Cpr Actigraphy

1.0 BACKGROUND

ACTIGRAPHY HAS BEEN USED TO STUDY SLEEP/WAKE PAT-TERNS FOR OVER 20 YEARS. The advantage of actigraphy over tra-ditional polysomnography (PSG) is that actigraphy can convenientlyrecord 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 Disor-ders Association (now called the American Academy of Sleep Medicine,AASM), reviewed the current knowledge about the role of actigraphy inthe evaluation of sleep disorders. They concluded that actigraphy doesprovide useful information and that it may be a “cost-effective methodfor assessing specific sleep disorders...[but that] methodological issueshave not been systematically addressed in clinical research and prac-tice.” Based on that task force’s report, the AASM Standards of PracticeCommittee concluded that actigraphy was not indicated for routine diag-nosis or for assessment of severity or management of sleep disorders,but might be a useful adjunct for diagnosing insomnia, circadian rhythmdisorders or excessive sleepiness.2 Since that time, actigraph technologyhas improved, and many more studies have been conducted. Severalreview papers have concluded that wrist actigraphy can usefully approx-imate sleep versus wake state during 24 hours and have noted that actig-raphy has been used for monitoring insomnia, circadian sleep/wake dis-turbances, and periodic limb movement disorder.3,4 This paper beginswhere the 1995 paper left off. Under the auspices of the AASM, a newtask force was established to review the current state of the art of thistechnology.

Actigraphs are devices generally placed on the wrist (although theycan also be placed on the ankle or trunk) to record movement. Collecteddata are downloaded to a computer for display and analysis of activi-ty/inactivity that in turn can be further analyzed to estimate wake/sleep.The latter technology is based on the observation that there is less move-ment during sleep and more movement during wake. As described inAncoli-Israel,5 the first actigraphs were developed in the early 1970’s.6-8

Kripke and colleagues were some of the first investigators to publishreliability data on the use of wrist actigraphy for the assessment ofsleep.9-11 Over the years, additional types of actigraphs were developedleading to the digital types used today.

Actigraphs today have movement detectors (e.g., accelerometers) andsufficient memory to record for up to several weeks. Movement is sam-pled several times per second and stored for later analysis. Computerprograms are used to derive levels of activity/inactivity, rhythm param-eters (such as amplitude or acrophase) and sleep/wake parameters (suchas total sleep time, percent of time spent asleep, total wake time, percentof time spent awake and number of awakenings).

2.0 OBJECTIVES

This paper reviews four major areas in which actigraphy is used forthe measurement of sleep or rhythms. The first area of review covers themore recent papers on the technology and validity of actigraphy. Sadehet al. concluded that the validation studies for normal subjects showedgreater than 90% agreement and were very promising.1 Actigraphs andcomputer programs using different algorithms to process the data havebeen commercially available for quite some time. Actigraphs differ inhow they detect and record movements and they use different method-ologies for computing activity levels. The output of the analysis pro-grams has been compared to the results of PSG and sleep diaries. Thissection reviews the results and evaluates the conclusions of these typesof studies.

The second area of review is of those studies examining actigraphy inpopulations with sleep disorders. Actigraphy is being used more often instudies of sleep disorders, either as an alternative to PSG, as an additionto partial unattended monitoring devices or for follow-up. This is espe-cially common in patients with complaints of insomnia.

In addition to gaining information about sleep, data collected overlong periods can be used to determine activity circadian rhythm cycles.Actigraphy is particularly useful for recording rhythms, as it is very dif-ficult to record PSG for 24-hours and almost impossible to record formore than 24-hours. The use of actigraphy in studies of circadianrhythms comprises the third area of review.

The fourth area of review is those studies in which actigraphy wasused as a treatment outcome measure or to examine the relationshipbetween sleep/activity patterns and demographic or clinical variables.Since actigraphy is easier to use, less invasive and substantially lessexpensive than PSG, actigraphy is often used in lieu of PSG in both clin-ical trials where it is necessary to determine the effect of a treatment onsleep and in studies requiring multiple measurements.

3.0 METHODS

As with the first review in 1995, the Standards of Practice Committeeof the American Academy of Sleep Medicine commissioned this updat-ed review. A Medline literature search was conducted from the year 1995to April 2002. Key words for the Medline search included actigraphy,actigraph, actigraphic recording, actimeter, actometer, wrist actigraph,actigraph recording, wrist activity, rest activity, activity, and sleep-wakeactivity, each paired with sleep, sleep disorders and sleep disorders-cir-cadian. Articles published prior to the original American Academy of

Actigraphy Review Paper—Ancoli-Israel et alSLEEP, Vol. 26, No. 3, 2003 342

The Role of Actigraphy in the Study of Sleep and Circadian Rhythms

AMERICAN ACADEMY OF SLEEP MEDICINE REVIEW PAPER

Sonia Ancoli-Israel PhD,1 Roger Cole PhD,2 Cathy Alessi MD,3 Mark Chambers PhD,4 William Moorcroft PhD,5 Charles P. Pollak MD6

1Department of Psychiatry, University of California, San Diego and Veterans Affairs San Diego Healthcare System, 2Synchrony Applied Health Sci-ences, Del Mar, CA, 92014, 3Geriatric Research, Education and Clinical Center; VA Greater Los Angeles Healthcare System and UCLA School ofMedicine, Multicampus Program in Geriatric Medicine and Gerontology, 4Private Practice, Las Vegas, Nevada, 5Colorado State University andNorthern Colorado Sleep Consultants, LLC, 6Department of Neurology, The Ohio State University

Citation: Ancoli-Israel S, Cole R, Alessi C et al. The role of actigraphy in the study of sleep and circadian rhythms. American Academy of Sleep MedicineReview Paper. SLEEP 2003;26(3):342-92.

Disclosure StatementSupported by: NIA AG08415, NCI CA85264, the Department of Veterans AffairsVISN-22 Mental Illness Research, Education and Clinical Center (MIRECC),the Research Service of the Veterans Affairs San Diego Healthcare System [toSAI]; NIA AG13885, VA HSRD IIR 01-053-1, the Department of Veterans AffairsGeriatric Research, Education and Clinical Center (GRECC) at the VA GreaterLos Angeles Healthcare System [to CA].

Address correspondence to: Sonia Ancoli-Israel, Ph.D., Department of Psychia-try, VASDHS, 3350 La Jolla Village Drive, San Diego, Ca 92161,USA. Tele-phone: 858 642-3828; Fax: 858 552-7536; email: [email protected]

Sleep Medicine’s (AASM) Practice Parameters for the Use of Actigra-phy in the Clinical Assessment of Sleep Disorders1 in 1995 were notincluded in the current update, and only articles written in English wereincluded.

A total of 171 articles were identified as potentially relevant based onthese Medline searches. All of these were obtained in full length andexamined. Upon review of these articles, approximately 30 additionalreferences were discovered by perling (i.e., checking the reference sec-tions for articles otherwise missed). These were references located in

publications not typically found through Medline. In an attempt toinclude all articles matching the stated criteria, task force members alsoadded any articles they discovered through their personal review of theliterature. All new articles published up to the point of the final draft ofthis manuscript (July 2002) were reviewed.

Only papers where actigraphs were used to measure some aspect ofsleep/wake activity or circadian rhythms were included. Papers that onlymeasured activity (without any reference to sleep) or that made mea-surements only in the daytime were excluded. Only papers published inEnglish, in peer-reviewed journals, were included. Case studies andreview articles were included in the narrative, but not in the evidencetables. No conference abstracts, even if published, were included. Paperswere categorized into four sections: Technology, Sleep Disorders, Circa-dian Rhythms, and Other Clinical Research.

Within each category, task force members were assigned to read eachpaper, summarize the relevant points for the evidence tables and rate thestudy according to the evidence levels shown in Table 1. Abbreviationsused in the evidence tables are described in Appendix A.

4.0 TECHNOLOGY

The technology section (see Table 2) includes studies that comparedfunctional differences between actigraphic devices, data acquisitionstrategies, and software programs. The question asked was, “How welldid the devices and the computer programs that process data, assessstates of sleep/wake and related phenomena?”

4.1 Data Acquisition

Mechanically, the first generation actigraphs were threshold-motiondetectors, which were nonlinear and failed to be sensitive enough todetect small movements.12 They also tended to saturate with modest lev-els of movement. Some of the newer actigraphs detect motion with lin-ear accelerometers in a single axis or multiple axes.12 Most single axisacceleration devices in use today use .25 to 2-3Hz bandpass filteringbefore data are stored, essentially eliminating very slow movements ofless than .25 Hz and movements faster than 2-3 Hz. This is consistentwith the early recommendations of Redmond and Hegge who noted thatvoluntary human movement rarely exceeds 3-4 Hz, and that involuntarymovements such as tremor and shivering exceed 5Hz.13 However, vanSomeren et al. suggested using 0.5-11Hz bandpass filters that wouldreduce gravitational artifacts while picking up some of the faster move-ments that occur in younger subjects.14

After motion is transduced into an analog electrical form, it is digi-tized and stored. Some aspects of these processes are programmable bythe user, such as the length of the epoch over which activity counts areaccumulated and stored. Other aspects of the digitizing are built into thedevice. One key component is how the analog signal is digitized: timeabove threshold, zero crossings, or integration (see Figure 1).

The “time above threshold” strategy cumulatively counts the amountof time per epoch that the level of the signal produced in response tomotion is above some threshold (commonly 0.1 to 0.2 g). Two potentialproblems with this strategy are that the degree to which the amplitude isabove threshold is ignored and that the acceleration of the movement isnot reflected.

The “zero-crossing method” counts the number of times per epochthat the activity signal level crosses zero (or very near zero). Threepotential problems with this approach are that the amplitude of themovement is ignored, the acceleration of movements is not registered,and high frequency artifacts may potentially be counted as considerablemovement.

“Digital integration” involves sampling the accelerometry output sig-nal at a high rate, then calculating the area under the curve for eachepoch. Rectifying the analog signal doubles the amount of data availablefor analysis. Digital integration reflects acceleration and amplitude ofmovement, however duration and frequency of movements are notshown.


Table 1—Levels of Evidence for Actigraphy

Level1 Grade2 Criteria 1 A Blind, prospective comparison of results obtained by actigraphy

to those obtained by a reference standard3 on an appropriate spec-trum of subjects and number of patients.

2 B Blind, prospective comparison of results obtained by actigraphyto those obtained by a reference standard3 on a limited spectrumof subjects or number of patients.

3 C Comparison of results obtained by actigraphy to those obtained by a reference standard3, but not blind, not prospective or other-wise methodologically limited.

4 C a - Adequate comparison of results obtained by actigraphy to those obtained by a non-standard reference3; orb - Actigraphy not compared to any reference, but actigraph results demonstrated ability to detect significant difference between groups or conditions in well-designed trial.

5 D Actigraphy not adequately compared to any reference, and eithera - Actigraph not used in a well-designed trial, orb - Actigraph used in such a trial but did not demonstrate abilityto detect significant difference between groups or conditions.

1 Level refers to level of evidence. 2 Grade refers to grade of recommendation.3 Reference standards for actigraphic evaluation of sleep and circadian rhythms mayinclude, as appropriate, polysomnography, oximetry, melatonin rhythms, core body tem-perature rhythms, and/or other generally accepted “gold standards,” applied in an accept-able manner. Non-standard references include such items as sleep logs, spousal reports,other experimental monitors, etc.

a. Time above threshold

b. Zero crossing

c. Digital integration

Figure 1—Three different methods for deriving activity counts in actigraphy. Panel A, timeabove threshold, derives the amount of time per epoch that the activity is above somedefined threshold (represented by a dashed line). Panel B, zero crossings, counts the num-ber of times the activity reaches zero (represented by the solid baseline) during the epoch.Panel C, digital integration, calculates the area under the curves represented by black shad-ing. (Based on Gorny and Spiro (15))

In direct comparisons of these three methods of deriving activitycounts, using the same movement input, digital integration was found tobe better for identifying movement amplitude than time above thresholdand both digital integration and time above threshold were better thanzero crossing.15 Some devices simultaneously utilize more than onemethod of acquiring data thus increasing the benefits and reducing thedeficits of utilizing only one method.

Many investigators have begun to report actigraphy data simply asactivity counts. However, different devices, different data collectionstrategies,12 and different scoring algorithms produce very differentcounts for the same activity.15 These differences have made direct com-parisons between laboratories and clinics difficult and contentious.Although relative changes in activity can be meaningful, more directcomparisons following computer processing of the data (such assleep/wake scoring) are more meaningful.

4.2 Data Processing

Actigraphy data today are generally processed by computers, after thedata are downloaded from the actigraphs, rather than by hand or eye.While most programs are designed to work with a specific device, someare intended to work with data produced by several, if not all, devices.Different programs often use different algorithms. However, there are nopublished articles comparing the different algorithms. Rather, publishedarticles present information about the accuracy and/or usefulness of theoutputs of specific computer programs. Before choosing an actigraph touse, two questions need to be asked and answered satisfactorily aboutsuch programs and the device(s) they work with:1. Is the output reliable, that is, how well does the same input result in

the same output?2. Is the output valid, that is, how well does the output actually measure

what it is purported to measure?There are only a few published reports of direct studies of reliability

between actigraphs and PSG. In general, when tested, actigraphy deviceshave been found to be reliable. Jean-Louis et al. compared new and oldinstruments of the same make and model in healthy adults and found nodifferences when the devices were worn on the same wrist (evidencelevel 3C).16 In a second study when healthy adults wore two actigraphs,one on each wrist or two on the same wrist, correlations of activitycounts were 0.80 to 0.96; when these data were converted to sleep/wakescores the agreement rates between pairs of devices ranged from 93% to99% (evidence level 1A).17 The correlations between devices for datacollected just at night were between 0.60 and 0.96 and the sleep/wakescoring agreements again were between 93% and 99%.17 Pollak and col-leagues had their subjects wear actigraphs from two different manufac-turers and found that there were differences between them (evidencelevel 3C).18

There are many published reports on the validity of actigraphs formeasuring sleep/wake. Many of these are reviewed in other sections ofthis report. When comparing actigraphic to other biological variables,their similarity needs to be taken into account. If the actigraphic andother variables are judged to have equal standing, a measure of correla-tion is appropriate, but if one of the variables is invested with definitiveimportance (“gold standard”), different measures are needed to quantifyhow close actigraphy approaches the gold standard. For studies of sleep,PSG is considered definitive. Most tests of actigraph validity, therefore,involve comparing actigraphy with PSG. Comparison by correlation pro-vides information about the relative, but not the absolute performance ofactigraphy. For example, a high correlation on total sleep time wouldmean that individuals who sleep longer by PSG criteria also sleep longerby actigraph criteria, and vice versa, but this could be true even if actig-raphy systematically over-estimated total sleep time. Therefore, it is pos-sible for the correlation between actigraph and PSG sleep results to behigh, even when the epoch-by-epoch agreement is relatively low. Corre-lations provide an incomplete picture, especially if most of the datacome from the sleep period.19

An alternate approach is Tryon’s method of calculating and reporting

sensitivity, specificity, and overall accuracy or agreement (true sleepepochs + true wake epochs/all epochs) separately.20 Sensitivity for sleepis the proportion of PSG sleep epochs also identified as sleep by actig-raphy. Specificity for sleep is the proportion of non-sleep (wake) epochscorrectly identified by actigraphy. Sensitivity and specificity for wake-fulness are similarly defined. Agreement is the proportion of PSGepochs correctly identified by actigraphy. Sensitivity, specificity andagreement therefore assess actigraphic recorders using an establishedstandard. Data collected using this scheme have shown that actigraphy ismore likely to detect sleep (sensitivity) but less reliable at detectingwake (specificity) (evidence level 1A and 3C).19,21

More recently, Pollak and colleagues have suggested different ways tocompute the performance of an actigraph’s ability to detect sleep andwake.21 They use “predicted value for sleep” (PVS) which is the pro-portion of actigraphic sleep epochs that are also classified as sleep byPSG, and use “predicted value for wakefulness” (PVW) which is the pro-portion of actigraphic wake epochs that are also classified as wakeful-ness by PSG. PVS answers the question, “What percentage of the epochsthat the actigraph scores as sleep are true (PSG) sleep?” This is not thesame as sensitivity for sleep, which answers the question, “What per-centage of true (PSG) sleep epochs are detected by the actigraph?” Pol-lak and colleagues also report agreement rates but correctly point outthat this measure is actually not very useful because it confounds PVSwith PVW. For example, a high PVS but a poor PVW during the sleepperiod would yield a high agreement rate since most of the epochs wouldbe sleep. This high agreement rate gives a false sense of validity sincemuch of wake after sleep onset (WASO) could be mis-scored by actig-raphy because of the low PVW. In fact, it has generally been shown thatactigraphy is better at detecting sleep (high PVS) than at detecting wake(PVW) during the sleep period (evidence level 1A and 3C).19,21 Resultsof future studies are likely to result in more useful measures if predictivevalues are reported in addition to sensitivity, specificity and agreement.It is worth noting that all of these measures vary with the proportion ofrecorded PSG epochs that represent sleep (base rate of sleep). During thesleep period, even malfunctioning recorders that are not being worn orare insensitive to movement will appear to accurately identify sleep ifthe low activity counts recorded by them are interpreted by scoring algo-rithms as “sleep”.

