4 This paper begins where the 1995 paper left off. Under the auspices of the AASM, a new task force was established to review the current state of the art of this technology.
1,919 citations
TL;DR: These evidence-based practice parameters are an update to the Practice Parameters for the Use of Actigraphy in the Clinical Assessment of Sleep Disorders, published in 1995 and developed by the Standards of Practice Committee and reviewed and approved by the Board of Directors of the American Academy of Sleep Medicine.
Abstract: Actigraphy is a method used to study sleep-wake patterns and circadian rhythms by assessing movement, most commonly of the wrist. These evidence-based practice parameters are an update to the Practice Parameters for the Use of Actigraphy in the Clinical Assessment of Sleep Disorders, published in 1995. These practice parameters were developed by the Standards of Practice Committee and reviewed and approved by the Board of Directors of the American Academy of Sleep Medicine. Recommendations are based on the accompanying comprehensive review of the medical literature regarding the role of actigraphy, which was developed by a task force commissioned by the American Academy of Sleep Medicine. The following recommendations serve as a guide to the appropriate use of actigraphy. Actigraphy is reliable and valid for detecting sleep in normal, healthy populations, but less reliable for detecting disturbed sleep. Although actigraphy is not indicated for the routine diagnosis, assessment, or management of any of the sleep disorders, it may serve as a useful adjunct to routine clinical evaluation of insomnia, circadian-rhythm disorders, and excessive sleepiness, and may be helpful in the assessment of specific aspects of some disorders, such as insomnia and restless legs syndrome/periodic limb movement disorder. The assessment of daytime sleepiness, the demonstration of multiday human-rest activity patterns, and the estimation of sleep-wake patterns are potential uses of actigraphy in clinical situations where other techniques cannot provide similar information (e.g., psychiatric ward patients). Superiority of actigraphy placement on different parts of the body is not currently established. Actigraphy may be useful in characterizing and monitoring circadian rhythm patterns or disturbances in certain special populations (e.g., children, demented individuals), and appears useful as an outcome measure in certain applications and populations. Although actigraphy may be a useful adjunct to portable sleep apnea testing, the use of actigraphy alone in the detection of sleep apnea is not currently established. Specific technical recommendations are discussed, such as using concomitant completion of a sleep log for artifact rejection and timing of lights out and on; conducting actigraphy studies for a minimum of three consecutive 24-hour periods; requiring raw data inspection; permitting some preprocessing of movement counts; stating that epoch lengths up to 1 minute are usually sufficient, except for circadian rhythm assessment; requiring interpretation to be performed manually by visual inspection; and allowing automatic scoring in addition to manual scoring methods.
721 citations
TL;DR: The findings support the validity of the Sleep Habits Survey estimates in comparison with diary and actigraphy, andStrengths and limitations for survey measures of high school students' usual sleep/wake patterns are discussed.
Abstract: Study Objectives: To examine the validity of self-reported survey estimates of sleep patterns in adolescents through a comparison of retrospective survey descriptions of usual school- and weekend-night sleep habits with diary-reported sleep patterns and actigraphically estimated sleep behaviors over a subsequent week. Design and Setting: High school students completed a Sleep Habits Survey about the previous 2 weeks and then wore an actigraph (AMI, Ardsley, NY) for 8 days while keeping a daily sleep diary. Matched-pair t tests assessed average differences between survey and diary reports and between survey and actigraph estimates. Pearson correlations assessed the extent to which survey reports were in agreement with diary reports and actigraphy estimates. Participants: 302 high school students (196 girls, 106 boys) in grades 912 from five high schools. Results: School-night survey total sleep times and wake times did not differ from sleep amounts reported in the diary or estimated by actigraphy; survey bedtimes were slightly earlier. On weekends, survey total sleep times and wake times were longer and later, respectively, than estimated with actigraphy and reported on diaries. Moreover, school- and weekendnight survey variables were significantly correlated both with diary and actigraphy variables. Strengths of the associations were consistently greater for school-night variables than the corresponding weekend-night variables. Conclusions: The findings support the validity of the Sleep Habits Survey estimates in comparison with diary and actigraphy. Strengths and limitations for survey measures of high school students’ usual sleep/wake patterns are discussed.
630 citations
TL;DR: The Bland and Altman concordance technique was revealed to be a powerful tool to evaluate how well actigraphy agreed with polysomnography, and appears to be the most adequate procedure for the assessment of concords.
