This is the current release of this guideline.

This guideline updates a previous version: American Sleep Disorders Association. Practice parameters for the use of actigraphy in the clinical assessment of sleep disorders. Sleep - Europe 1995 May;18(4):285-7.

The levels of recommendations (Standard, Guideline Option) and levels of evidence (I-V) are defined at the end of the "Major Recommendations" field.

Use of Actigraphy in the Evaluation of Sleep Disorders

Actigraphy is a valid way to assist in determining sleep patterns in normal, healthy adult populations (Standard), and in patients suspected of certain sleep disorders. (Option-Guideline-Standard; see specific parameter below)

Actigraphy is indicated to assist in the evaluation of patients suspected of advanced sleep phase syndrome (ASPS), delayed sleep phase syndrome (DSPS), and shift work sleep disorder (Guideline); and circadian rhythm disorders, including jet lag and non-24-hour sleep/wake syndrome [including that associated with blindness] (Option)

When polysomnography is not available, actigraphy is indicated as a method to estimate total sleep time in patients with obstructive sleep apnea syndrome. Combined with a validated way of monitoring respiratory events, use of actigraphy may improve accuracy in assessing the severity of obstructive sleep apnea compared with using time in bed. (Standard)

Actigraphy is indicated as a method to characterize circadian rhythm patterns or sleep disturbances in individuals with insomnia, including insomnia associated with depression. (Option)

Actigraphy is indicated as a way to determine circadian pattern and estimate average daily sleep time in individuals complaining of hypersomnia (Option).

Use of Actigraphy in Assessing the Response to Therapy of Sleep Disorders

Actigraphy is useful as an outcome measure in evaluating the response to treatment for circadian rhythm disorders. (Guideline)

Actigraphy is useful for evaluating the response to treatment for patients with insomnia, including insomnia associated with depressive disorders. (Guideline)

Use of Actigraphy in Special Populations and Special Situations

Actigraphy is useful for characterizing and monitoring sleep and circadian rhythm patterns and to document treatment outcome (in terms of sleep patterns and circadian rhythms) among older adults living in the community, particularly when used in conjunction with other measures such as sleep diaries and/or caregiver observations. (Guideline)

Actigraphy is indicated for characterizing and monitoring sleep and circadian rhythm patterns and to document treatment outcome (in terms of sleep patterns and circadian rhythms) among older nursing home residents (in whom traditional sleep monitoring by polysomnography can be difficult to perform and/or interpret). (Guideline)

Actigraphy is indicated for delineating sleep patterns, and to document treatment responses in normal infants and children (in whom traditional sleep monitoring by polysomnography can be difficult to perform and/or interpret), and in special pediatric populations. (Guideline)

Definitions:

Levels of Recommendations

Standard: This is a generally accepted patient-care strategy, which reflects a high degree of clinical certainty. The term standard generally implies the use of Level 1 evidence, which directly addresses the clinical issue, or overwhelming Level 2 evidence.

Guideline: This is a patient-care strategy, which reflects a moderate degree of clinical certainty. The term guideline implies the use of Level 2 evidence or a consensus of Level 3 evidence.

Option: This is a patient-care strategy, which reflects uncertain clinical use. The term option implies either inconclusive or conflicting evidence or conflicting expert opinion.

Evidence Levels

1. Blind, prospective comparison of results obtained by actigraphy to those obtained by a reference standard* on an appropriate spectrum of subjects and number of patients.
2. Comparison of results obtained by actigraphy to those obtained by a reference standard* but blinding not specified, not prospective, or on a limited spectrum of subjects or number of patients.
3. Comparison of results obtained by actigraphy to the mean value of a reference standard*, but not direct within-subject comparison, or otherwise methodologically limited.
4. Actigraphy compared to nonstandard reference or group differences shown:
   1. Adequate comparison of results obtained by actigraphy to those obtained by a non-standard reference*; or
   2. Actigraphy not compared to any reference, but actigraphy results demonstrated ability to detect significant difference between groups or conditions in well-designed trial.

5. Actigraphy not adequately compared to any reference, and either
   1. Actigraphy not used in a well-designed trial, or
   2. Actigraphy used in such a trial but did not demonstrate ability to detect significant difference between groups or conditions.

* Reference standards for actigraphic evaluation of sleep and circadian rhythms varied by diagnostic category, and included generally accepted "gold standards," applied in an acceptable manner. By diagnostic category, reference standards for insomnia included polysomnography (PSG) and/or sleep logs; for circadian rhythm sleep disorders, PSG, phase markers, and/or sleep logs; for sleep apnea, PSG; for restless legs syndrome and periodic limb movements during sleep, PSG; for infants, caregiver reported observations; for elderly or demented persons, phase markers, sleep logs, and/or caregiver reports; and for healthy controls, PSG, phase markers, or sleep logs. Nonstandard references include such items applied outside their diagnostic category, or other experimental monitors.

None provided

The type of supporting evidence is identified for each recommendation (see "Major Recommendations" field).

Not applicable: Guideline was not adapted from another source.

1995 (revised 2007 Apr)

American Academy of Sleep Medicine - Professional Association

American Academy of Sleep Medicine

Standards of Practice Committee

Committee Members: Timothy Morgenthaler, MD, Mayo Clinic, Rochester, MN; Cathy Alessi, MD, VA Greater Los Angeles Healthcare System-Sepulveda and University of California, Los Angeles; Leah Friedman, PhD, Stanford University School of Medicine, Stanford, CA; Judith Owens, MD, Rhode Island Hospital, Providence, RI; Vishesh Kapur, MD, University of Washington, Seattle, WA; Brian Boehlecke, MD, University of North Carolina, Chapel Hill, NC; Terry Brown, DO, St. Joseph Memorial Hospital, Murphysboro, IL; Andrew Chesson, Jr., MD, LSU Health Sciences Center in Shreveport, Shreveport, LA; Jack Coleman, MD, Murfreesboro Medical Center, Murfreesboro, TN; Teofilo Lee-Chiong, MD, National Jewish Medical and Research Center, Denver, CO; Jeffrey Pancer, DDS, Toronto, Canada; Todd J. Swick, MD, Houston Sleep Center, Houston, TX

All members of the American Academy of Sleep Medicine (AASM) Standards of Practice Committee (SPC) and Board of Directors (BOD) completed detailed conflict-of-interest statements and were found to have no conflicts of interest with regard to this subject.

This is the current release of this guideline.

This guideline updates a previous version: American Sleep Disorders Association. Practice parameters for the use of actigraphy in the clinical assessment of sleep disorders. Sleep - Europe 1995 May;18(4):285-7.

None available

None available

This summary was completed by ECRI on April 25, 1999. The information was verified by the guideline developer on May 24, 1999. This NGC summary was updated by ECRI Institute on May 25, 2007.

This NGC summary is based on the original guideline, which is subject to the guideline developer's copyright restrictions. Please contact the American Academy of Sleep Medicine (AASM) for information regarding reproduction of AASM guidelines.