4.3 Comparisons to PSG

As PSGs are still considered the gold standard, most studies havecompared actigraphy to PSG. A technical difficulty in doing these com-parisons is accurately time-locking the epochs of the actigraph withthose of the PSG.21 If they gradually drift apart, over time different seg-ments of sleep or wake may be compared with each other, rendering theresults meaningless. A related problem is how to compare the often-used1-minute epoch of actigraphy with the standard 30-second epoch of PSG.

In these comparisons, low threshold actigraph algorithms (e.g., defin-ing wake as occurring even when a small number of activity countsaccumulated during the epoch) yielded the best accuracy rate and PVS,however, as sleep efficiency diminished, accuracy rate diminished (evi-dence level 1A).19 Actigraph PVW was best with high threshold algo-rithms (e.g., defining wake as occurring when a large number of activi-ty counts, such as 100, accumulated during the epoch) compared to lowthreshold algorithms but at a cost of lower accuracy and PVS.19 Onecomputer program, Actigraph Data Analysis Software (ADAS), whichconverts raw actigraph data into information about sleep/wake, has beenshown to be valid when compared to PSG (evidence level 2B),22 evenwhen raw data were derived from different devices and in patients withinsomnia (evidence level 3C).16

Other studies have also shown that actigraphy was highly correlatedwith PSG for differentiating sleep from wake (evidence level 2B and 3Crespectively),22,23 with reported correlations for total sleep time (TST)being 0.97.22 Comparisons showed 91%-93% overall agreement inadults (age 20-30 years) (evidence level 2B),24 and 91.4%-96.5%


minute-by-minute agreement rates in adolescents (age 10-16 years) andadults (age 20-30 years) (evidence level 1A).17 In healthy adults, actig-raphy was valid for assessing sleep durations and sleep/wake activity,but less reliable for more specific measures such as sleep offset or sleepefficiency (evidence level 3C).25 There was also no first night effect inhealthy adults (evidence level 3C).16 In nursing home populations,Ancoli-Israel et al. reported correlations between actigraphy and PSGfor TST of 0.81 - 0.91 and for percent sleep of 0.61 - 0.78 (evidence level3C).26

There are discrepant reports about the validity of actigraphy for othersleep variables. One study of four adults found good correlations forsleep onset latencies, wake time after sleep onset, sleep efficiency, andtotal sleep time (evidence level 3C),27 while two other studies of healthyadults found poorer relationships for sleep onset latency and wake timeafter sleep onset with quiet wake being frequently misidentified as sleep(evidence level 2B and 3C respectively).22,23 Early actigraph validationresearch found that the correlation between actigraphy and PSG forsleep onset latency was only 0.53 when sleep onset was defined as thefirst minute of actigraph-estimated sleep, but jumped to 0.94 when sleeponset was defined as the beginning of the first period containing 20 min-utes of actigraph-identified sleep with no more than one minute of wakeintervening.28 However, subsequent research has continued to use thefirst-minute definition. This may account for some of the observed errorin actigraphic scoring not only of sleep onset latency, but also of vari-ables that depend upon it, such as sleep efficiency and wake time aftersleep onset. A study of healthy adults on a shiftwork schedule found poorrelationships with sleep efficiency and less reliability for determiningsleep offset compared to PSG (evidence level 3C).25 Yet others foundthat actigraphy overestimated sleep efficiency and total sleep time inpatients with sleep disorders (evidence level 1A).19 To summarize, whencompared to PSG, actigraphy was found to be valid and reliable fordetecting sleep in normal, healthy adult populations but less reliable fordetecting sleep as sleep became more disturbed (evidence level 2B).22

4.4 Comparisons to Observations, Sleep Logs, and Diaries

Actigraphy has also been compared to both direct observations ofsleep and to sleep logs and diaries. In a study of the effects of circadianrhythms entrainment (entrained vs. free-running) on sleep by Lockley etal., sleep logs and actigraphy yielded similar data for sleep timing, sleepduration, sleep onset and sleep offset but not for sleep latency, numberand duration of night awakenings or number of naps (evidence level1A).29 Nurses’ observations of sleep in psychiatric patients were similarto actigraph data but sleep logs kept by patients in the morning were notfound to be satisfactory (evidence level 4C-a).30 Observations of nursinghome residents by research staff yielded a PVS of 87% and PVW of 90%when compared to actigraphy (evidence level 3C).26

Monk et al. compared both actigraphs and sleep diaries to PSG duringspace flight (evidence level 3C).31 Predicted values of actigraphy wereclearly superior to those of diaries for sleep onset and offset, sleep dura-tion, and sleep efficiency. The authors concluded that in general, actig-raphy is a simple, efficient means of evaluating sleep in situations, suchas space, when PSG is too cumbersome for routine use.31 Dijk et al. mea-sured wrist activity continuously in five astronauts during 10 to 16 daysof space flight, and performed sleep PSG on four of those days (evidencelevel 3C).32 They found that actigraphically estimated sleep duration wassignificantly longer on PSG-recording nights than non-PSG nights. Theyconcluded that astronauts probably adhered more closely to their sched-uled bedtime when their work duties included PSG sleep recording.

Actigraphy appears to be useful in other populations where PSGmight be difficult to obtain, such as in nursing home patients as men-tioned above,26 or in infants and young children. In general, Sadeh con-cluded that with infants, actigraphy should be paired with parental sleeplogs for screening infant sleep problems, although actigraphy appearedto be a more consistent measure than parents’ sleep logs of the child’ssleep/wake (evidence levels 4C-a).33,34 The agreement rates between the

logs and actigraphy declined over time apparently because the parentsincreasingly tended to omit items from the logs. Thus, for determining ifa child’s night awakenings decline during treatment, actigraphy appearsto be more accurate (evidence level 4C-a).35

In a study of children and adolescents, Sadeh found that a minimumof seven nights of actigraphy were needed to get five nights of usefuldata for sleep onset and number of minutes of wake (evidence level 4C-a).33 In another study of children and teenagers, Acebo et al. reportedgood agreement between observations and actigraphy for sleep onset,number of minutes awake, and sleep efficiency (evidence level 4C-a).36

Acebo et al. also found that, in children, more than seven nights of datacollection were needed to get useful data for sleep efficiency, sleep peri-od and number of minutes of sleep.36

4.5 Comparisons to MSLT

In a study of the effects of diphenhydramine vs. placebo on daytimesleepiness, Roehrs et al. showed that MSLT was more sensitive thanactigraphy to sleep loss (evidence level 2B).37 Yet, their data showed thatactigraphy during the day reflected prior sleep loss with more epochs ofinactivity, suggesting more daytime sleep. Since actigraphy is notrestricted to use in a laboratory as is the MSLT, the authors concludedthat actigraphy during the day may yield a more accurate index of theeffects of sleepiness.

4.6 Comparisons to EMG

Since the actigraph records movements, placement on the foot can beused to record movements that are most typical of periodic limb move-ment disorder (PLMD). In a study of PLMD, Kazenwadel et al. foundactigraphy recorded on the foot to be comparable to surface EMG ante-rior tibialis measurements during PSG (evidence level 1A).38 The corre-lations between leg kicks determined by activity counts and tibialisEMG measurements remained high both on and off medication. Theauthors concluded that measurement of PLMD by actigraphy was possi-ble if 0.5-second epochs were used. However, considerable manualadjustment and editing of computerized data were necessary to avoidunderestimating the number of leg kicks. These results were in dis-agreement with those of Sforza et al., who also compared actigraphyrecorded from the foot to PSG-recorded anterior tibialis EMG (evidencelevel 5D-b).39 However, the Sforza et al. study had a very small samplesize for a validity study, and only two out of 35 patients had PLMD. (Foradditional discussion on the use of actigraphy in PLMS see also section5.5, Restless Legs Syndrome/Periodic Limb Movement Disorder)

4.7 Actigraph Placement

Two studies found no difference between data collected from acti-graphs placed on different locations (e.g., dominant wrist, non dominantwrist, ankle, or trunk) (evidence level 3C and 1A respectively).16,17 How-ever, in a series of two studies by Middelkoop et al., other results werefound. In one study, wrist placement was shown to detect more move-ments than ankle placement which in turn detected more movementsthan trunk placement in the first study (evidence level 4C-a).40 In a sec-ond study of healthy adults, wrist placement was again superior to bothankle and trunk placement, however, dominant wrist placement was bet-ter than all other placements at detecting wake (evidence level 4C-b}.41

Violani et al. found that the right wrist recorded more activity than theleft wrist both early and late in the sleep period but no differences werefound between ankle placements (evidence level 4C-a).42 Middelkoopand colleagues concluded that more studies which compare differentplacements of actigraphy concomitant with PSG recordings were need-ed.41

4.8 Artifacts in Actigraphic Recordings

There are some potential artifact problems when using actigraphy for


sleep/wake determinations. For example, artifacts can come from non-compliance (not wearing the recorder), from breathing movements, frompostural blocking of arm movements, or from externally imposed move-ment from riding in vehicles.21 Many investigators routinely have vol-unteers who wear actigraphs keep concomitant logs of sleep times andactigraph removal, and use these data to help with artifact rejection.43,44

4.9 Summary

Recent research has refined the ability of actigraphs to studysleep/wake. Although there are still some technical differences in themechanical aspects of how actigraphs accumulate data on movements,how these data are processed, and the nature of the algorithms used toprocess these data, both the actigraphs themselves and the algorithmsthat process the data from actigraphs have improved since the last task-force report published in 1995.1 For example, a method using dichoto-mous indices of activity has been developed to compare activity in-bedto out-of-bed that, among other things, might be useful for studying cir-cadian phase shifts.45 However, no head-to-head comparisons have beenmade between actigraphs and no conclusions can be drawn about whichmethod is more valid vs. PSG.

Actigraphy is useful in populations where PSG would be difficult torecord, such as in demented patients,26 and in astronauts in space.31

There does not seem to be a first night effect with non-sleep disorderedpatients (evidence level 3C),16 which is of particular benefit when onlyone night of recording is possible. If more nights are needed, the acti-graph also has the advantage of being easy to record for multiple nights.There may be advantages of using combined data from actigraphy and asubjective questionnaire with sleep-disordered patients, especially ifthey are excessively somnolent (evidence level 1A).19 For studies ofrhythms or for studies where time of lights out is important, an actigraphthat also records light exposure would be beneficial.5,46

Yet, regardless of the technology, research studies must demonstratethat actigraphy serves the needs of sleep/wake researchers and clini-cians. Given the expanded use of actigraphy, the time has arrived forstandards to be established, similar to those developed for polysomnog-raphy in 1968 by Rechtshaffen and Kales.47 Such standards mightinclude device standards (e.g., digital integration is best) and/or countsdefined with standardized units of measurements (e.g., g-force units) sodata from different machines and algorithms could be compared andcomparisons could be made to other acceleration measures. In addition,bench-test minimal standards for computer programs used with actigra-phy need to be developed.

Ultimately, field tests are needed to determine what actigraphy iscapable of doing and how well it can do it. Data showing that actigraphyis reliable and valid are necessary as are data demonstrating the best pro-cedures for getting the best measurements for sleep/wake evaluations(e.g., best location on the body to place the device, how to analyze rawdata) and evaluating potential problems. Published reports using actigra-phy must contain complete reporting of sensitivity, specificity, scoringalgorithm, and filters, as well as reliability, validity, ruggedness, and arti-fact rejection for the device and computer program used.18 On the otherhand, technical standards may not be as important as simply demon-strating validity and reliability for determination of sleep/wake status ofall actigraphic measurements with any given apparatus and scoring algo-rithm.

5.0 ACTIGRAPHIC ASSESSMENT OF CLINICAL SLEEP DISORDERS

One possible application of actigraphy in sleep medicine has been thediagnosis and assessment of clinical sleep disorders (see Table 3). Com-pared to traditional polysomnography, the actigraph is relatively unob-trusive and can record for multiple days and nights. This may be usefulin the assessment of insomnia patients, whose sleep has been shown tobe quite variable from night to night.48 Moreover, actigraphy makeshome recording more accessible, permitting the evaluation of patients intheir natural sleeping environment and eliminating laboratory effects

that may alter a patient’s typical sleep patterns.The convenience of using actigraphy to evaluate disordered sleep,

however, must be weighed against its reliability and validity as com-pared to the traditional gold standard for sleep assessment, polysomnog-raphy. In addition, a determination of actigraphy’s potential usefulnessmust take into consideration how it compares to alternative methods thatmay be equally or less expensive, such as self-report. Although it mightbe expected that the objective and unbiased nature of data produced bythe actigraph would necessarily be more accurate than those yielded bysubjective assessment techniques such as sleep logs, this assumptionmust be confirmed empirically.

5.1 Insomnia

Chambers, in an analysis of previously published data,49 found thatwhen total sleep time estimates from actigraphs and sleep logs werecompared to polysomnography for a group of insomnia patients, therewas no significant difference in the mean absolute error for the two tech-niques (evidence level 4C-b).50 Moreover, sleep log estimates of totalsleep time had a significantly higher correlation with PSG than did thosefrom actigraphy, suggesting that for insomnia patients as a group, sleeplog error, at least with respect to the estimation of total sleep time, ismore systematic and predictable for sleep logs than for actigraphy. How-ever, this same analysis did reveal a substantial within-subjects, or night-to-night correlation (r = 0.81) between actigraph and PSG total sleeptime. Such a finding indicates that those factors contributing to actigrapherror for a given patient (e.g., periodic leg movements, minimal activityduring extended periods of nocturnal wakefulness) tend to be consistentfrom night to night. Therefore, at least for insomnia patients, actigraphymay be useful in the assessment of sleep variability or in the measure-ment of treatment effects.

A number of recent studies have employed actigraphy in the evalua-tion of sleep of the patient with insomnia; however, few of these studieshave validated the actigraphy findings with PSG data. Guilleminault andcolleagues in a study of non-drug treatments for insomnia, evaluatedpotential subjects using a sleep questionnaire, one week of sleep diaries,and four days of actigraph monitoring (evidence level 4C-b).51 Thesesubjects also underwent one night of laboratory polysomnography, butsimultaneous recording with an actigraph was not performed, so directvalidation of the actigraphy with PSG findings was not possible. How-ever, baseline data from this study did show that actigraphy consistentlyproduced higher estimates of total sleep time and the number of awak-enings and lower estimates of sleep onset latency than those yielded bysleep logs. The differences between actigraph and sleep log data wereattenuated somewhat in the post-treatment recordings, with greater treat-ment-related improvement seen in sleep log variables than in actigraphvariables.