Abstract: Study objectives Actigraphy is generally compared to polysomnography (PSG), which has been considered the gold standard for sleep studies. The objective of the present study was to evaluate the concordance between PSG and two previously proposed algorithms (Cole et al, 1992; Sadeh et al, 1994) to analyze actigraphic recordings. The minute-by-minute agreement rate was evaluated through calculation of sensitivity, specificity, and accuracy. Regarding the sleep parameters, the concordance was performed through the Bland and Altman technique. Design A night of adaptation to the sleep laboratory followed by simultaneous polysomnographic and actigraphic recordings throughout the night. Participants 21 healthy volunteers. Setting A sleep laboratory Interventions None. Results Ninety-one percent of all PSG epochs were correctly identified by both algorithms, and this accuracy is reasonably satisfactory. The actigraphy was a sensitive method, with values of 99% and 97% for Cole's and Sadeh's algorithms, respectively. However, actigraphy had a low specificity: 34% and 44% for Cole's and Sadeh's algorithms, respectively. The Bland and Altman technique showed that actigraphy systematically overestimated Sleep Latency, Total Sleep Time and Sleep Efficiency while it underestimated Intermittent Awakenings. Conclusions The results of this study show the utility of actigraphy as a useful method for assessment of sleep, despite its limitations regarding identification of waking epochs during sleep. The Bland and Altman concordance technique was revealed to be a powerful tool to evaluate how well actigraphy agreed with polysomnography. This technique, combined with calculations of sensitivity and specificity, appears to be the most adequate procedure for the assessment of concordance.
610 citations
TL;DR: Results showed that both morning and evening bright light resulted in more consolidated sleep at night, as measured with wrist actigraphy, and evening light increased the quality of the circadian activity rhythm.
Abstract: Sleep in the nursing home environment is extremely fragmented, possibly in part as a result of decreased light exposure. This study examined the effect of light on sleep and circadian activity rhythms in patients with probable or possible Alzheimer's disease. Results showed that both morning and evening bright light resulted in more consolidated sleep at night, as measured with wrist actigraphy. Evening light also increased the quality of the circadian activity rhythm, as measured by a 5-parameter extended cosine model (amplitude, acrophase, nadir, slope of the curve, and relative width of the peak and trough). Increasing light exposure throughout the day and evening is likely to have the most beneficial effect on sleep and on circadian rhythms in patients with dementia. It would behoove nursing homes to consider increasing ambient light in multipurpose rooms where patients often spend much of their days.
360 citations
TL;DR: It is demonstrated that sleep is significantly compromised in patients with AD and patients' perception of their sleep provides less detail and accuracy than actigraphy, which can provide an important outcome measure in clinical trials.
Abstract: Background: Patients with atopic dermatitis (AD) frequently report compromised quality of life because of disturbed sleep and daytime fatigue secondary to their skin disease, but few studies provide objective measurement of sleep change in this population. Objective: The purpose of this investigation was to contrast subjective and objective measures of sleep quality in patients with AD. Methods: Fourteen adult patients with AD and 14 adult control subjects with no skin disease wore actigraphs for 1 week and completed questionnaires about sleep, itch, and quality of life. Results: As measured by self-report and actigraphy, the AD group slept more poorly and reported more daytime fatigue than the control group. Actigraphy alone was correlated with itch and quality of life and was able to discriminate movement during sleep, number of awakenings, minutes asleep, and minutes awake. Conclusions: Results from this study demonstrate that sleep is significantly compromised in patients with AD. Patients' perception of their sleep provides less detail and accuracy than actigraphy. The actigraph is an objective, unobtrusive measure of sleep at home in patients with skin disease and can provide an important outcome measure in clinical trials. (J Allergy Clin Immunol 2003;111:598-602.)