Wilson et al., in a study of insomnia patients with musculoskeletalpain, found a similar discrepancy between the sleep estimates reportedon sleep logs and those determined by the actigraph, with a much largerdisagreement in the number of awakenings during the night (evidencelevel 5D-b).52 These researchers found relatively low correlations amongpatients (r = 0.34 to 0.42) between the two measures for estimates oftotal sleep time and number of awakenings, and no significant correla-tion for sleep efficiency. Consistent with the analysis of Chambers (evi-dence level 4C-b),50 the highest correlation found in this study was fornight-to-night actigraphic estimates of total sleep time. However, acti-graph sleep variables consistently failed to produce significant correla-tions with clinical assessment measures such as pain severity estimatesor scores on the Pittsburgh Sleep Quality Index. Two other studies alsofailed to find correlations between actigraph sleep variables and globalsubjective reports of well-being, sleep behaviors, and health-relatedsymptoms (evidence level for both 5D-b).53,54

Wicklow and Espie examined the relationship between cognitiveintrusions prior to sleep onset and sleep-related variables as measured byactigraphy and sleep logs (evidence level 4C-a).55 Their findings indi-cated that the presence of certain categories of intrusive thoughts was


associated with longer sleep-onset latencies, but only as measured byactigraphy, not sleep logs. These researchers also found that actigraphicTST was greater and sleep latency was less than that indicated by sleeplogs. However, there were significant correlations (r = .419 for sleeplatency, r = .526 for TST, both p < .001) between the two methods forthese variables.

5.2 Insomnia Secondary to Circadian Rhythm Disturbance

Other researchers have utilized actigraphy to assess insomnia com-plaints secondary to a circadian rhythm disturbance. Kerkhof and vanVianen divided a group of chronic insomniacs into early- and late-sleepphase groups, based on oral body temperature data, and found greaternocturnal motor activity, as measured by actigraph, in the early phasegroup (evidence level 4C-b).56 This finding was consistent with the sub-jective assessments of these subjects, who reported spending more timeawake during the night than the late phase group. Several studies haveused actigraphy to assist in the diagnosis of delayed sleep phase syn-drome (DSPS) and to assess effects of DSPS treatments.44,45,57-61 DSPSis characterized by a consistent pattern of late sleep onset and offset,often making diagnosis by PSG impractical. Although sleep logs areoften used to diagnose DSPS, actigraphy can potentially offer objectiveevidence about rest-activity patterns that either corroborates logs or callsthem into question. Dagan et al. used 4-7 days of actigraphy at home inconjunction with a comprehensive clinical assessment to diagnosedozens of subjects with DSPS, but they offered no independent evidenceof the validity of this method (evidence level 5D-a).57 Similarly, Quintoet al. reported that actigraphy “confirmed” sleep logs in a case ofDSPS.59 Minors et al. reported that there were significant differences inwrist activity patterns that distinguished people with DSPS from normalsleepers (evidence level 4C-b).45 Nagtegaal et al., in two separate stud-ies, provided evidence that wrist activity patterns in DSPS were consis-tent with a “gold-standard” biological marker of circadian rhythm dis-turbance. In the first study (a case report), they found that the late timeof day of low activity corresponded with a late period of high melatoninsecretion in a case of DSPS.60 In the second study (a randomized, place-bo-controlled trial), they found that actigraphy detected a 38-minuteadvance in sleep-onset time with melatonin treatment, parallelingadvances in dim-light melatonin onset. Sleep log variables, however,failed to detect this phase shift (evidence level 1A).61 Cole et al. also pro-vided objective evidence that actigraphy can detect circadian rhythmdisturbance in DSPS (evidence level 2B).44 They reported that the circa-dian phase of melatonin secretion was significantly delayed, comparedto normal, historical controls, in 45 DSPS volunteers whose delayedsleep was identified both by actigraphy and sleep logs. Additional infor-mation on the use of actigraphy in circadian rhythms can be found insection 6.0.

5.3 Disturbed Sleep in Children

Actigraphy has also been used to assess disturbed sleep in children.Franck et al. compared sleep, recorded by actigraph, of HIV-infectedchildren to that of normal controls and confirmed that sleep-related com-plaints, as reported by parents, were greater in the patient group (evi-dence level 4C-b).62 Actigraph estimates of sleep efficiency, WASO, andnumber of awakenings were significantly different between the twogroups, while differences in TST and SOL failed to reach significance.Within the patient group, the only significant correlation between acti-graph data and subjective reports was for night waking. Another studyexamined autistic children with and without parent-reported sleep prob-lems and found an earlier sleep offset time for the sleep problem groupbut no other significant differences in actigraphically measured sleepvariables (evidence level 5D-b).63 Sadeh et al. using actigraphy, report-ed that newborns slept twice as much during night time hours than dur-ing the day and that later gestational age was correlated with anincreased percentage of quiet sleep time (evidence level 4C-b).64 In acase report, Etzioni et al., using wrist actigraphy, found that 3mg of

melatonin administered in the evening for two weeks restored sleep con-tinuity in a child with a germ cell tumor involving the pineal region.65

Some studies have used actigraphy to examine developmental differ-ences in sleep patterns. Sadeh et al. recorded the sleep of school-agechildren for 4 to 5 nights and found that older subjects had delayedsleep-onset times, shorter sleep periods, and shorter sleep times thanyounger subjects (evidence level 4C-b).66 They also found that increasedreported daytime sleepiness was associated with greater age and shortersleep periods, as measured by the actigraphy. Aronen et al. demonstrat-ed that actigraphically measured TST was negatively correlated withteacher-reported behavioral symptoms in young children (evidence level4C-b).67 Kramer et al., although not specifically studying children, didshow apparent developmental differences in sleep between young andelderly adult subjects (evidence level 4C-b).68 They found the elderlysubjects, whose average age was 65 years, to have less variability fortime in bed, advanced sleep phase, and more nocturnal awakenings thanthe younger subjects (mean age = 20.6 years).

5.4 Sleep-Related Breathing Disorders

Several study protocols have attempted to detect the presence ofobstructive sleep apnea from actigraphic data. This work has generallyrelied on the fact that compared to normal sleepers, apnea patients havemore fragmented sleep and that this fragmentation is manifested in bodymovements that can be detected by the actigraph. Middelkoop et al.found that the average duration of periods with no movement (i.e., noactivity), as measured by the actigraph, differed significantly amongthree subject groups of varying apnea severity (evidence level 4C-b).69

No other actigraph or sleep log variable correlated significantly with theapnea index. However, the proportion of variance accounted for by thisvariable was small (11%), and the sensitivity of this measure to detectsubjects with an apnea index greater than 5 was 5% while the specifici-ty was 100%.

Drinnan et al. attempted to determine whether the specific placementof the actigraph might affect its accuracy in the identification of arousalsassociated with sleep-disordered breathing (evidence level 5D-b).70

Their data revealed that a left tibia placement resulted in the most favor-able relationship between actigraph-measured movement and EEGarousals, with placement on the right tibia, left ankle, and left wrist far-ing somewhat worse. Still, none of the placements yielded statisticallysignificant correlations with EEG arousals, and none were adequate inpredicting the degree of sleep disordered breathing present. As with theMiddelkoop et al. study (evidence level 4C-b),69 however, the relativelylow severity of sleep apnea among patients in this study (mean apnea-hypopnea index or AHI = 18.9) may have limited the power of the tech-nique to differentiate between groups.

Kushida et al. compared PSG, actigraphy and subjective reports in astudy of 100 sleep clinic patients, the majority of whom had a diagnosisof obstructive sleep apnea syndrome or upper airway resistance syn-drome (evidence level 2B).19 Consistent with previous studies, theyfound that the actigraph was considerably better at detecting sleep thandetecting wakefulness, with a sensitivity of 98% for sleep detection anda specificity of 48% for wake detection using a high-threshold algo-rithm. This algorithm compared PSG and actigraphic data in 30-secondepochs, modifying the activity counts during the epoch by the level ofactivity in the surrounding 2-minute time period. When compared toPSG, the actigraph was much more prone to overestimate total sleep timeand sleep efficiency than was subjective patient report. However, theactigraph’s estimates of number of nocturnal awakenings did not differsignificantly from PSG data while self-report did, suggesting actigraphywas more accurate than the patient’s subjective reports.

Elbaz et al. reported on an inventive use of actigraphy in the diagno-sis of sleep-disordered breathing that combines the actigraph with whatthey termed “simplified polysomnography,” consisting of airflow, tho-racic and abdominal movements, and pulse oximetry (evidence level3C).71 They reasoned that the addition of actigraphy could improve theestimation of the RDI from that of simplified polysomnography alone by


supplying a more precise value for TST than the traditionally used TIB.However, the actual increase in correlation with RDI estimates from tra-ditional polysomnography was somewhat modest, from r = .94 for sim-plified polysomnography alone to r = .976 for simplified polysomnogra-phy plus actigraphy. The authors did find that specificity and negativepredictive value were substantially improved with use of the actigraph,but only for severe OSAS (RDI > 30).

5.5 Restless Legs Syndrome/Periodic Limb Movement Disorder

One of the more natural applications of actigraphy has been in theidentification and assessment of periodic leg movement disorder(PLMD). Sforza et al. conducted a study of 35 patients with varyingdiagnoses to determine if actigraphy could reliably detect leg move-ments during sleep (evidence level 5D-b).39 Subjects were simultane-ously recorded using PSG and actigraphy placed on the upper part of theright foot. PSG-recorded EMG tibialis activity was visually scored andclassified in 8 levels based on duration and amplitude. Actigraphic datawere collected in 5-second epochs and compared directly to EMG activ-ity of similar-length epochs. The results of this analysis revealed thatalthough there was a high correlation between the two collection meth-ods, actigraphy substantially underestimated the number of movementsyielded by the EMG. However, this failure may be attributable to the lowsensitivity of the actigraph used, which is only able to detect accelera-tions greater than 0.1 g. In contrast, Pollak used actigraphs that were sen-sitive to 0.033 and 0.024 g, respectively (evidence level 4C).18 ForSforza, agreement was greater for the activity events with greater dura-tion and amplitude. Because of the actigraph’s failure to detect manyevents of lesser duration or amplitude, this study’s authors concludedthat the device “cannot be regarded as a good method to estimate motoractivity during sleep” (p. 158). However, other authors did note that theactigraph had adequate night-to-night reliability and suggested that itmight be useful in the assessment of treatment effects in patients withPLMD or restless legs syndrome (RLS) (evidence level 4 C-b and 5 D-b, respectively).50,52

Two recent studies have employed actigraphy in the evaluation oftreatment efficacy for RLS.72,73 Trenkwalder et al. in a placebo-con-trolled crossover design, studied the effects of L-dopa therapy for idio-pathic and uremic restless legs syndrome, using both PSG and actigra-phy at baseline and at the end of each treatment period (evidence level1A).72 Their data revealed that treatment resulted in a significant reduc-tion of leg movements, measured by both PSG and actigraph, for bothpatient types. Both PSG and actigraphic data also showed that thisimprovement was limited to the first 4 hours of recording time. Parallelto these objective indices, subjective measures such as sleep diaries andquality of life ratings showed similar improvement in response to treat-ment. Furthermore, because actigraphy was continued for two addition-al nights after the PSG study, the authors were able to confirm the sta-bility of this treatment effect.

Collado-Seidel et al. conducted a similar study of L-dopa and slow-release L-dopa efficacy, but without the use of polysomnography (evi-dence level 4C-b).73 Like Trenkwalder et al.,72 these researchers foundsignificant treatment-related effects for most actigraphic variables,including movements per hour and number of movement episodes. Onlythe change in the time without movements in the first half of the nightfailed to reach significance. Subjective improvements were also seenwith patients reporting increases in sleep quality and overall well-beingand decreases in number of awakenings, time awake, and reports of day-time fatigue.

5.6 Other Sleep Disorders

Various case reports have employed actigraphy in the assessment ofother sleep disorders, including fatal familial insomnia,74 non-24-hoursleep-wake syndrome,75,76 REM sleep behavior disorder,77 and posttrau-matic delayed sleep phase syndrome.59 In each of these reports, the acti-graph provided data relevant to the patients’ sleep/wake patterns, in

many cases over a substantial period of time. However, these case stud-ies did not compare the actigraphy data to PSG, nor did they indicatewhether the actigraph alone was sufficient to diagnose the conditions.

5.7 Summary

Recent literature suggested that actigraphy might have some value inthe assessment of sleep disorders. For insomnia, actigraphy may be mostvaluable in assessing treatment effects or night-to-night variations insubjects’ sleep. It has been demonstrated that actigraphy has the abilityto detect sleep phase alterations associated with circadian rhythm distur-bances. Additionally, actigraphy is capable of distinguishing moderate tosevere sleep apnea patients from normal controls, due to its greater sen-sitivity, compared to sleep logs, in detecting brief arousals from sleep.For patients with restless legs and periodic leg movements, the diagnos-tic value of actigraphy is limited by its tendency to underestimate the fre-quency of leg movements during sleep. However, it does show somepromise in the assessment of treatment-related improvement.

Later-generation scoring algorithms have demonstrated greater accu-racy than earlier versions in the detection of sleep and wake, improvingthe actigraph’s ability to detect sleep latency, nocturnal awakenings, andtotal sleep time, variables important in evaluating an insomnia com-plaint. The actigraph appears to have a particular advantage over alter-native assessment methods such as sleep logs in the measurement ofawakenings during the night, as many of these awakenings appear to goundetected by patients and subjects completing sleep diaries. The abili-ty of actigraphy for detecting activity also holds some promise in theidentification of other disorders characterized by frequent movementssuch as obstructive sleep apnea and periodic limb movement disorder.Perhaps of greatest importance is the actigraph’s ability to measurenight-to-night changes in sleep patterns within a given individual, afunction that has great value for assessing treatment effects and otherfactors that affect the consistency of a patient’s sleep. This, combinedwith its relative economy in assessing sleep-wake patterns over extend-ed periods of time, suggests a potentially important role for the actigraphin longitudinal research and clinical studies in which long-term changesin sleep patterns are of particular interest.

The actigraph’s limitations, however, continue to restrict its value as astand-alone diagnostic device. Recent research has reasserted the find-ings from previous studies that the accuracy of the actigraph to detectsleep and wakefulness declines as sleep efficiency is decreased, a prob-lem particularly relevant to insomnia and other sleep disorders. Thereare indications that for the simple estimation of total sleep time, insom-nia patients’ subjective estimates outperform the actigraph (evidencelevel 4 C-b).50 Moreover, although the actigraph may be able to distin-guish patients with a particular sleep disorder (e.g., obstructive sleepapnea, periodic limb movement disorder) from normal controls, there isvirtually no evidence to date that the actigraph can distinguish betweendifferent sleep disorders. Until such evidence becomes available, theactigraph’s function in the assessment and diagnosis of clinical sleep dis-orders is likely to be restricted to the role of an adjunct to clinical histo-ry, sleep diary data, and PSG findings or to examine treatment effectsand follow-up.

6.0 CIRCADIAN RHYTHMS

Activity is a standard marker of circadian rhythms in studies of non-human mammals. This section examines the use of wrist activity in themeasurement of circadian rhythms in humans. In the studies reviewedhere, wrist actigraphy was used in a number of different ways relevantto human rhythms. Methodologies included characterizing spontaneousrhythms in adults, children, infants and the elderly, exploring the rela-tionships between activity rhythms and the light-dark cycle, helping toidentify sleep or rhythm disturbances induced by change of schedule,measuring improvement in disturbed rhythms after experimental inter-vention, helping to diagnose circadian rhythm sleep disorders, charac-terizing rhythm abnormalities that accompany dementia or psychiatric


disturbance, and investigating the role of motor activity in cardiovascu-lar rhythms.

6.1 Actigraphy for the Study of Circadian Rhythms

Several studies have demonstrated that human wrist activity oftenshows a robust circadian pattern. Pollak et al. showed that the circadianperiod of the actigraph-defined sleep/wake rhythm accurately predictedthe period of the PSG-defined sleep/wake rhythm, measured simultane-ously (evidence level 3C).21

Actigraphs have measured circadian rhythms under circumstanceswhere it would not be practical to record with polysomnography. Forexample, Binkley measured wrist activity in one woman continuouslyfor an entire year.78 She found well-defined, entrained circadian rest-activity cycles, changes in sleep length synchronized with the menstrualcycle, and annual phase changes she attributed to daylight saving time.Wirz-Justice and colleagues presented several case reports in which acti-graphs were worn daily by demented or psychiatric patients for extend-ed periods of up to 1.5 years.79-84 The long-duration recordings allowedthe authors to produce plots that graphically revealed striking changes incircadian rhythms over time. These included severe, apparently medica-tion-induced disruption of the rest activity cycle, the gradual consolida-tion of the cycle upon change of medication, circadian effects ofimposed therapeutic rest/activity schedules, and the gradual decline ofcircadian organization over time. Siegmund et al. measured seven-daywrist activity rhythms in inhabitants of Papua New Guinea, living in atraditional culture without electric lights (evidence level 4C).85 Theyfound that rest-activity rhythms were synchronized with the light-darkcycle, and that time of arising was more consistent than bedtime. Acti-graphic recordings in infants showed that circadian activity rhythmsarose from ultradian antecedents. Periods of inactivity presumablyencompassing sleep were shorter (9-12 hours/day) than typically foundin European society. In another actigraphic study of infants, “sleep” dif-ferences were not explained by differences in temperament (evidencelevel 5D-b).86 Dijk et al. measuring wrist activity during 10 to 16 daysof space flight, visually identified imposed advances in the sleep-wakeschedule, and noted that time of arising was more regular than bedtime(evidence level 3C).32

In the studies cited above, and many others,87-91 circadian rhythmresults were computed from actigraphic sleep/wake predictions. Usual-ly, the phase marker was sleep onset time or sleep offset time. Similarly,Binkley marked circadian phase with visually identified “activity onset”and “activity offset,” defined by threshold criteria similar to those usedin some sleep/wake prediction algorithms (evidence level 4C-b).92

Another way actigraphic sleep/wake predictions (or similar “activitylevel” scores) have been used to yield circadian results is by showingthat actigraph-identified sleep is disturbed when people attempt to sleepout of phase with their endogenous rhythm, as in shift work,93-96 jet

lag,92,97 illness,91 or experimental manipulations of the sleep/wakecycle,87,98 or by showing98 that sleep is improved by treatment that nor-malizes rhythms.93,99-101 For example, both Dawson et al.93 and Yoon etal.102 found that actigraphic indicators of sleep improved during the dayfollowing simulated night shift work in volunteers treated with brightlight or melatonin, but not in those treated with placebo (evidence levels4C-b). Actigraphy was also used to infer when shiftworking nurses sleptand, along with shifts of the melatonin rhythm, demonstrated that a sub-group of nurses was able to successfully adapt to rapid changes in work-shift (evidence levels 4C-b).94,95

Although three shift work studies reported negative results,103-105

enough well-designed, well-controlled studies showed significant dis-turbance of actigraph-defined sleep after shift work or other circadiandisturbance to make a convincing case that actigraphy can be useful fordetecting such disturbances (evidence levels 3C to 4C-b).87,91-95,97,98,106

6.2 Actigraphy Algorithms for Computing Circadian Rhythms

As noted earlier, the study of rest-activity rhythms has a long history.Prolonged actigraphic recordings lasting for multiple circadian periodscan therefore give valuable chronobiological information, even if noattempt is made to convert the rest-activity rhythm to the sleep-wakerhythm. To extract this information, the raw activity values are analyzeddirectly. The most popular method has been cosinor analysis,43,89-92,107,108

in which a cosine curve with a period at or near 24 hours is fit to the databy the least-squares method. The parameters that are of interest areacrophase (time of peak activity), amplitude (peak-to-nadir difference)and mesor (mean) of the fitted curve (see Fig 2). A “five-parameterextended cosinor analysis” has also been used to provide a better fit toactivity data, which typically deviate from the shape of a cosinecurve.109,110 The five model parameters are circadian minimum, ampli-tude, acrophase, alpha (width of the rhythm) and beta (steepness of fit-ted curve, which can approximate a square wave if beta is high). F-statis-tics for goodness-of-fit derived from this model have been used in stud-ies of nursing home patients to detect a significant strengthening effectof light treatment on circadian activity rhythms (evidence level 4C-b),110

and a significant weakness of the activity rhythm relative to rhythms ofbehavioral agitation and environmental light exposure (evidence level4C-b).109 Van Someren and colleagues found that two analyses that makeno a prioi assumptions about the waveform of activity data, autocorrela-tion and interdaily stability, showed significant strengthening of activityrhythms in demented patients in response to light therapy, while simplecosinor analysis (and other analyses that assume a fixed waveform)showed no significant effect in the same data sets (evidence level 4C-b).111 Autocorrelation is the correlation between activity values at spe-cific time lags of interest. High autocorrelation at or near 24-hours indi-cates a robust circadian rhythm. Interdaily stability is a measure of thestrength of coupling of a rhythm to environmental zeitgebers, based onthe chi-square periodogram, which, in turn, is based on wave-form educ-tion (see below). Some investigators have computed the “circadian quo-tient” (amplitude/mesor) to characterize the strength of the circadianrhythm (more robust rhythms have a higher amplitude, but people whomove more vigorously may also have higher amplitude; the circadianquotient expresses amplitude relative to mesor, providing a normalizedvalue that allows comparison between individuals).91,112 A similar nor-malized variable that does not rely on the assumption of a cosine fit isrelative amplitude (based on the difference between the most active 10-hour interval and the least active 5-hour interval of the day).111

Additional circadian outcome measures that have been computeddirectly from raw activity data include the ratio of nighttime activity todaytime activity or total activity (evidence level 2B and 4C respective-ly),91,99 standard deviation of sleep onset time,113 intradaily variability(based on the changes in activity level from hour-to-hour),100,111,114-116

various types of spectral analysis,89-91,117 and waveform eduction. Wave-form eduction is carried out by calculating an “average waveform” forsome period. For example, if a period of 24.0 hours is chosen, succes-


Amplitude

Mesor

06 12 18 00 06 12 18

Time

Period

Acrophase

Activity

Figure 2—Circadian rhythm representation in which a cosine curve with a period at or near24 hours is fit to the data by the least-squares method. The parameters that are of interestare acrophase (time of peak activity), amplitude (peak-to-nadir difference) and mesor(mean) of the fitted curve.

sive activity levels at similar times of the 24.0-hour day are averaged.Sleep-wake consolidation is the extent to which continuous bouts ofsleep and wakefulness are clustered into periods that are circadian (lastfor several hours). Waveform eduction can be quantified by a measure-ment related to the lengths of the “stair treads and risers” in cumulativeplots of sleep vs. wakefulness.21

6.3 Actigraphy versus Other Methodologies for Determining CircadianRhythms

Several studies compared circadian outcomes derived from wristactigraphy to those derived from other measurement methods consideredreference standards. Pollak’s finding that actigraphic sleep/wake predic-tions have the same circadian period as PSG sleep/wake scores suggest-ed that actigraphy could provide valid measurements of entrainedsleep/wake rhythms (evidence level 3C).21 Youngstedt et al. providedgood evidence that the phases of actigraph-identified bedtime, wake-uptime, mid-sleep time and acrophase were all significantly correlated withthe acrophase of urinary 6-sulphatoxymelatonin secretion in entrainedyoung and elderly adults living at home (evidence level 1A).43 Cole etal. found similar home results in volunteers with delayed sleep phasesyndrome (DSPS) (evidence level 2B).44 Middleton et al. found that thephase and period of actigraph-derived sleep onset time, wake-up timeand fitted cosine were generally consistent with those of both 6-sulpha-toxymelatonin and “demasked” core body temperature in men undergo-ing experimental manipulations in constant dim light (both evidence lev-els 2B).89,90 However, these studies also showed that activity rhythmswere less stable than melatonin or temperature rhythms, and could bereadily masked by voluntary behavior. Carskadon et al., studying ado-lescents, found correlations ranging from .39 to .82 between actigraph-identified sleep onset time at home and salivary dim light melatoninonset time (evidence level 2B to 3C).118,119 However, in one study thecorrelation dropped to a non-significant level under an imposed light-dark cycle,118 and in the other it was not significant on weekends.119

Heikkilä et al. found that in children suffering a severe medical disorder,the circadian rhythm of wrist activity could be grossly disturbed despitenormal rhythms of melatonin, temperature and cortisol (evidence level5D).120 Guilleminault et al. found that consolidated wakefulness, visual-ly scored from wrist activity, only developed in infants after they estab-lished a circadian rectal temperature rhythm (evidence level 3C).121 Bla-grove et al. provided very strong evidence that actigraph-identified sleepwas influenced directly by the central circadian pacemaker (presumablythe suprachiasmatic nuclei, or SCN of the hypothalamus) (evidence level3C).87 They measured wrist activity during a forced desynchrony proto-col in which volunteers lived on a 27-hour day (9 hours in bed, 18 hoursup and active), so the pacemaker free-ran at a period closer to 24 hours,and sleep was attempted at various circadian phases. Despite theimposed rest-activity rhythm, actigraph-identified total sleep time waslower when sleep was attempted at an unfavorable phase of the circadi-an cycle. This strongly suggested that the influence of the circadianclock on actigraph-identified sleep could not be entirely masked by asocially-dictated rest/activity schedule. On the other hand, the maskingeffect of the imposed schedules was substantial, and this was likely to betrue of actigraph studies in general. Because of their susceptibility tomasking, wrist activity rhythms alone cannot be used as pure markers ofSCN circadian output, even though they contain an SCN signal. Actig-raphy has been used to “demask” the circadian temperature rhythm, byremoving the effects of activity and inactivity (evidence level 5D-b).98

Another line of evidence that actigraphy can accurately characterizethe circadian sleep/wake rhythm is that the rhythm of actigraph-inferredsleep/wake generally agrees with that of sleep/wake reported on sleeplogs (evidence level 3C).29 This raises the question of whether sleep logsare just as good as actigraphs for circadian measurements. Two studiessuggest a possible advantage of actigraphy, that is, that it may identifynaps that volunteers do not report on their sleep logs (both evidence level4C-a).88,103 However, actigraphy may also identify naps when none exist.

6.4 Actigraphy and Circadian Rhythm Sleep Disorders

There is good evidence that actigraphy can detect circadian phasedelays in people with DSPS, corresponding to delays in melatoninrhythms (level 1A to 2B) e.g., (44,60,61). This evidence is summarizedabove in the section 5.2. Insomnia Secondary to Circadian Rhythm Dis-turbance. There are also case reports in which actigraphy identified sys-tematic delays of the rest-activity cycle in non-24-hour sleep-wake syn-drome.75,76

6.5 Actigraphy and Circadian Rhythms in Aging and Dementia

Actigraphy has been used to explore circadian rhythms in aging anddementia. Three studies found that the overall activity level declinedwith age (evidence level 4C-b to 5D-a),108,122,123 as did the amplitude ofthe circadian rest-activity cycle (evidence levels 4C-b).116,124 Fragmenta-tion (hour-to-hour variability) of the rest-activity rhythm was found inhealthy elderly101,116 and could be reduced in elderly men by aerobictraining (evidence levels 4C-b).101

Mishima found increased overall activity and nighttime activity inAlzheimer’s disease (evidence level 4C-b).125 Friedman et al. showedthat actigraphic measures of circadian activity (including amplitude,acrophase and mesor) did not correlate significantly with behavioral dis-turbance in patients with Alzheimer’s disease (AD) (evidence level 4C-b).126 Martin et al. found little evidence of sundowning (increased agita-tion around sunset) (evidence level 4C-b).109 Actigraphic rest-activityrhythms in demented patients were stabilized by increased illuminationif vision was intact (evidence level 4C).100

6.6 Actigraphy and Cardiovascular Rhythms

Another group of studies used sleep and wake activity to help distin-guish “dippers” (people whose blood pressure decreases normally atnight) from “non-dippers” (blood pressure that remains the same or risesduring sleep). Although sleep wake activity was not necessarily corre-lated with blood pressure or heart rate (evidence level 5D-b),127 twostudies found that dippers have lower nocturnal activity than nondippers(both at evidence level 4C).128,129 Daytime activity levels were also cor-related with the nocturnal dip in BP (evidence level 4C).129 By usingactigraphy to define sleep and wake periods, a calcium-channel blockerwas found to have therapeutic effects in hypertensives that differedaccording to the time of day it was administered (evidence level 4C-b).130 A third study found that defining “night” as the actigraph-identi-fied sleep period yielded very different blood pressure results than diddefining “night” by fixed clock time criteria (evidence level 5D-a).131

6.7 Actigraphy and Circadian Rhythms in Psychiatry

Actigraphy has also been used to examine circadian rhythms in psy-chiatry. Wirz-Justice and colleagues found severe disturbance of rest-activity rhythms in one bipolar individual82 and several schizophrenicindividuals recorded for extended periods (evidence level 5D-a).79,81,83

Similarly, Martin et al. found that both rest-activity rhythms and acti-graph-identified sleep were often seriously disturbed in 28 olderschizophrenics (evidence level 4C-b).132 The magnitude of disturbancewas associated with the degree of neuropsychological impairment. Neu-roleptic-induced akathisia was associated with increased motor activityin schizophrenic patients, at least at certain times of the day (evidencelevel 4C-a).133 Two studies reported that specific depressive syndromeswere characterized by distinctive circadian activity rhythms.107,134 Glodet al. found blunted circadian amplitude but normal phase of wrist activ-ity in children with Seasonal Affective Disorder, compared to healthycontrols (evidence level 4C-b).107 Lemke et al. found that depressedadult inpatients displayed significantly greater motor activity in themorning than the evening (evidence level 4C-b).134

These studies, taken together, provide preliminary evidence that actig-raphy may prove useful for characterizing and monitoring the circadian


rhythm disturbances that often accompany psychiatric disorders.

6.8 Summary

In summary, actigraphy has been used successfully in a variety ofhuman circadian studies. Wrist activity appears to be a valid marker ofentrained PSG sleep phase, and a strong correlate of entrained endoge-nous circadian phase. Under non-entrained conditions, wrist activityrhythms may become dissociated from the endogenous rhythm of theSCN pacemaker; however, actigraphy still appears to be useful for iden-tifying disturbed sleep caused by disruption of circadian rhythms, andimproved sleep caused by treatments that improve rhythms. There is evi-dence that the circadian phase of wrist activity covaries with the phaseof melatonin secretion in DSPS, supporting the use of actigraphy inhelping to diagnose this condition. Actigraphy may also be useful in cir-cadian characterization of non-sleep disorders, such as schizophreniaand hypertension. A variety of methods for analyzing circadian aspectsof activity data show promise. It would be useful to formally comparethese to arrive at standard methodology.

7.0 OTHER CLINICAL RESEARCH

Actigraphy has been used as a measure of sleep/wake activity or cir-cadian rhythms in a broad range of clinical studies. These studies varyconsiderably with respect to the specific actigraphy variables of interest,the methodology used and the types of individuals studied. Unfortunate-ly, many of these studies do not report adequate detailed information onthe technical aspects of the actigraphy devices used, and few studiesattempt validity testing on the use of actigraphy in the particular popu-lation or setting studied.

7.1 Actigraphy in Sleep Intervention Trials and Comparative Studies ofSleep/Activity

Much of the work using actigraphy as a measure of sleep disorders isreviewed earlier in this paper (see section 5.0). This section focuses onthe use of actigraphy as an outcome measure in other sleep interventiontrials and in comparative studies of sleep or activity.

In a placebo-controlled clinical trial of controlled-release melatonintreatment for insomnia in older people (mean age 76 years), Garfinkel etal. reported that melatonin administration resulted in greater sleep effi-ciency and shorter wake after sleep onset, both estimated by wrist actig-raphy (evidence level 4C-b).135 Friedman et al. used multiple modali-ties, including actigraphy, to measure sleep outcomes in a trial compar-ing the effects of sleep restriction and sleep hygiene treatments on thesleep of older adults (aged 55 years or older) with insomnia (evidencelevel 2B).136 The main study outcomes found few between-group differ-ences in treatment efficacy. However, in a sub-sample of 16 subjectswho had simultaneous wrist actigraphy and polysomnography for 3nights, wrist actigraphy estimation significantly correlated withpolysomnographic estimation of total sleep time (r = .96), sleep effi-ciency (r = .63), sleep latency (r = .72) and wake after sleep onset (r =.68). In this study, wrist actigraph variables correlated more highly thansleep log data with polysomnography results.

Maus et al. performed actigraphy in a study of circulating cate-cholamines and aqueous flow in the eyes of normal subjects and in thosewith severe obstructive sleep apnea (evidence level 4C-b).137 Sleepapnea subjects, who were untreated on the night of testing, had a signif-icantly higher nighttime activity index as measured by actigraphy(p<.001) and lower sleep efficiency (p<.001) compared to healthy con-trols. In addition, there were significant differences in activity index andsleep efficiency in controls who were kept awake during the night ver-sus those allowed to sleep.