165 citations
TL;DR: In this paper, a prospective study with a historic comparison group was conducted to characterize the function and quality of sleep in patients with irritable bowel syndrome (IBS) and found that IBS patients had more than 70% less slow-wave stage sleep (45 +/- 73% vs 193 +/- 129%; P = 0006), compensated by increased stage 2 sleep (722 +/- 66% vs 601 +/- 168%; P < 001) The IBS group had significant sleep fragmentation with a significantly higher arousal and awakening index (P < 0001), a longer wake period after sleep
Abstract: STUDY OBJECTIVE To characterize the function and quality of sleep in patients with irritable bowel syndrome (IBS) DESIGN A prospective study with a historic comparison group SETTING A regional hospital that also serves as a tertiary referral center PATIENTS Eighteen patients with IBS and a comparison group of 20 matched adults with mild benign snoring INTERVENTIONS A polysomnography study and a wrist actigraphy study MEASUREMENTS All subjects underwent sleep studies and completed self-report questionnaires (IBS severity, psychosocial variables, sleep function, and Epworth Sleepiness Scale) Fourteen IBS and 11 comparison patients underwent actigraphy RESULTS The IBS patients had more than 70% less slow-wave stage sleep (45 +/- 73% vs 193 +/- 129%; P = 0006), compensated by increased stage 2 sleep (722 +/- 66% vs 601 +/- 168%; P = 001) The IBS group had significant sleep fragmentation with a significantly higher arousal and awakening index (P < 0001), a longer wake period after sleep onset (P = 002), and more downward shifts to lighter sleep stages (P = 001) The 4-night actigraphy study supported the polysomnography findings The sleep fragmentation index was significantly higher (P = 0008) in the IBS group The IBS patients reported greater daytime sleepiness (90 +/- 48 vs 64 +/- 48, Epworth Sleepiness Scale score, P < 001) and greater impairment in quality of life, which correlated significantly with the sleep fragmentation indexes The difference between the groups was not due to differences in baseline anxiety/depression levels CONCLUSIONS Patients with IBS have impaired sleep quality, reduced slow-wave sleep activity, and significant sleep fragmentation The cause-and-effect relationship of these findings with patients' daytime symptoms should be studied further
108 citations
TL;DR: Self-reported sleep quality and fatigue are associated with behavioral indicators of sleep quality at home in women with FM and actigraphy is a useful objective measure of improved sleep outcomes in intervention studies.
Abstract: Background: Limited data are available on the relationship between self-reported sleep quality, fatigue, and behavioral sleep patterns in women with fibromyalgia (FM). Objectives: To compare self-reported sleep quality, fatigue, and behavioral sleep indicators obtained by actigraphy between women with FM and sedentary women without pain, and to examine relationships among these variables. Methods: Twenty-three women with FM (M = 47.3, ′ 6.7 years) and 22 control women (M = 43.5, ′ 8.2 years) wore an actigraph on the nondominant wrist for 3 consecutive days at home. Each day women reported bedtimes, rise times, and ratings of sleep quality and fatigue in a diary. Self-reported sleep quality, fatigue, and indicators of sleep quality obtained from actigraphy (e.g., total sleep time, sleep efficiency, sleep latency, wake after sleep onset, and fragmentation index) were averaged. The Mann Whitney U test was used to assess group differences. Pearson Product Moment Correlation was used to evaluate relationships between sleep quality and fatigue, and among sleep quality, fatigue, and actigraphy sleep indicators. Results: Women with FM reported poorer sleep quality and more fatigue compared to controls (both p <.001). Actigraphy sleep indicators were not different between groups. In women with FM but not in controls, self-reported sleep quality was directly related to actigraphy indicators of total sleep time (r =.635, p <.01) and inversely related to sleep fragmentation (r = -.46, p <.05), Fatigue in women with FM was directly related to actigraphy indicators of wake after sleep onset (r =.57, p <.01), and inversely related to sleep efficiency (r = -.545, p <.01). Discussion: Self-reported sleep quality and fatigue are associated with behavioral indicators of sleep quality at home in women with FM. Actigraphy is a useful objective measure of improved sleep outcomes in intervention studies.
108 citations
TL;DR: The results of two studies fail to support epidemiologic data on the value of exercise for sleep, but are consistent with experimental evidence showing only modest effects of exercise on sleep.
96 citations
TL;DR: In this group of young adult males (mean age 19 years), there was a better overall adaptation to the early morning sleep, perhaps related to the general tendency in most adolescents to present some phase-delay during late teen-aged years.
TL;DR: Melatonin did not significantly improve any sleep parameter measured in either group, and 5 mg of fast release melatonin taken at bedtime does not improve the quality of sleep in older people with age-related sleep maintenance problems.