Pollak et al. studied a small group of community-dwelling elderlypeople who frequently used bedtime medications (including benzodi-azepines, minor analgesics, antihistamines and antidepressants) andcompared them to elderly controls who did not have sleeping difficulty

and did not use hypnotics (evidence level 4C-b).138 Although there wereno differences between groups when the 24-hour period was consideredas a whole, post-hoc comparisons in the early morning hours indicatedthat subjects using bedtime medications became active, as measured byactigraphy, about 1.5 hours earlier in the morning than controls.

7.2 Actigraphy in Studies of Healthy Adults

Several studies involving normal individuals under differing testingsituations have used actigraphy as a measure of sleep/wake or circadianrhythms. Duka et al. measured wrist movement in a placebo-controlledstudy of the effects of a beta-carboline benzodiazepine receptor antago-nist on night sleep pattern in healthy male volunteers (evidence level 5D-a).139 Compared to placebo, the benzodiazepine receptor antagonistinduced activation as measured by actigraphy (i.e., frequency of move-ment and intensity of movement). French et al. used actigraphy to mea-sure sleep patterns in military aircraft crew members undergoing simu-lated, long duration bomber missions (evidence level 4C-b).140 Theyfound shorter sleep duration and greater wrist activity during sleep peri-ods during the first mission, with evidence of improvement in sleep insubsequent missions. In a study of the effects on sleep from caffeinatedbeverages in healthy volunteers, Hindmarch et al. found a dose-depen-dent negative effect (of caffeine) on total sleep time as estimated bywrist actigraphy (evidence level 4C-b).141 In another study, Hindmarchet al. found that promethazine (a sedating antihistamine) caused a sig-nificant increase in percent sleep, as estimated by wrist actigraphy, dur-ing the daytime and across the study period compared with differentdoses of fexofenadine, loratadine and placebo (evidence level 4C-b).142

Jean-Louis et al. analyzed actigraphy data in a large sample (N=273)of community-dwelling residents of San Diego who had been identifiedby random telephone survey (evidence level 4C-b).143 In this cross-sec-tional study, they found significant differences between men andwomen, and between Caucasian and minority subjects, in sleep variablesestimated by wrist actigraphy. In a second smaller community-basedsample (n=32), Jean-Louis et al. used wrist actigraphy in healthy volun-teers and again found significant gender differences, with women hav-ing a better sleep profile than men (evidence level 4C-b).122

Mendlowicz et al. performed an observational study using wrist actig-raphy in community dwelling volunteers. In regression analysis theyfound several significant predictors of depressed mood, including thefollowing variables estimated by actigraphy: daytime activity level,sleep onset latency, wake after sleep onset, total sleep time and total timein bed (evidence level 5D-a).144 Moorcroft et al. used nocturnal actigra-phy to estimate sleep and wake periods and time of final awakening inpeople who reported the ability to self-awaken at a self-predeterminedtime without external means and found that they were in fact able to doso (with a 95% confidence interval of 4.1-10.7 minutes) (evidence level5D-b).145

Pankhurst et al., studying the influence of bed partners on nighttimewrist activity in community dwelling adults living in the United King-dom, found that subjects sleeping with bed partners had a greater num-ber of movements than subjects who slept alone, and movementsdecreased during the temporary absence of the usual bed partner (evi-dence level 4C-b).146 In a similar but larger sample in the UK, Reyner etal. found a significant decline with age in average movement as mea-sured by wrist actigraphy, with men having more nighttime movementthan women (evidence level 4C-b).147 The authors compared sleep logreports of time of sleep onset with actigraphy estimation of sleep onset,and found that the time difference between the two methods was small;however, the actual time difference was not reported in the manuscript.

7.3 Actigraphy in Studies of Cancer-related Fatigue

Actigraphy has also been used in descriptive studies of cancer-relatedfatigue. In an observational study of breast cancer patients, Berger et al.found that greater reported cancer-related fatigue was significantly asso-ciated with a higher number of nighttime awakenings, lower amplitude


and lower peak activity as measured by wrist actigraphy (evidence level4C-b).148 In an observational study of cancer patients undergoing radia-tion therapy for bony metastases, Miaskowski et al. did not find a sig-nificant association between wrist actigraphy estimation of nighttimesleep and self-ratings of quality of sleep and feeling rested (evidencelevel 4C-b).149 Using wrist actigraphy to measure circadian rhythms,Mormont et al. found that cancer patients with marked activity rhythmshad better quality of life, reported less fatigue and had longer survivalcompared to those with rhythm alteration (evidence level 4C-b).150 Inmultivariate analysis, rest-activity rhythm remained a significant predic-tor of one-year survival.

In a series of articles, Berger et al. reported findings from wrist actig-raphy performed in women with breast cancer undergoing several cyclesof chemotherapy (both evidence levels 4C-b).148,151 They found thatfatigue ratings were higher during chemotherapy, and negatively corre-lated with activity as estimated by wrist actigraphy. Subjects with lowercircadian measures (specifically lower peak activity) had greater fatigue.

7.4 Actigraphy in Studies of Psychiatric Patients

Actigraphy has been used to investigate movement and sleep distur-bance in psychiatric patients (circadian activity disturbance is discussedabove in section 6.0. Circadian Rhythms). Dursun et al. conducted adescriptive study of wrist actigraphy estimation of sleep in outpatientswith schizophrenia prescribed risperidone compared to those on “typi-cal” antipsychotics, and to normal controls (evidence level 5D-a).152

They found a greater degree of nighttime wrist movement (i.e., highermovement index) in patients on a typical antipsychotic compared tothose on risperidone. Friedman et al. compared wrist actigraphy datawith measures of behavioral problems in a sample of patients withAlzheimer’s disease (AD) who were participating in a larger longitudi-nal study (evidence level 4C-b).126 They found that greater behavioraldisturbance was correlated with lower actigraphically estimated sleepefficiency (r=-.35, p<.05) and greater wake after sleep onset (r=.43,p<.01).

Lemke et al. used wrist actigraphy to estimate mean activity levels inpsychiatric unit inpatients with major depressive disorder (evidencelevel 4C-b).153 They found that subjects whose Pittsburgh Sleep QualityIndex indicated poor sleep had higher mean nighttime motor activitylevels that those who reported good sleep. In addition, subjects withfewer depressive symptoms had lower mean nighttime motor activitylevels than those with greater depressive symptomatology.

7.5 Actigraphy in Studies of Adults with Other Specific Medical Conditions

Actigraphy has been used in a variety of clinical studies involvingadults with other specific medical conditions. Baker et al. comparedwrist actigraphy findings between menopausal women and controls, andfound that menopausal women had more arousals and greater sleep dis-ruption. In a study of sleep disturbance in cirrhosis, Cordoba et al. foundthat compared to normal controls, cirrhosis patients had decreased motoractivity, more fragmentation of sleep and dampened rhythms, as mea-sured by actigraphy (evidence level 4C-b).154

Redeker et al. reported a series of studies using actigraphy in adultsundergoing coronary artery bypass graft surgery (CABG), and in adultshospitalized for cardiac conditions (all with evidence level 4C-b). In onestudy, 25 women (mean age 63.7 years) undergoing CABG had wristactigraphy applied after admission to the open-heart recoveryroom/intensive care unit, and wore the actigraphs continuously through-out their hospital stays. Findings from the first postoperative week afterCABG, indicated that, after controlling for preoperative functional sta-tus, there was a relationship between both recovery from surgery andlength of stay with the rhythmic and linear patterns of activity. Positivelinear trends in circadian activity periods were related to better func-tioning and shorter length of stay.155 When wrist actigraphy was repeat-ed up to four times over the 6 months following CABG, sleep consoli-dated and daytime sleep decreased and subjects’ perceived sleep

improvements were consistent with results of actigraphy.156 In anothersample of 22 men and women undergoing CABG, Redeker et al. foundthat activity levels and strength of circadian rhythms increased over days2 to 5 post-operatively, with a longer time for recovery of activity inolder adults.155 Finally, in another sample of 33 men and women admit-ted to the hospital for acute myocardial infarction or unstable angina,Redeker et al. found that previous severity of heart disease was thestrongest predictor of lower sleep efficiency and longer duration ofawakenings during hospitalization.157

7.6 Actigraphy in Studies of Older Adults

Actigraphy is particularly useful in studies involving older adults,both in the community and in the nursing home. In addition to the com-munity-based studies described above, which included healthy olderpeople in their sample, studies specifically targeting the elderly haveused actigraphy as outcome measures. Pollak et al. used wrist actigraphyin a descriptive study of 44 pairs of older people (aged 65 years or older)with disruptive nocturnal behaviors such as complaining and calling forhelp, and their principal caregiver (evidence level 4C-b).158 Twenty-twoof the elders met criteria for dementia. Both the older person and theircaregiver wore wrist actigraphs. Activity level was less similar duringthe daytime between the older person and their caregiver, as comparedto nighttime. In addition, actigraphy suggested that at night it was theelders that initiated the elder-caregiver interaction, thus disturbing thesleep of the caregiver.

Sleep and circadian rhythm variables deduced from actigraph record-ings have been used as outcome measures in multiple studies of nursinghome residents, a population that had been understudied and in whichPSG is particularly difficult. Ancoli-Israel et al. found significant sleepdisruption (with frequent nighttime awakening and frequent daytimesleeping, based on actigraphy) in a sample of 25 nursing home residents(evidence level 4C-b).159 In another study, Ancoli-Israel et al. comparednursing home residents with severe dementia to those with moderate,mild or no dementia, and found that the severely demented group hadlower activity mesor, lower amplitude and were more phase delayed thanthose with moderate, mild or no dementia (evidence level 4C-b).112

Hourly profiles of sleep and wakefulness in this group suggested that theseverely demented residents had more sleepiness during the day andnight and residents with moderate or mild dementia had more wakeful-ness during the night (evidence level 4C-b).160 Actigraphy with lightexposure was also used to study the relationship between sleep and lightexposure with results suggesting that higher light levels predicted fewernighttime awakenings and later activity acrophase (evidence level 4C-b).161 Additionally, when these same patients were treated with 10 daysof bright light therapy, although there was no improvement in sleep atnight, morning bright light delayed the peak of the activity rhythm (i.e.,acrophase), increased the mean activity level (i.e., increased the mesor)and improved activity rhythmicity (evidence level 4C-b).110

Alessi et al. used wrist actigraphy estimation of sleep as an outcomevariable in a controlled clinical trial of physical activity in nursing homeresidents (evidence level 4C-b).162 They found no significant improve-ment in sleep associated with improved physical function. Likewise, inan observational study of incontinent nursing home residents, Alessi etal. found no significant differences in nighttime sleep variables betweensubjects on psychotropic medications and subjects not on these medica-tions (evidence level 5D-b).163 However, in a controlled trial of a com-bined physical activity and environmental intervention in nursing homeresidents, Alessi et al. found a higher percent sleep at night estimated bywrist actigraphy in the intervention group compared to controls (evi-dence level 4C-b).164

Cruise et al. performed an observational study in nursing home resi-dents to study the nighttime environment and incontinence care practicesin nursing home residents (evidence level 4C-b).165 They found that 42%of nighttime waking episodes identified by wrist actigraphy were asso-ciated with noise, light or incontinence care. Ouslander et al. found that


nighttime urinary incontinence was not related to sleep disruption (evi-dence level 5D-b).166

7.7 Actigraphy in Studies of Children

Actigraphy has been increasingly used in children, particularly instudies involving children with behavioral, psychiatric or neurologicalillness. Corkum et al. compared wrist actigraphy estimates of sleep inchildren with attention deficit/hyperactivity disorder (ADHD) to normalcontrols and found no statistically significant differences in total sleepduration, sleep onset and number of nighttime awakenings by wristactigraphy (evidence level 5D-b).167 Glod et al. used waist placement ofactigraphs in children who were victims of abuse, comparing their sleepto that of children with major depression or dysthymia, and with that ofnormal controls (evidence level 4C-b).168 In this study, abused childrenhad higher levels of nocturnal activity than both normal controls anddepressed children, and the abused children had more difficulty fallingand staying asleep. Hatonen et al. tested for differences in motor activi-ty rhythms with melatonin treatment versus placebo in 5 children aged12-19 with a neurodegenerative disease, neuronal ceroid lipofuscinosis(NCL) (evidence level 5D-b).117 In these children, there were no differ-ences between melatonin and placebo in actigraphic motor activitybased on period analysis by maximum entropy spectral, autocorrelationor harmonic analyses. In a controlled trial of melatonin therapy in chil-dren with Rett syndrome (an X-linked genetic disorder with motor andcognitive impairment, and often severe sleep dysfunction), McArthur etal. found high variability in subject responsiveness to melatonin, but asa group, sleep onset latency was significantly reduced with melatoninduring the first 3 weeks of the trial (evidence level 4C-b).169

Mennella et al. tested the immediate, short-term effects of ethanol inbreast milk on actigraphy estimation of sleep in infants from 15 mother-infant pairs (evidence level 4C-b).170 They found lower total sleep time,lower active sleep and shorter sleep bouts when infants received breastmilk with ethanol compared to breast milk without ethanol.

Sadeh and colleagues, in two separate studies, used actigraphy tomeasure sleep in relation to cognitive functioning in preterm infants andschool-age children.171,172 In the first study, early mature patterns ofsleep were related to later cognitive maturity (evidence level 4C-b).171 Inthe second study, children with fragmented sleep had lower performanceon measures of neurobehavioral functioning, particularly among themore complex tasks and behavior problems were more prevalent amongpoor sleepers (evidence level 4C-b).172

7.8 Summary

Actigraphy is increasingly being used in clinical research involvingindividuals of various ages, who are of normal health or with a varietyof health conditions, and in a number of different settings. In the major-ity of these studies, actigraphy was used to measure sleep and activityrhythms that might not otherwise be available using traditional (e.g.,PSG) techniques. In a growing number of sleep intervention trials, actig-raphy performed for multiple days and nights of testing was reported toshow evidence of beneficial treatment effects. Actigraphy has also beenused in studies involving otherwise healthy adults to demonstrate sedat-ing effects of various medications and to show differences in sleep dur-ing periods of sleep deprivation, for example, among military aircraftpersonnel on long flights. In addition, several large studies have usedactigraphy in community-based samples to demonstrate differencesbetween individuals based on age, gender, ethnicity, depressed mood,and other characteristics.

Another growing area of research is cancer-related fatigue, wherestudies involving multiple days and nights of actigraphy have demon-strated that cancer patients with more robust circadian rhythms of activ-ity report less fatigue, better quality of life and have longer survival.Likewise, in a series of studies involving adults undergoing coronaryartery bypass surgery, the strength of circadian activity rhythms as mea-sured by actigraphy in the post-operative period was related to recovery

from surgery and length of stay. Actigraphy has been used extensively in studies involving older peo-

ple, particularly in the nursing home setting. These studies have demon-strated significant sleep disruption among nursing home residents, andsleep and circadian rhythm disturbances have been shown to be moresevere among residents with more severe dementia. In addition, actigra-phy has been used to measure treatment effects in sleep interventionresearch in the nursing home setting, where other measures, such asPSG, would be extremely problematic to perform.

Finally, there is a growing literature using actigraphy in children. Forexample, actigraphy has been used to demonstrate differences in sleepbetween abused children and those with depression or normal controls.Actigraphy has also been used to test treatment effects of melatonin ther-apy in children with severe neurological disorders.

Taken as a whole, these clinical studies demonstrate the increasingexperience in the use of actigraphy in a variety of populations, condi-tions and settings. Unfortunately, the majority of these studies do notreport adequate detail on the technical aspects of the specific actigraph-ic devices used. However, it seems clear from these trials that the use ofactigraphy enables studies involving multiple days and nights of testing,and allows populations that might otherwise not be studied, such aspatients with dementia or young children, to participate in research stud-ies and clinical trials of sleep/wake activity and circadian rhythms

8.0 DISCUSSION

The last published practice parameters for actigraphy only consideredthe use of actigraphy for the clinical assessment of sleep disorders.1

Their conclusion in 1995 was that actigraphy should not be used for theclinical diagnosis of any sleep disorder, but that it might be a usefuladjunct to a good history and examination, particularly if multiple daysof information were needed, if objective data on the pattern of sleep wasneeded or in order to clarify the effects of compliance with treatment.2

Since that time advances have been made in actigraphs and in thealgorithms that process their data both within the apparatus and on com-puters following downloading of the data. Additionally, over 210 articlesand case studies have been published which have further examined thevalidity of actigraphy. As summarized in a recent review article bySadeh and Acebo,173 the number of yearly publications on sleep andactigraphy has risen steadily in the last ten years. In the research setting,actigraphs have been used for studying sleep disorders and circadianrhythms. Actigraphic variables have also been used as outcome mea-sures in clinical trials, often as a replacement for the more traditional, butmore expensive and cumbersome PSG.

One consistent finding of the current studies was that, when comparedto PSG, actigraphy was found to be moderately valid and reliable for dif-ferentiating sleep from wake in normal, healthy adult populations butless reliable for identifying sleep as sleep became more disturbed. Takentogether, these studies provide evidence that important applications ofthe actigraph may be in the assessment and in the measurement of thesleep variability found in patients with insomnia, in assisting in the diag-nosis of circadian rhythm disorders, in characterizing and monitoringcircadian rhythm disturbances that often accompany psychiatric disor-ders, in studying sleep/wake patterns in populations where PSG wouldbe difficult if not impossible, and in the assessment of treatment effectsand follow-up studies.

It is important to remember that actigraphy is not polysomnography.Although actigraphy may not be 100% accurate when compared to PSG,one still can get reliable information in situations where PSG is not prac-tical. Actigraphy makes home recordings more accessible, permitting theevaluation of patients in their natural sleeping environment and mini-mizing laboratory effects that may alter a patient’s typical sleep patterns.Actigraphy may provide an opportunity for subjects to adhere moreclosely to their scheduled bedtime and wakeup time than a PSG record-ing, thus providing a more accurate estimate of typical sleep durationthan does PSG.


LIMITATIONS

In general, when actigraphy was compared to PSG, it was found to beboth somewhat valid and apparently reliable in normal, healthy adultpopulations. Overall, actigraphy is best at estimating total sleep time.However, as sleep became more fragmented, the actigraph became lessaccurate in the detection of sleep and wake. Newer studies agree witholder studies (e.g., Webster et al.,11) in suggesting that actigraphy mayoverestimate sleep and thus underestimate wake, particularly during theday when an individual is more likely to sit quietly while awake. In aneffort to reduce this error, early investigators developed secondary algo-rithms that rescore sleep epochs as wake if adjacent to many wakeepochs.11

While some data suggest that actigraphy consistently yields estimatesof total sleep time and the number of awakenings that are higher thanestimates on sleep logs, these results are more difficult to interpret, par-ticularly since sleep logs themselves do not correlate highly with datafrom PSG. It is not unusual for clinicians to report that their patients areseen filling out a week’s worth of sleep logs while in the waiting room,waiting to be evaluated. This brings up two questions. First, what is themeaning of a reliability study when the comparison is made with some-thing other than a gold standard, such as when actigraphy is compared tosleep logs? For example, although the actigraphic estimates of totalsleep time may have been higher than that reported in sleep logs, how dowe know that the actigraph estimations were not actually more accuratethan the sleep log estimation?

The second question is which is more important, the subjective reportof the sleep log or the objective estimation of actigraphy? Many clini-cal trials are now using subjective reports as their final outcome mea-sures, particularly in studies of insomnia, as they believe that if thepatients feel they are sleeping better, it may not matter what the objec-tive data show. If that is the case, then neither actigraphy nor PSG arenecessary. If, however, a more objective estimate is desired, then actig-raphy is a less expensive approach than PSG and has the added benefitof being able to record for multiple days and nights. When PSG is notfeasible, the best approach may be to use a combination of actigraphywith sleep logs. When there is agreement between the two methods, con-fidence is increased in the results of both. When there is disagreement,it may reveal problems with one or the other.

Other problems with actigraphy relate to the determination of sleeponset latency and variables whose calculations depend on it, for exam-ple, sleep efficiency and wake after sleep onset. First, it is impossible todetermine sleep onset latency accurately without either an accuratemarker of bedtime, such as a very accurate sleep log or an event markerpushed at lights out. Activity monitors coupled with light sensors may beuseful for objectively determining the time of lights out, although a bed-partner may continue to use lights after the person wearing the actigraphhas gone to sleep. Second, studies to date have often reported pooragreement between sleep onset latency estimated by actigraphy and thatdetermined by EEG. The problem may lie in the method of scoring, how-ever, and not in the intrinsic properties of actigraphy. Cole et al.28 foundthat the actigraph was more accurate (i.e., had a higher correlation) foridentifying sleep onset latency than any other sleep variable, when anappropriate scoring algorithm was used (see section 4.3. Comparisons toPSG). If this finding could be replicated, it might be possible to sub-stantially improve actigraphic estimates of sleep latency, sleep efficien-cy and wake time after sleep onset.

FUTURE RESEARCH

Standardization of acceptable norms needs to be established beforeactigraphy can be more generally used with full confidence in the realmof sleep/wake studies. More development and research of both thedevices that record the data and the algorithms that process the data isneeded. In addition, disclosure of types of algorithms used should berequired in all manuscripts.

The question of the best placement of the actigraph must also be

answered. The data suggest that the wrist in general is more accurate forsleep estimation than other placements. Although traditionally actigra-phy has been recorded from the non-dominant wrist, newer data suggestthat movement from the dominant wrist may reflect sleep and wakemore accurately than movements recorded from the non-dominant wrist.

The problem of overestimating sleep must also be addressed. A poten-tial approach to this problem might be the development of separate algo-rithms for scoring sleep from daytime vs. nighttime activity records. Itwould be desirable for future research to systematically evaluate these orother ways to overcome the actigraph’s tendency to overestimate sleep.It may be that a different scoring algorithm is needed for periods whenthe individual is expected to be awake (out-of-bed periods) than the onecurrently used for periods during which the individual is expected to beasleep (in-bed periods). Studies of actigraphy compared to EEG outsideof the traditional sleep period, in patients that are known to fall asleepduring the day, need to be done to more reliably determine the effec-tiveness of actigraphy during waking hours.

SUMMARY

In summary, although actigraphy is not as accurate as PSG for deter-mining some sleep measurements, studies are in general agreement thatactigraphy, with its ability to record continuously for long time periods,is more reliable than sleep logs which rely on the patients’ recall of howmany times they woke up or how long they slept during the night and ismore 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 disor-ders. However, it should not be held to the same expectations aspolysomnography. Actigraphy is one-dimensional, whereas polysomno-graphy comprises at least 3 distinct types of data (EEG, EOG, EMG),which jointly determine whether a person is asleep or awake. It is there-fore doubtful whether actigraphic data will ever be informationallyequivalent to the PSG, although progress on hardware and data process-ing software is continuously being made.

Although the 1995 practice parameters paper determined that actigra-phy was not appropriate for the diagnosis of sleep disorders, more recentstudies suggest that for some disorders, actigraphy may be more practi-cal than PSG. While actigraphy is still not appropriate for the diagnosisof sleep disordered breathing or of periodic limb movements in sleep, itis highly appropriate for examining the sleep variability (i.e., night-to-night variability) in patients with insomnia. Actigraphy is also appropri-ate for the assessment of and stability of treatment effects of anythingfrom hypnotic drugs to light treatment to CPAP, particularly if assess-ments are done before and after the start of treatment. A recent indepen-dent review of the actigraphy literature by Sadeh and Acebo reachedmany of these same conclusions.173

Some of the research studies failed to find relationships between sleepmeasures and health-related symptoms. The interpretation of these datais also not clear-cut. Is it that the actigraph is not reliable enough to theaccess the relationship between sleep changes and quality of life mea-sures, or, is it that, in fact, there is no relationship between sleep in thatpopulation and quality of life measures? Other studies of sleep disor-dered breathing, where actigraphy was not used and was not an outcomemeasure also failed to find any relationship with quality of life. Is it thenthe 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 inthe evaluation of circadian rhythm disorders. Actigraphy has been shownto be very good for identifying rhythms. Results of actigraphic record-ings correlate well with measurements of melatonin and of core bodytemperature rhythms. Activity records also show sleep disturbance whensleep is attempted at an unfavorable phase of the circadian cycle. Actig-raphy therefore would be particularly good for aiding in the diagnosis ofdelayed or advanced sleep phase syndrome, non-24-hour-sleep syn-drome and in the evaluation of sleep disturbances in shift workers. Itmust be remembered, however, that overt rest-activity rhythms are sus-ceptible 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 clin-

ical setting, actigraphy is reliable for evaluating sleep patterns in patientswith insomnia, for studying the effect of treatments designed to improvesleep, in the diagnosis of circadian rhythm disorders (including shiftwork), and in evaluating sleep in individuals who are less likely to tol-erate PSG, such as infants and demented elderly. While actigraphy hasbeen used in research studies for many years, up to now, methodologicalissues had not been systematically addressed in clinical research andpractice. Those issues have now been addressed and actigraphy maynow be reaching the maturity needed for application in the clinical arena.

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APPENDIX A. ABBREVIATIONS

ACT - actigraphy ADAS - Actigraph Data Analysis Software ADHD - Attention deficit hyper-activity disorderAIMS – Abnormal Involuntary Movement ScaleANOVA - analysis of varianceASA – Actigraphic Scoring Analysis BL - baseline

BP - blood pressure BRM - behavioral response monitoring BT - bedtime CES-D - Center for Epidemiologic Studies-Depression scale CR - circadian rhythmCSQP – Child Sleep Questionnaire ParentD - day DB - double-blinded DSPS - delayed sleep phase syndromedesats - desaturation events DLMO - Dim Light Melatonin Onsetdom - dominant dur - duration Dx - diagnosisECG - electrocardiogram EDS - excessive daytime sleepiness EMG - electromyogram epi - epinephrine EPS – Simpson Angus Extrapyramidal Symptom ScaleF- female f/u - follow-upg-gramsGH - growth hormoneGrp - group h/o- history ofHADS – Hospital Anxiety and Depression ScaleHAMD - Hamilton Depression ScaleHR - heart rate h – hour(s)IS: interdaily stabilityIV: interdaily variabilitylog - sleep log or diary LSEQ - Leeds Sleep Evaluation QuestionnaireLt - left M - male meds - medicationsmel – melatoninMID – multi-infarct dementiamins – minutesMML – Mini-MotionLogger (AMI – Ambulatory Monitoring, Inc)MMDG - mild-moderately demented group MMNDG - Moderate, Mild or No Dementia Group MMSE - Mini-Mental State Exammo - monthMSLT - multiple sleep latency test ndom -non dominantNINCDS-ADRDA – National Institute of Neurological and Commu-nicative Disorders and Stroke and the Alzheimer’s Disease and RelatedDisorders AssociationNH - nursing homenorepi - norepinephrineNS - not stated Nt - night num - number OBJ - objectiveOCP - oral contraceptive OSAS - obstructive sleep apnea syndrome PLM - periodic limb movements PLMD/RLS - periodic limb movement disorder/restless legs syndrome POMS-Profile of Mood StatesPRMT - Probed recall memory testPSG - polysomnography PSQI - Pittsburgh Sleep Quality IndexPTSD – Post Traumatic Stress Disorderpts - patients PVT - psychomotor vigilance task


QOL - quality of lifeQWB - Quality of Well Beingr - correlation coefficient RA- relative amplitudeRCT - randomized controlled trialRDI – respiratory disturbance indexRt- rightRx - drugSAD – Seasonal Affective DisorderSANS – Scale for the Assessment of Negative SymptomsSAPS – Scale for the Assessment of Positive SymptomsSB - single-blinded SBJ - subjective SDAT – Senile Dementia of Alzheimer’s typesecs - secondsSDG - Severe Dementia Group, Sdur - Sleep duration SE - sleep efficiency SEI – Sleep Efficiency IndexSH - sleep hygieneSHAPS-D - Snaith-Hamilton-Pleasure-Scale SL - sleep latencySOff - sleep offsetSOL - sleep onset latency SOn -sleep onsetSP-sleep periodSQ - sleep qualitySSS - Stanford Sleepiness Scale STAI- State Trait Anxiety InventoryS/W - sleep/wakeSWT - sleep wake transitionstemp - temperatureTENS - transcutaneous electrical nerve stimulation TIB - time in bed TST - total sleep time TWT - total wake timeTx - treatmentVAS - visual analogue scaleW - wake w/ - withw/o - without w/i - withinWASO - wake after sleep onset wk - weekyr - year6SMT - 6-sulphatoxymelatonin

CompaniesAMI - Ambulatory Monitoring, Inc.MM - Mini Mitter


Actigraphy Review Paper—Ancoli-Israel et alSLEEP, Vol. 26, No.3, 2003 360

Cit

atio

n - A

utho

r/

Evi

denc

e L

evel

St

udy

Cri

teri

a D

esig

n /

Loc

atio

n / P

roto

col

Sam

ple

Size

(C

ompl

eted

Stud

y) /

Mea

n A

ge (

Ran

ge)

/M

edic

al C

ondi

tion

s

Com

pari

son

Mea

sure

s /

Act

igra

ph a

ppar

atus

/P

lace

men

t / E

poch

Len

gth

/Se

nsit

ivit

y / S

cori

ng

Out

com

e M

easu

res

Incl

usio

n / E

xclu

sion

/ B

ias

Stud

y C

oncl

usio

n fr

ompa

per

Com

men

ts f

rom

Rev

iew

er

Anc

oli-

Isra

el (

26)

3C

Val

idat

ion

/ NH

/ E

ntir

e 24

-h;

1D A

CT;

1N

t (ov

erla

ppin

g)PS

G, S

taff

obs

erva

tions

eve

ry30

min

s fr

om 1

000L

to 1

930L

10 (

10)

/ 86.

4±60

yrs

/ Se

vere

dem

entia

; All

Pts

whe

elch

air

boun

d

PSG

; Obs

erva

tion

by s

taff

/A

ctill

ume

/ wri

st /

1 m

in /

003g

. / C

ole

et a

l. ‘9

2

PSG

: TST

, tot

al W

time,

sle

ep%

; AC

T: T

ST, t

otal

Wtim

e,sl

eep

% f

or b

oth

max

. AC

T&

sum

AC

T; S

taff

obs

erva

tions

-S/

Wde

tect

ion

Seve

re d

emen

tia (

MM

SE<

20)

/ NS

/ Sm

all s

ampl

e si

ze

Obs

erva

tion

com

pari

sons

toA

CT,

Sen

sitiv

ity 8

7%,

Spec

ific

ity 9

0%. P

SG; A

CT

agre

emen

t rat

es (

0.33

to 0

.85

for

max

; 0.2

9 to

0.9

5 fo

rsu

m)

but n

ot m

eani

ngfu

l for

this

pop

ulat

ion.

PSG

com

pari

-so

n (r

val

ues)

: AC

TM

AX

TST

0.81

, % s

leep

0.7

8, T

WT

0.67

; AC

TSU

M T

ST0.

91, %

slee

p 0.

61, T

WT

0.75

.