Abstract: Study objective: to determine whether melatonin will improve quality of sleep in healthy older people with age-related sleep maintenance problems. Design: a double blind randomised placebo controlled crossover trial in healthy older volunteers. Setting: a largely urban population, Auckland, New Zealand. Participants: participants were part of the larger Possible Role of Melatonin in Sleep of Elders study. People 65 years or more of age were recruited through widespread advertising. We screened 414 potential participants by mail using the Pittsburgh Sleep Quality Index, and selected 194 for clinic interview. Exclusions included depression, cognitive impairment, hypnosedative medications, sleep phase abnormalities, medical and/or environmental problems that might impair sleep. Twenty normal and 20 problem sleepers were randomly allocated for this study from a larger sample of 60 normal and 60 problem sleepers. Measurements and results: 24-hour urine 6-sulphatoxymelatonin was measured to estimate melatonin secretion in each participant. Five milligrams of melatonin, or matching placebo were each taken at bedtime for 4 weeks, separated by a 4-week washout period. Sleep quality was measured using sleep diaries, the Leeds Sleep Evaluation Questionnaire, and actigraphy. There was a significant difference between the groups in self-reported sleep quality indicators at entry, but no difference in melatonin secretion. Melatonin did not significantly improve any sleep parameter measured in either group. Conclusion: 5 mg of fast release melatonin taken at bedtime does not improve the quality of sleep in older people with age-related sleep maintenance problems.
TL;DR: In this article, the authors evaluated the ability of the device to discriminate sleep/wake patterns during nighttime and during napping, and found that the performance of the WristCare® and actigraphy were similar.
Abstract: Study Objective: Vivago WristCare® is a new activity monitoring device, which allows long-term online monitoring of the activity of the user. This study evaluates the ability of the device to discriminate sleep/wake patterns during nighttime and during napping. Design: Participants spent one night in the sleep laboratory where signals from polysomnography, actigraphy and WristCare® were acquired. In addition, actigraphy and WristCare® were used for 3-6 days for nap-analysis. Setting: NA Patients or Participants: Participants were 32 adults aged 26-89 years. The participants were studied in three study groups: all subjects, senior subjects (age>65 years) and middle-aged subjects (age<65 years). Interventions: NA. Results: Sleep/wake patterns were extracted from polysomnography, actigraphy and WristCare® for the night slept in sleep laboratory. The agreement percents between the scorings of polysomnography and actigraphy, and between polysomnography and WristCare® were about 80 % for all study groups. As total sleep time was estimated and the algorithm was optimized for this measure, the performance of the WristCare® and actigraphy were similar. Both actigraphy and WristCare® overestimated appreciably total sleep time (TST). Also in nap-analysis, actigraphy and WristCare® performed similarly as the number of naps and the length of the naps were compared. Conclusions: The performance of the WristCare® can be assumed to be well comparable to actigraphy in sleep/wake studies. The study suggests that the device may be used in long-term monitoring of sleep/wake patterns with similar performance to actigraphy.
1 Jan 2003
TL;DR: The performance of the WristCare can be assumed to be well comparable to actigraphy in sleep/wake studies and the study suggests that the device may be used in long-term monitoring of sleep/ wake patterns with similar performance to actigy.
Abstract: Study Objective: Vivago WristCare is a new activity monitoring device, which allows long-term online monitoring of the activity of the user. This study evaluates the ability of the device to discriminate sleep/wake patterns during nighttime and during napping. Design: Participants spent one night in the sleep laboratory where signals from polysomnography, actigraphy and WristCare were acquired. In addition, actigraphy and WristCare were used for 3-6 days for nap-analysis. Setting: NA Patients or Participants: Participants were 32 adults aged 26-89 years. The participants were studied in three study groups: all subjects, senior subjects (age>65 years) and middle-aged subjects (age<65 years). Interventions: NA. Results: Sleep/wake patterns were extracted from polysomnography, actigraphy and WristCare for the night slept in sleep laboratory. The agreement percents between the scorings of polysomnography and actigraphy, and between polysomnography and WristCare were about 80 % for all study groups. As total sleep time was estimated and the algorithm was optimized for this measure, the performance of the WristCare and actigraphy were similar. Both actigraphy and WristCare overestimated appreciably total sleep time (TST). Also in nap-analysis, actigraphy and WristCare performed similarly as the number of naps and the length of the naps were compared. Conclusions: The performance of the WristCare can be assumed to be well comparable to actigraphy in sleep/wake studies. The study suggests that the device may be used in long-term monitoring of sleep/wake
TL;DR: In this article, the authors examined the feasibility of training caregivers to implement sleep hygiene recommendations in dementia patients and found that caregivers in active treatment were more successful in setting goals related to sleep scheduling and increasing daytime activity than control caregivers who received written materials only.
Abstract: Objectives: To examine the feasibility of training caregivers to implement sleep hygiene recommendations in dementia patients.
Design: A randomized, controlled trial.
Setting: Community.
Participants: Twenty-two community-dwelling patients with Alzheimer's disease (AD) and their family caregivers.