Cor

rela

tion

of A

CT

(sum

) w

/PS

G f

or %

sle

ep lo

wer

ed b

y 2

outli

ers

AC

Tsh

owed

mor

esl

eep

than

did

PSG

. E

EG

sdi

ffer

ent i

n th

is p

opul

atio

nm

akin

g sl

eep

scor

ing

on P

SGdi

ffic

ult;

No

infe

rent

ial s

tats

for A

CT

com

pare

d to

obs

er-

vatio

ns

Ace

bo (

36)

4C-

a

Val

idat

ion

/ Hom

e / N

octu

rnal

only

for

30

min

s pr

ior

to B

Tto

30

min

s po

st B

T; S

tudy

1:4-

7Nt A

CT,

Stu

dy2:

7D

AC

T,St

udy3

: 7N

t AC

T, 7

Nt A

CT

274

(224

) / G

rp1

NS

(12-

60m

os);

Grp

2 12

.9 (

11.2

-14

.4yr

); G

rp3

15.0

(14

.0-

16.2

yr)

/ Nor

mal

log

used

to e

stim

ate

SOn

&SO

ff; O

bser

vatio

n by

oth

ers

(mot

her

for

Grp

1) /

MM

L/ L

ankl

e if

und

er 3

6 m

os, n

dom

wri

st /

1 m

in /

.05g

/ A

SA;

Oth

er:

zero

cro

ssin

g

AC

T: s

leep

sta

rt, S

P, s

leep

min

s, W

min

s du

ring

SP,

SE

N

S / M

ajor

gen

etic

med

ical

,ps

ycho

logi

cal o

r sl

eep

prob

-le

ms;

med

s th

at c

ould

aff

ect

slee

ples

snes

s; m

enta

l hea

lthor

sle

ep p

robl

ems

in p

rim

ary

rela

tives

/ Fe

w in

fere

ntia

l sta

-tis

tical

ana

lyse

s pr

esen

ted

Los

s of

up

to 2

8% o

f AC

Tda

ta f

rom

chi

ldre

n &

ado

les-

cent

s sh

ould

be

expe

cted

;re

cord

for

7N

ts to

get

5us

able

. Gen

eral

ly 5

Nts

AC

Tyi

elde

d re

liabl

e re

sults

for

slee

p st

art,

Wm

ins,

SE

, SP

&sl

eep

min

s m

ay r

equi

re m

ore

than

7N

ts o

f da

ta to

be

reli-

able

. Goo

d re

liabi

lity

for

slee

p st

art t

ime

but p

oore

stfo

r SP

.

AC

Tus

eful

in c

hild

ren

&ad

oles

cent

s

Tabl

e 2—

Evi

denc

e le

vels

for

tech

nolo

gy p

aper

s

Bla

grov

e (8

7)

3C

AC

TC

ompa

red

w/ o

ther

tech

niqu

es; F

orce

d de

syn-

chro

ny /

Lab

orat

ory

(dor

mito

-ry

use

d as

lab)

/ E

ntir

e 24

-h;

BL

8Nt s

leep

mid

nigh

t-08

00;

Slee

p D

ep.1

: 26h

; For

ced

desy

nchr

ony:

17

cycl

es (

27hr

D)

slee

p 9

h, W

18 h

; Sle

epD

ep.2

: 26h

r; R

ecov

ery

slee

p:9h

r; c

ontin

uous

AC

T

9 (9

) / N

S (1

9-20

) / N

orm

al

log;

(te

mp

repo

rted

els

e-w

here

) / G

aew

hile

r / n

dom

wri

st /

30 s

ec /

NS

/A

CC

OR

D s

oftw

are

(UK

) +

Hor

ne e

t al 1

994

algo

rith

m +

cust

om a

lgor

ithm

s

Log

: BT,

SO

L, W

ASO

, SO

ff,

SBJ

SQ; A

CT

: SO

n, S

Off

,T

ST, m

ovem

ent i

ndex

, fre

q.of

mov

emen

t ons

ets

Hea

lthy,

no

slee

p di

sord

ers/

NS

/ low

num

of

subj

ects

, all

F, n

ot b

lind

to ti

me

of D

Mov

emen

t fre

q. (

wea

kly)

pre

-di

cts

SBJ

SE, S

Q; C

irca

dian

time

of g

oing

to s

leep

aff

ect-

ed A

CT

TST

& S

BJ

SE &

qual

ity (

all r

educ

ed w

hen

star

ting

slee

p be

twee

n 10

00h

and

1300

h), b

ut d

id n

ot a

ffec

tm

ovem

ent i

ndex

or

freq

.

AC

Tap

pear

ed to

det

ect

expe

cted

red

uctio

n of

TST

indu

ced

by f

orce

d de

syn-

chro

ny p

roto

col (

poor

er s

leep

whe

n ou

t of

phas

e w

/ tem

prh

ythm

), s

ugge

sts

AC

Tca

nde

tect

a d

istu

rban

ce in

duce

dby

cir

cadi

an p

acem

aker

, but

no r

efer

ence

sta

ndar

d.

Blo

od (

23)

3C

AC

Tco

mpa

red

w/ o

ther

tech

-ni

ques

/ H

ome

/ Noc

turn

alon

ly f

or N

S h;

1N

ttPS

G+

AC

T+

BR

M, 1

+ N

ttim

eout

, 1N

tPS

G+

AC

T+

BR

M (

w/ 4

impo

sed

awak

enin

gs d

urin

gni

ghts

of

reco

rdin

g)

8 (8

) / F

27±

1.4,

M 3

3±8.

3 /

Nor

mal

PS

G; B

RM

/ A

ctill

ume

/ dom

arm

/ 1

min

/ N

S / A

ctio

n 3

(mod

ifie

d); O

ther

: 0 c

ross

ing;

SOL

PSG

: SO

L; A

CT

: SO

L; B

RM

(lig

ht a

nd to

ne c

ondi

tions

)SO

L

NS

/ Med

s, s

leep

dis

orde

rs /

Low

sam

ple

size

, for

ced

wak

es d

urin

g ni

ght

AC

Tte

nds

to r

epre

sent

qui

etW

as s

leep

; AC

Tco

nsis

tent

lyun

dere

stim

ated

SO

L; N

ous

able

infe

rent

ial s

tats

for

Sens

itivi

ty, S

peci

fici

ty, o

rA

ccur

acy

AC

Tgo

od f

or m

easu

ring

slee

p bu

t not

goo

d in

det

ect-

ing

quie

t W, S

OL

, WA

SO;

focu

s of

rep

ort w

as v

alid

atin

gB

RM

. Muc

h of

the

data

grap

hed

thus

not

pos

sibl

e to

give

mea

n an

d S.

D.

Eis

sa (

174)

3C

Ret

rosp

ectiv

e / H

ome

/ 20-

24h;

1 D

am

bula

tory

BP

mon

i-to

ring

+ A

CT

+ lo

g

62 (

62)

/ (6-

71)

/ ess

entia

l or

seco

ndar

y hy

pert

ensi

on o

rno

rmot

ensi

ve

Log

/ M

ini l

ogge

r / n

dom

wri

st /

NS

/ NS

/ Am

bula

tory

Mon

itori

ng

Am

bula

tory

BP

mon

itori

ng

Pt in

dat

a ba

se w

ho h

ad s

uc-

cess

ful a

mbu

lato

ry B

Pm

oni-

tori

ng /

NS

/ NS

In p

atie

nts

unde

rgoi

ng a

mbu

-la

tory

BP

mon

itori

ng c

ompl

i-an

ce w

ith A

CT

(91%

) su

peri

-or

to lo

g co

mpl

etio

n (7

1%)

(mor

e so

in c

hild

ren

and

youn

g ad

ults

). N

o di

ff in

cla

s-si

fica

tion

of h

yper

tens

ion

sta-

tus

with

AC

Tco

mpa

red

to lo

gin

38

subj

ects

com

plet

ing

both

but

dip

per

stat

us (

=gr

eate

r th

an 1

0% d

rop

inm

ean

BP

at N

t) w

as 5

5% m

is-

clas

sifi

ed u

sing

log

com

pare

dto

AC

Tsl

eep

data

(32

% f

alse

nega

tive

and

23%

fal

se p

osi-

tive)

The

re is

an

adva

ntag

e to

usin

g A

CT

whe

n do

ing

ambu

-la

tory

BP

mon

itori

ng to

det

er-

min

e di

ppin

g st

atus

Cit

atio

n - A

utho

r/

Evi

denc

e L

evel

St

udy

Cri

teri

a D

esig

n /

Loc

atio

n / P

roto

col

Sam

ple

Size

(C

ompl

eted

Stud

y) /

Mea

n A

ge (

Ran

ge)

/M

edic

al C

ondi

tion

s

Com

pari

son

Mea

sure

s /

Act

igra

ph a

ppar

atus

/P

lace

men

t / E

poch

Len

gth

/Se

nsit

ivit

y / S

cori

ng

Out

com

e M

easu

res

Incl

usio

n / E

xclu

sion

/ B

ias

Stud

y C

oncl

usio

n fr

ompa

per

Com

men

ts f

rom

Rev

iew

er


Hau

ri (

175)

3C

AC

Tco

mpa

red

w/ o

ther

tech

-ni

ques

/ L

abor

ator

y /

Noc

turn

al o

nly;

1N

tPS

G+

slee

p sw

itch+

AC

T

25 (

25)

/Grp

1: 4

4.5

(22-

65)

/25

.5 (

19-4

0) /G

rp 1

:In

som

nia,

Grp

2, n

orm

alsl

eepe

rs

PSG

, oth

er /

NS

/ NS

/ N

S /

NS

/ Sad

ah e

t al.

1989

A

CT

: SO

n, T

ST; F

ING

ER

SLE

EP

SWIT

CH

; SO

n T

STG

rp 1

: Ins

omni

a; G

rp 2

;/N

orm

al s

leep

ers

/NS

/ NS

AC

Tno

t ver

y go

od a

t mea

s-ur

ing

SOL

; und

eres

timat

es it

“qui

te m

arke

dly”

; AC

Tbe

tter

than

the

slee

p sw

itch

devi

ce&

logs

at T

STco

mpa

red

toPS

G b

ut o

vere

stim

ates

it

AC

Tw

as n

ot f

ocus

of

stud

ybu

t use

d as

a c

ompa

riso

n fo

rth

e sl

eep

switc

h de

vice

Jean

-Lou

is (

22)

2B

Val

idat

ion

/ Lab

orat

ory

/N

octu

rnal

; 1N

t AC

T+

PSG

20

(20

) / 2

9.95

±8.

98 (

21-5

3) /

Nor

mal

PS

G; B

T&

mor

ning

que

s-tio

nnai

re /

Gae

hwile

r / d

omw

rist

/ 60

/ 0.

1g /

AD

AS;

Oth

er: b

andp

ass

0.25

-3.0

kg

PSG

: TST

, SO

L; A

CT

: TST

,SO

L, W

ASO

N

S / N

o sl

eep

path

/A

wak

enin

gs a

fter

SO

n co

unt-

ed o

nly

if >

3 m

ins

The

AD

AS

AC

Tsc

orin

g so

ft-

war

e co

rrel

ates

w/ P

SGr=

0.97

for

TST

w/ a

vera

gedi

scre

panc

y 12

min

s.

Jean

-Lou

is (

16)

3C

Val

idat

ion;

AC

Tco

mpa

red

w/

othe

r te

chni

ques

/ L

abor

ator

y;H

ome

/; G

rp I

. Noc

turn

al;

Ent

ire

24 h

1N

t AC

T+

log

inho

me,

1N

t AC

T&

PSG

inla

b; G

rp 2

. Noc

turn

al E

ntir

e24

h 1

D A

CT

+lo

g+SS

S in

hom

e, 3

Nt A

CT

+PS

G in

lab

46 (

46)

/ Grp

1 30

±9.

0, G

rp2

46.5

±10

.8 /

Grp

2 In

som

nia

PSG

/ G

rp1

Gae

hwile

r, G

rp2

(AM

I) /

Grp

1 do

m a

rm, G

rp2

NS

/ NS

/ NS

/ AD

AS

PSG

: TST

; AC

T: T

STG

rp1

Nor

mal

/ N

S / N

S A

CT

is v

alid

for

ass

essi

ngS/

W; A

CT

is u

sefu

l to

asse

ssS/

Win

inso

mni

acs;

AD

AS

isa

valid

sof

twar

e fo

r AC

Tin

diff

eren

t typ

es o

f ap

para

tus

Jean

-Lou

is (

176)

4C-a

Val

idat

ion

/ Hom

e /

Noc

turn

al; E

ntir

e 24

-h;

Grp

1 24

h A

CT

+lo

g; G

rp2

24h

AC

T+

log;

Grp

3 1

Nt

AC

T+

log;

Grp

4 1

Nt

AC

T+

log;

Grp

5 3

or m

ore

Nt

AC

T+

log

148

(148

) / G

rp1

30.1

±13

.1,

Grp

2 28

±10

, Grp

3 34

±10

,G

rp4

29±

14,

Grp

5 25

.7±

5.0

/ Nor

mal

NS

/GA

EW

ILE

R /

Grp

1 do

mar

m, G

rp2

1 ol

d, 1

new

on

dom

arm

, Grp

3-1

on e

ach

arm

, Grp

4-do

m w

rist

, Grp

5-do

m w

rist

/ N

S / N

S / A

DA

S

log;

AC

T: T

ST, S

E I

ndex

,SO

L, W

ASO

, Act

ivity

leve

l,A

ctiv

ity c

ount

s>sl

eep

thre

sh-

old,

num

aro

usal

per

iods

>3

min

s

NS

/ NS

/ NS

No

diff

eren

ce in

act

igra

phpl

acem

ent a

nd (

dom

vs.

ndo

mw

rist

or

wri

st v

s. a

nkle

) an

dre

liabi

lity

(bet

wee

n ne

win

stru

men

ts a

nd n

ew c

om-

pare

d to

old

) O

bser

ved

nofi

rst n

ight

eff

ect

For

firs

t nig

ht e

ffec

t stu

dy,

wou

ld h

ave

been

bet

ter

toin

clud

e th

ird

nigh

t of

data

also

Jean

-Lou

is (

177)

1A

AC

Tsc

orin

g so

ftw

are

/L

abor

ator

y; H

ome

/N

octu

rnal

Ent

ire

24-h

; 1 w

kA

CT

at h

ome

+ S

SS; 3

Nt

PSG

+A

CT

(onl

y 1

nigh

tPS

G+

AC

Tan

alyz

ed)

26 (

26)

/ 46.

4±10

.8 /

NS

SSS

/ (A

MI)

/ N

S /

30se

c/1

min

/ N

S / A

DA

S; O

ther

:ze

ro-c

ross

ing

PSG

: TST

, SE

; AC

T: s

leep

thre

shol

d, W

ASO

, TST

, SE

In

som

niac

/ N

S / N

S A

CT

:PSG

in in

som

niac

s;A

CT

“is

an e

xcel

lent

tool

for

unob

trus

ive

docu

men

tatio

n of

S/W

activ

ity in

indi

vidu

als

w/…

inso

mni

a”

Aro

usal

s af

ter

SOn

defi

ned

aslo

nger

than

3 m

ins

scor

ed a

sW

; sev

eral

dif

fere

nt r

val

ues

repo

rted

for

sam

e da

ta

Jean

-Lou

is (

46)

4C-a

Unb

linde

d, n

onra

ndom

ized

,ob

serv

atio

nal s

tudy

, cro

ss-

sect

iona

l stu

dy /

Hom

e /

Ent

ire

24-h

; 3D

AC

T

273

(273

(40

-64)

/ no

rmal

,N

S di

ary/

Act

illum

e (A

MI)

/ 1

min

/ N

S / N

S /

Aut

omat

icsc

orin

g rh

ythm

; AC

TIO

N3

AC

T: T

ST, S

OL

, SE

inde

x,m

esor

, am

plitu

de (

of th

eco

sine

) an

d ph

ase

(tim

ing

ofth

e pe

ak o

f th

e fi

tted

cosi

ne)

Lev

el o

f ill

umin

atio

n

com

mun

ity d

wel

ling

resi

dent

sof

San

Die

go id

entif

ied

byra

ndom

tele

phon

e su

rvey

/N

S / N

S

CR

of

illum

inat

ion

wer

e si

g-ni

fica

ntly

ass

ocia

ted

w/ a

ctiv

-ity

and

sle

ep r

hyth

m m

eas-

ures

. Hig

her

ampl

itude

of

log

illum

inat

ion

corr

elat

ed w

ithsl

eep

phas

e (r

= .1

6), l

ower

SE in

dex

(r=

-.15

), a

nd le

ssre

port

ed d

aytim

e na

ppin

g (r

=-

.16)

. Hig

her

ampl

itude

of

activ

ity c

orre

late

d w

ith s

leep

ampl

itude

(r=

.30)

,Sd

ur(r

=.2

1) a

nd le

ss d

aytim

ena

ppin

g (r

= -

.16)

.

Hig

her

ampl

itude

of

activ

ity(b

y A

CT

) w

as a

ssoc

iate

d w

/le

ss r

epor

ted

dayt

ime

nap-

ping

. (r

=-.