Interventions: All participants received written materials describing age- and dementia-related changes in sleep and standard principles of good sleep hygiene. Caregivers in active treatment (n=10) also received specific recommendations about setting up and implementing a sleep hygiene program for the dementia patient. Control subjects (n=12) received general dementia education and caregiver support.
Measurements: Success implementing sleep hygiene recommendations was measured using daily log reports to calculate the percentage of days that caregivers reported that patients met individualized sleep scheduling, daytime-napping, and walking goals.
Results: Caregivers in active treatment were more successful in setting goals related to sleep scheduling and increasing daytime activity than control caregivers who received written materials only. Among patients who were candidates for sleep hygiene changes, active treatment subjects were also significantly (P<.01) more likely than controls to maintain a consistent bedtime (83% vs 38% of days attempted) and a consistent rising time (96% vs 59%), to nap less during the day (70% vs 28%), and to walk daily (86% vs 7%).
Conclusion: This study provides evidence that sleep hygiene interventions are feasible with community-dwelling AD patients. Caregivers were able to help patients change sleep scheduling, napping, and walking routines, but clinicians who recommend sleep hygiene changes for their dementia patients should be aware that many caregivers need active assistance setting up and implementing a sleep hygiene program. Simply providing caregivers with education is often insufficient.
TL;DR: A moderate proportion of adults experience postoperative sleeping problems, and those who had higher state anxiety in the holding area also had more difficulty sleeping over the 4-day monitoring period.
TL;DR: Paradoxical intention (PI) is a cognitive treatment approach for sleep-onset insomnia as discussed by the authors, which aims to eliminate voluntary sleep effort, thereby ameliorating sleep performance anxiety, an aroused state incompatible with sleep.
Abstract: Paradoxical Intention (PI) is a cognitive treatment approach for sleep-onset insomnia. It is thought to operate by eliminating voluntary sleep effort, thereby ameliorating sleep performance anxiety, an aroused state incompatible with sleep. However, this remains untested. Moreover, few PI studies have employed objective sleep measures. The present study therefore examined the effect of PI on sleep effort, sleep anxiety and both objective and subjective sleep. Following a seven-night baseline, 34 sleep-onset insomniacs were randomly allocated to 14 nights of PI, or to a control (no PI) condition. Consistent with the performance anxiety model, participants allocated to PI, relative to controls, showed a significant reduction in sleep effort, and sleep performance anxiety. Sleep-onset latency (SOL) differences between PI participants and controls using an objective sleep measure were not observed, although an underlying trend for significantly lowered subjective SOL amongst PI participants was demonstrated. This may relate to actigraphic insensitivity, or more probably confirms recent suggestions that insomniacs readily overestimate sleep deficit, due to excessive anxiety about sleep. Together, results help determine putative mechanisms underlying PI, have important implications for the clinical application of PI, and emphasize the need for further PI research within an experimental cognitive framework.
TL;DR: The rhythm of elderly subjects hospitalized in the acute care unit is severely altered during the initial period and is progressively resynchronized following clinical improvement, under the acute underlying disease and/or aging, environmental conditions should be considered to maintain regular rest–activity rhythm.
Abstract: Hospitalization for acute illness is a major risk factor of rest-activity rhythm disturbance among elderly subjects. The rest-activity rhythm is disturbed by the acute illness, aging and hospital environment. The purpose of this study is to assess the rest-activity rhythm and light exposure (using a wrist worn actigraph) of 10 patients (mean age 81 years, seven females) admitted on an acute care unit, suffering from cardiac, respiratory or renal acute disease. A non-parametric method was used to analyze activity data. With an improvement of the underlying diseases, the mean relative amplitude of rhythm increased from 0.31 +/- 0.19 for the first 5-day period after admission to 0.54 +/- 0.21 for the second period before discharge (P < 0.05). The amount of time at night spent above a lighting threshold of 50 lux decreased from 31.4 to 12.3 min between the two periods. The rhythm of elderly subjects hospitalized in the acute care unit is severely altered during the initial period and is progressively resynchronized following clinical improvement. Under the acute underlying disease and/or aging, environmental conditions (light, noise) should be considered to maintain regular rest-activity rhythm.
TL;DR: It is concluded that there is a convincing body of evidence for the utility of actigraphy as a technique in human psychopharmacology.
Abstract: Over the last 25 years wrist actigraphy has predominantly been used in sleep research and chronobiology where the technique has proved useful in the measurement of sleep and the characterisation of the sleep/wake cycle. Whilst there are a large number of studies published that have used actigraphy, there have only been relatively few studies that have shown that the technique is capable of measuring drug-induced changes in nocturnal and/or diurnal behaviour. Thus the use of actigraphy to measure drug effects in clinical trials has up till now remained on the periphery of psychopharmacology. However this may be because of the disparate nature of the studies published rather than lack of usefulness. This paper reviews the relevant literature and in doing so concludes that there is a convincing body of evidence for the utility of actigraphy as a technique in human psychopharmacology.
TL;DR: Home polysomnography is a viable option for evaluating patients with moderate or high clinical suspicion for sleep-disordered breathing, however, patients with failed or equivocal home studies and those with negative studies but persistent symptoms should undergo standard polysOMnography.
Abstract: Purpose of review There is growing awareness of the significance of obstructive sleep apnea in the general population and in the medical community and, as a result, there is a growing demand for diagnosis and treatment. Attended, in-laboratory polysomnography is resource intensive and not readily available in some communities. Alternate diagnostic strategies have been proposed including the use of home sleep studies. Although these portable systems have been in use for many years, only in the past few years have a significant number of studies been performed to evaluate these systems in the home setting. The use of actigraphy and peripheral arterial tonometry for diagnostic purposes has also recently been investigated. Recent findings In the laboratory setting, measurements of sleep-disordered breathing with specific portable sleep systems correspond well with measurements provided by standard polysomnography. In the home setting, portable systems demonstrate several important limitations including lost or inadequate data collection, logistic concerns, and mildly reduced diagnostic accuracy. Data regarding the potential cost benefit of home studies is inconclusive. Summary Home polysomnography is a viable option for evaluating patients with moderate or high clinical suspicion for sleep-disordered breathing. However, patients with failed or equivocal home studies and those with negative studies but persistent symptoms should undergo standard polysomnography. Further investigations are needed to compare long-term outcomes in patients evaluated using portable devices versus standard polysomnography.
TL;DR: It is shown that fatigue can be repeatedly assessed with an ambulatory device and that self-reported fatigue levels vary enormously from hour to hour in a healthy normal sample.
Abstract: Objective: The four objectives of this study were to test the ability of a 1-item fatigue scale to correlate with the fatigue subscale of the Profile of Mood States (POMS), to test the acceptability of recording hourly fatigue ratings, to examine the chronobiological variation in self-reports of fatigue, and finally to examine the degree to which self-report of fatigue correlated with actigraphy findings. Methods: Ten healthy normal controls completed the POMS fatigue subscale hourly for three days. The same 10 healthy subjects wore an actigraph for 72 consecutive hours. The actigraph was modified to incorporate two event buttons which subjects were asked to push hourly to report their level of fatigue. Results: The 1-item fatigue rating correlated significantly (mean r v = v 0.61) with the rest of the POMS subscale for fatigue. Subjects had no difficulty using the event button on the actigraph in entering the 1-item fatigue ratings. Fatigue ratings revealed marked differences in how healthy subje...
TL;DR: The results, while preliminary, suggest that short-term actigraphy may be apt to reflect central nervous system arousal, and that occipital and temporoparietal β1 power was statistically significantly higher in patients with higher activity scores and lower in those with a high density of sleep (SB) or wake bouts (WB).
Abstract: Actigraphy is a quantitative method for the measurement of motor activity In the present study, actigraphy was used to examine psychomotor correlates of brain activity Thirty-four psychiatric patien
TL;DR: It is suggested that elderly people often have naps that are not subjectively recognized as naps, and countermeasures such as improvement of the light environment and short-time naps are recommended to rouse elderly people from a sleepy state.
Abstract: Fourteen elderly people (mean age 73.8 years) kept a sleep log for 4–7 days, and their wrist-activity was monitored simultaneously. Their sleep onset and wake-up times, assessed by using actigraphy, were 21:04 and 05:51 hours, respectively, and these were advanced compared with young adults (00:45 and 07:34 hours, respectively). Elderly people often had naps actigraphically in the afternoon. There were marked discrepancies between the actigraphic sleep-wake state and sleep log in the afternoon and evening. Our observation implies that elderly people often have naps that are not subjectively recognized as naps. To rouse elderly people from a sleepy state, countermeasures such as improvement of the light environment and short-time naps are recommended.
Journal Article•
TL;DR: The sleep efficiency and total sleep time are highly correlated in PSG and actigraphy, and OSAS had a significantly higher movement and fragmentation index (MFI) than that of primary insomnia.
Abstract: Background : Although actigraphy has been used to evaluated sleep-wake patterns and quality of sleep disorders patients, its usefulness in obstructive sleep apnea syndrome (OSAS) and primary insomnia is unclear. To investigate the value of actigraphy in OSAS and differentiating OSAS from primary insomnia, night polysomnography (PSG) and actigraphy were performed simultaneously. Methods : 31 OSAS patients and 21 primary insomnia patients were included (16 females, 36 males). Sleep latency, total sleep time, sleep efficiency and actual wake time, movement and fragmentation index (MFI) were obtained in actigraphy and compared with PSG results. Spearmann correlation analysis and Mann-Whitney U test were used. Results : The sleep efficiency and total sleep time are highly correlated in PSG and actigraphy (p0.05). OSAS had a significantly higher movement and fragmentation index (MFI) than that of primary insomnia (p
1 Jan 2003
TL;DR: Polysomnography (PSG) has come to be viewed as the single most important laboratory technique for assessment of sleep and its disorders and for diagnosis and differential diagnosis of abnormal movements during sleep at night as discussed by the authors.
Abstract: Publisher Summary Scientific progress in the laboratory evaluation of sleep and its disorders has been rather slow; however, great advances have been made in the last century. The driving forces in this understanding have been the discovery of the human electroencephalogram (EEG) by Berger and rapid eye movements (REMs) during sleep by Aserinsky and Kleitman. Polysomnography (PSG) has come to be viewed as the single most important laboratory technique for assessment of sleep and its disorders and for diagnosis and differential diagnosis of abnormal movements during sleep at night. PSG refers to recordings of multiple physiological characteristics during sleep, whereas polygraphy denotes recordings of similar characteristics during any time of the day. The first polygraphic study to record motor activities during sleep was probably reported by Oswald in 1959 under the title of “sudden bodily jerks on falling asleep”. This chapter briefly outlines PSG recording techniques, indications for PSG, simultaneous video-PSG, and pertinent PSG findings in selected sleep disorders, computerized PSG, recording artifacts, and related laboratory procedures for assessment of patients with movement disorders with or without complex behavior during sleep including multiple sleep latency test (MSLT), maintenance of wakefulness test (MWT) and actigraphy.
1 Jan 2003
TL;DR: In this article, the authors examined the effects of a "constructive worry" procedure in an undergraduate population with impaired sleep and found that the worry resulted in decreased pre-sleep cognitive and overall arousal relative to the control group and relative to baseline scores.
Abstract: Worry is often reported as interfering with sleep onset and sleep maintenance, and pre-sleep cognitive arousal can persist after successful behavioral treatment of insomnia. The present investigation will examine the effects of a “constructive worry” procedure in an undergraduate population with impaired sleep. Thirty-three undergraduate students who reported three or more nights per week in the last month of sleep onset and/or sleep maintenance problems, either recorded worries and possible solutions (experimental CW group) or recorded worries and completed worry questionnaires (control Worry group) for five nights. As hypothesized, the CW group had decreased pre-sleep cognitive and overall arousal relative to the Worry group and relative to baseline scores. Although the CW group reported decreased cognitive arousal, there were no significant effects on somatic arousal, anxiety, Sleep Diary or actigraphy sleep variables. Suggestions for future investigations, and potential implications for the treatment of insomnia are discussed.
1 Jan 2003
TL;DR: Zucconi et al. as mentioned in this paper evaluated the efficacy and safety of cabergoline, a dopamine-receptor agonist with a long half-life, in restless legs syndrome (RLS).
Abstract: Study Objectives: To evaluate the efficacy and the safety of cabergoline, a dopamine-receptor agonist with a long half-life, in restless legs syndrome (RLS). Design: A 2 month, single blind ,open labeled clinical trial. Patients were evaluated with polysomnography at baseline (B), following 1 week of placebo (T0), and after 1 week (T1) and 2 months (T2) of cabergoline treatment. The clinical global impression was assessed using International RLS Study Group Rating Scale and nocturnal actigraphy. Setting: Sleep Disorders Center. Patients: Twelve patients with moderate to severe RLS (mean age 56.6 years) who were naive to treatment with dopaminergic agents. Interventions: Upward titration of cabergoline (from 0.5 mg to 2 mg) in a single evening dose. Measurements and Results: Ten patients completed the study (mean dose, 1.1 mg), and all showed an improvement of RLS symptoms. The results from the International RLS Study Group Rating Scale showed similarities between B (24.3±2.9) and T0 (23.1±5.9; P=0.6), with significant improvement at T1 (12.5±6.0; P=0.01 vs B and T0) and T2 (9.8±6.9; P=0.001 vs B and P=0.005 vs T0). The mean nocturnal activity value measured by actigraphy during week 1 decreased from T0 (19.8±9.3) to T1 (13.6±6.4) and dropped significantly at T2 (8.5±5.3; P=0.05). Nine patients continued the treatment up to 12 months with consistent efficacy, few side effects, and no augmentation Conclusions: Low doses of cabergoline showed effectiveness and safety in patients with moderate to severe RLS, with no appearance of augmentation phenomenon. Double blind, crossover, polysomnographic studies are necessary to confirm this preliminary data. Citation: Zucconi M; Oldani A; Castronovo C; Ferini-Strambi l. Cabergoline is an effective single-drug treatment for restless legs syndrome: clinical and actigraphic evaluation. SLEEP 2003;26(7):815-8.
TL;DR: The results suggest that actigraphy is a useful device for measuring treatment response and that it should be used as a complement to sleep-diary evaluation.
Abstract: Objective The present study explores the clinical utility and sensitivity of actigraphy as an outcome measure in the treatment of chronic insomnia. Design Following a screening-adaptation night, polysomnography, actigraphy, and sleep-diary data were collected in the sleep laboratory for 2 baseline nights and 2 posttreatment nights. Setting A university-affiliated sleep disorders center. Participants Seventeen participants with chronic primary insomnia. Mean age was 41.6 years. Interventions Participants took part in a treatment protocol investigating different sequential treatments for insomnia (these results are reported elsewhere). Measurements and results Compared to polysomnography, both actigraphy and sleep-diary instruments underestimated total sleep time and sleep efficiency and overestimated total wake time. Also, actigraphy underestimated sleep-onset latency while the sleep diary overestimated it as compared to polysomnography. Actigraphy data were more accurate than sleep-diary data when compared to polysomnography. Finally, actigraphy was sensitive in detecting the effects of treatment on several sleep parameters. Conclusions These results suggest that actigraphy is a useful device for measuring treatment response and that it should be used as a complement to sleep-diary evaluation.
TL;DR: Singer et al. as discussed by the authors evaluated the safety and efficacy of 2 dose formulations of melatonin for the treatment of insomnia in patients with Alzheimer's disease and found no statistically significant differences in objective sleep measures.
Abstract: Objectives: To determine the safety and efficacy of 2 dose formulations of melatonin for the treatment of insomnia in patients with Alzheimer's disease. Design: A multicenter, randomized, placebo-controlled clinical trial of 2 dose formulations of oral melatonin coordinated by the National Institute of Aging-funded Alzheimer's Disease Cooperative Study. Subjects with Alzheimer's disease and nighttime sleep disturbance were randomly assigned to 1 of 3 treatment groups: placebo, 2.5-mg slow-release melatonin, or 10-mg melatonin. Setting: Private homes and long-term care facilities. Participants: 157 individuals were recruited by 36 Alzheimer's disease research centers. Subjects with a diagnosis of Alzheimer's disease were eligible if they averaged less than 7 hours of sleep per night (as documented by wrist actigraphy) and had 2 or more episodes per week of nighttime awakenings reported by the caregiver. Measurements: Nocturnal total sleep time, sleep efficiency, wake-time after sleep onset, and day-night sleep ratio during 2- to 3-week baseline and 2-month treatment periods. Sleep was defined by an automated algorithmic analysis of wrist actigraph data. Results: No statistically significant differences in objective sleep measures were seen between baseline and treatment periods for the any of the 3 groups. Nonsignificant trends for increased nocturnal total sleep time and decreased wake after sleep onset were observed in the melatonin groups relative to placebo. Trends for a greater percentage of subjects having more than a 30-minute increase in nocturnal total sleep time in the 10-mg melatonin group and for a decline in the day-night sleep ratio in the 2.5-mg sustained-release melatonin group, compared to placebo, were also seen. On subjective measures, caregiver ratings of sleep quality showed improvement in the 2.5-mg sustained-release melatonin group relative to placebo. There were no significant differences in the number or seriousness of adverse events between the placebo and melatonin groups. Conclusions: Based on actigraphy as an objective measure of sleep time, melatonin is not an effective soporific agent in people with Alzheimer's disease. Citation: Singer C; Tractenberg RE; Kaye J et al. A multicenter, placebo-controlled trial of melatonin for sleep disturbance in Alzheimer's disease.