16,

p<.0

5).

Cit

atio

n - A

utho

r/

Evi

denc

e L

evel

St

udy

Cri

teri

a D

esig

n /

Loc

atio

n / P

roto

col

Sam

ple

Size

(C

ompl

eted

Stud

y) /

Mea

n A

ge (

Ran

ge)

/M

edic

al C

ondi

tion

s

Com

pari

son

Mea

sure

s /

Act

igra

ph a

ppar

atus

/P

lace

men

t / E

poch

Len

gth

/Se

nsit

ivit

y / S

cori

ng

Out

com

e M

easu

res

Incl

usio

n / E

xclu

sion

/ B

ias

Stud

y C

oncl

usio

n fr

ompa

per

Com

men

ts f

rom

Rev

iew

er


Jean

-Lou

is (

12)

3C

Cal

ibra

tion

& V

alid

atio

n /

Grp

1: h

ome;

Grp

2, l

abor

ato-

ry/ G

rp 1

: 24h

AC

T+

PSG

;G

rp 2

; 5N

t & 4

D n

octu

rnal

PSG

+24

h A

CT

Grp

1; 3

9 F

(37)

Grp

2: 4

M&

7 F

(N

S) /

Grp

1: 6

3.7

(51

– 77

) G

rp 2

: 25.

4 (1

9-34

) /

Grp

1; p

ost m

enop

ausa

l

PSG

/ A

ctill

ume

/ wri

st /

1m

in /

0.00

3g /

zero

-cro

ssin

gth

resh

old

with

Act

ion

3

NS

Hea

lthy

/NS/

NS

Grp

1: I

n be

d: m

inut

e-by

-m

inut

e ag

reem

ent r

ate

AC

Tw

ith P

SG =

85%

, r =

0.9

8;m

ean

diff

eren

ce b

etw

een

PSG

& A

CT

= 2

1 m

ins,

sen

sitiv

ity=

94.

8%, S

peci

fici

ty 4

0.6%

.A

CT

mis

sed

muc

h m

idsl

eep

W; s

ugge

sts

may

nee

d se

c-on

d-by

-sec

ond

mon

itori

ng o

fac

tivity

to c

atch

thes

e. 2

4h:

min

ute-

by-m

inut

e ag

reem

ent

rate

AC

Tw

ith P

SG =

89%

, r=

0.9

0; m

ean

diff

eren

cebe

twee

n PS

G &

AC

T=

1m

in.

Grp

2: 2

4h u

sing

Web

ster

et

al.,

(198

2) s

cori

ng r

ules

:m

inut

e-by

-min

ute

agre

emen

tra

te A

CT

with

PSG

= 9

1%, r

= 0

.92;

mea

n di

ffer

ence

betw

een

PSG

& A

CT

= 5

min

s.

Aut

hors

con

clud

e th

atA

ctill

ume

usef

ul f

or d

eter

-m

inin

g S

& W

at h

ome

& in

lab

with

eld

erly

and

you

ng,

how

ever

dif

fere

nt s

calin

g fa

c-to

rs in

the

scor

ing

algo

rith

mne

ed f

or o

ptim

al r

esul

tsde

pend

ing

if A

CT

used

in b

edon

ly o

r ov

er 2

4h a

nd w

ithin

divi

dual

dif

fere

nces

suc

h as

age

and

likel

ihoo

d of

WA

SOs.

Sho

ws

need

for

mor

e re

sear

ch to

opt

imiz

e us

eof

AC

Tin

var

ious

situ

atio

nsw

ith v

ario

us in

divi

dual

s.

Jean

-Lou

is (

24)

2B

Val

idat

ion;

AC

TC

ompa

red

w/ o

ther

tech

niqu

es;

Com

pari

son

of 2

AC

Ts &

5qu

antif

icat

ion

mod

aliti

es /

Lab

orat

ory

/ Diu

rnal

; 5N

t &4D

noc

turn

al P

SG+

2 A

CTs

5 (5

) / G

rp1

25±

6 /

No

med

-ic

al c

ondi

tions

, em

otio

nal i

ll-ne

ss o

r sl

eep

dist

urba

nce

PSG

/ A

ctill

ume

& M

ML

/w

rist

/ 1

min

/ 0.

003g

/A

ctio

n3; O

ther

: Act

illum

e-su

m o

f ac

tivity

and

max

imal

activ

ity; M

M-z

ero

cros

sing

,tim

e ab

ove

thre

shol

d, &

pro

-po

rtio

nal i

nteg

ratin

g m

odal

i-tie

s

PSG

: TST

, SE

I, W

, S; A

CT

:m

in b

y m

in a

gree

men

t w/

PSG

, % P

SG W

mis

scor

ed a

ssl

eep,

% P

SG s

leep

mis

scor

edas

W, s

ensi

tivity

, spe

cifi

city

No

med

ical

con

ditio

ns, e

mo-

tiona

l illn

ess,

or

slee

p di

stur

-ba

nces

/ N

S / 5

sub

ject

s of

unre

port

ed s

ex; d

ata

from

10

of th

e 25

nig

hts

wer

e no

t use

-ab

le; n

o A

NO

VA

to c

ompa

rede

vice

s or

mod

aliti

es

Act

illum

e pe

rfor

med

com

pa-

rabl

y to

MM

Lan

d th

e di

ffer

-en

t mod

aliti

es o

f ea

ch w

ere

all c

ompa

rabl

e fo

r S/

Wan

aly-

sis.

Alth

ough

all

5 m

odal

ities

perf

orm

ed w

ell,

prop

ortio

nal

inte

grat

ing

mod

ality

see

ms

bette

r ov

eral

l for

this

age

Grp

and

zero

cro

ssin

g m

ode

leas

tde

sira

ble

Kaz

enw

adel

(38

)

1A

Val

idat

ion

/ Lab

orat

ory

/N

octu

rnal

; 2w

k B

L, 4

wks

levo

dopa

& le

nser

azid

e, 4

wks

plac

ebo

in r

ando

miz

edcr

osso

ver

desi

gn; 2

Nt

AC

T+

PSG

w/ E

MG

at e

nd o

fB

L(1

st w

as a

dapt

atio

n ni

ght)

then

1N

t AC

T+

PSG

w/ E

MG

at e

nd o

f ea

ch T

x pe

riod

30 (

29)

/ 51.

0 (2

9-74

) /

PLM

D/R

LS

PSG

/ M

OV

OPO

RT

/ to

p of

Rt f

oot b

etw

een

1st &

2nd

toes

on

pts

repo

rted

mos

taf

fect

ed le

g / 0

.5 s

ec /

NS

/co

mpu

ter

dich

otom

izin

g re

la-

tive

to a

thre

shol

d fo

llow

edby

man

ual m

odif

icat

ions

PSG

: PL

M, T

IB, S

EI;

AC

T:

PLM

, TIB

R

LS

+ P

LM

/ N

S / N

S M

easu

rem

ent o

f PL

MD

by

AC

Tis

pos

sibl

e w

/ 1/2

-sec

-on

d ep

ochs

. Med

mad

e no

diff

eren

ce in

EM

G &

AC

Tco

rrel

atio

ns

Met

hod

requ

ires

con

side

rabl

em

anua

l adj

ustm

ent o

f co

m-

pute

r an

alyz

ed A

CT

data

toav

oid

unde

rest

imat

ion.

Mov

emen

ts o

f on

ly o

ne le

gre

cord

ed b

y A

CT

Kra

hn (

30)

4C-

a

AC

Tco

mpa

red

w/ o

ther

tech

-ni

ques

/ ou

t-of

-lab

hos

pita

lbe

d / E

ntir

e 24

-h; 3

D A

CT

&lo

g in

A.M

.

60 (

30)

/ Med

ian

58 (

20-8

7) /

NS

NS

/ (A

MI)

/ w

rist

/ N

S / N

S/ C

ole

et a

l. L

og: T

ST, W

ASO

, TIB

, SO

L;

AC

T: S

, W, T

ST, W

ASO

,T

IB, S

OL

; Obs

erva

tions

by

nurs

es f

or S

, W

Con

secu

tive

adm

its to

med

-ps

ych

or a

dult

acut

e ca

rein

patie

nt u

nits

/ Pa

tient

see

k-in

g 1:

1 nu

rsin

g ca

re o

r ot

her

cond

ition

s / P

atie

nt s

elec

tion

limite

d to

thos

e ab

le to

com

-pl

y w

/ stu

dy d

esig

n

Nur

ses

obse

rvat

ions

of

slee

pin

psy

chia

tric

pat

ient

agr

ees

satis

fact

orily

w/ A

CT

but p

tsse

lf-r

epor

ts u

sing

log

in a

.m.

is n

ot s

atis

fact

ory

AC

Tas

com

pari

son

stan

dard

for

SL&

nur

se o

bser

vatio

n of

patie

nt

Cit

atio

n - A

utho

r/

Evi

denc

e L

evel

St

udy

Cri

teri

a D

esig

n /

Loc

atio

n / P

roto

col

Sam

ple

Size

(C

ompl

eted

Stud

y) /

Mea

n A

ge (

Ran

ge)

/M

edic

al C

ondi

tion

s

Com

pari

son

Mea

sure

s /

Act

igra

ph a

ppar

atus

/P

lace

men

t / E

poch

Len

gth

/Se

nsit

ivit

y / S

cori

ng

Out

com

e M

easu

res

Incl

usio

n / E

xclu

sion

/ B

ias

Stud

y C

oncl

usio

n fr

ompa

per

Com

men

ts f

rom

Rev

iew

er


Loc

kley

(29

)

3C

AC

Tco

mpa

red

w/ o

ther

tech

-ni

ques

/ H

ome

/ Ent

ire

24-h

;m

ean

nigh

ts/s

ubje

ct=

23±

7(r

ange

6-3

5) o

f AC

T+

log

49 (

49)

/ 46.

6±12

.2 /

Blin

d lo

g; m

el; U

rine

sam

ples

/M

otio

n lo

gger

s or

MM

L/

wri

st /

1m /

NS

/ Act

ion

3;O

ther

: Zer

o cr

ossi

ng m

ode

log:

SO

L, S

On,

SO

ff, N

umaw

aken

ings

, dur

aw

aken

ings

,nu

m n

aps,

dur

nap

s; A

CT

:SO

L, S

On,

SO

ff, N

um a

wak

-en

ings

, dur

aw

aken

ings

, num

naps

, tot

al n

ap d

ur

Med

s in

flue

ncin

g sl

eep

orm

el /

NS

/ NS

AC

Tan

d lo

gs y

ield

ed s

imila

rre

sults

for

som

e as

pect

s of

slee

p bu

t not

oth

ers.

Prop

ortio

n of

pts

sho

win

g di

f-fe

renc

es b

etw

een

AC

Tan

dlo

g gr

eate

r th

an th

ose

show

-in

g no

dif

fere

nces

.

Uni

que

use:

to s

ee if

sle

ep(d

aytim

e na

p nu

m &

dur

&ni

ght s

leep

dur

) gr

eatly

alte

red

by C

R ty

pe (

norm

alen

trai

ned,

abn

orm

alen

trai

ned,

or

free

run

)

Mid

delk

oop

(40)

4C-a

Val

idat

ion

/ Hom

e / E

ntir

e24

-h; 4

5 h

AC

T10

(10

) / 2

4.1±

3.1

(19-

33)

/N

S L

og /

Gah

wile

r / b

oth

wri

sts

& b

oth

ankl

es &

trun

k at

nave

l / 5

sec

(m

in)

/ 0.1

g /

AC

TST

AR

1.0

; Oth

er: 0

.25-

3kg

log:

Tim

e to

bed

, lig

ht o

uttim

e, S

OL

, num

aw

aken

ings

,ri

se ti

me,

num

nap

s, n

ap d

ur;

AC

T: A

ctiv

ity le

vel,

epoc

hs>

,du

r of

epo

chs>

0

Rt b

ande

d, h

ealth

y, n

o m

eds

/N

S / N

S A

ctiv

ity r

ecor

ded

at w

rist

s >

ankl

es >

trun

k. M

otor

act

ivity

low

er a

t Nt c

ompa

rabl

y at

all

site

s bu

t sig

nifi

cant

ly m

ore

activ

ity o

f do

m w

rist

dur

ing

diur

nal p

erio

d, &

wri

st c

orre

-la

ted

mor

e w

/ tru

nk a

t Nt t

han

ankl

es; o

ppos

ite d

iurn

ally

.N

dom

wri

st a

ctiv

ity c

orre

late

sm

ore

w/ t

runk

act

ivity

than

does

dom

wri

st a

ctiv

ity;

Dur

ing

slee

p A

CT

reve

als

mor

e w

hole

bod

y, g

ener

aliz

edm

ovem

ent b

ut d

urin

g W

ther

ear

e m

ore

isol

ated

lim

b m

ove-

men

ts

Mid

delk

oop

(41)

4C-b

Val

idat

ion

/ Hom

e / 4

5 co

n-se

cutiv

e h

star

ting

at 1

2:00

;45

h A

CT

+lo

g

20 (

20)

/ 24.

1±3.

7 / N

orm

al

NS

/ GA

HW

ILE

R e

lect

roni

cC

H-8

634

Hom

brec

htik

on /

Lt

wri

st, R

t wri

st, L

t ank

le, R

tan

kle,

trun

k (n

avel

) / 5

sec

-on

ds /

NS

/ NS

AC

T: A

ctiv

ity le

vel

NS

/ NS

/ Hea

lthy

youn

gad

ults

onl

y W

rist

pla

cem

ents

det

ecte

dm

ore

activ

ity c

ount

s th

anan

kle

or tr

unk

plac

emen

ts.

dom

wri

st p

lace

men

t yie

lded

grea

ter

diur

nal a

ctiv

ity c

ount

sth

an n

dom

. All

site

s cl

earl

ysh

owed

cir

cadi

an s

leep

-Wdi

ffer

ence

s. S

ugge

sts

mor

est

udy

w/ p

lace

men

ts c

on-

com

itant

w/ P

SG

Wri

st p

lace

men

t sup

erio

r to

ankl

e or

trun

k. D

om w

rist

appe

ars

bette

r fo

r di

scri

min

at-

ing

leve

l of

wak

ing

activ

ity.

Min

ors

(45)

4C-b

Tech

niqu

e D

evel

opm

ent /

Hom

e / E

ntir

e 24

-h; 3

-26

24-

hper

iods

of A

CT

8 (8

) / G

rp1

49, G

rp2

(18-

20),

Grp

3 26

, Grp

3 (4

3-74

) /

Nor

mal

Grp

s 1&

2, C

R d

isor

-de

r, D

SPS

Grp

3; C

olor

ecta

lca

ncer

Grp

4

log

/ Gae

hwile

r / n

dom

wri

st /

6 m

ins

/ NS

/ NS

NS

NS

/ NS

/ Low

sam

ple

size

M

etho

d de

velo

ped

for

com

-pa

ring

leve

l of

activ

ity in

bed

vs. o

ut o

f be

d (=

”dic

hoto

my

indi

ces”

); H

ealth

y su

bjec

tssh

owed

gre

ater

dic

hoto

my

than

eith

er p

ts w

/ DSP

S or

colo

rect

al c

ance

r; M

ight

be

usef

ul te

chni

que

for

stud

y of

circ

adia

n ph

ase

shif

t (sh

ift-

wor

kers

, jet

lag)

& il

lnes

s

Min

ors

(96)

4C-a

Rep

eat m

easu

res,

2 c

ondi

tions

com

pare

d / H

ome

/ Ent

ire

24-

h; 2

Ds

rest

AC

T&

3 N

tsh

ifts

AC

T

8 (8

) / (

18-3

5) /

Nor

mal

lo

g / G

aehw

iler

/ ndo

m w

rist

/30

sec

/1 m

in /

NS

/ NS

AC

T: r

elat

ive

activ

ity le

vels

N

ight

shi

ft n

urse

/ N

S / N

S W

hen

data

is c

orre

cted

for

leng

th o

f sl

eep

D s

leep

has

grea

ter

activ

ity le

vels

than

nigh

t sle

ep; D

iffe

renc

ebe

twee

n W

activ

ity a

nd s

leep

activ

ity le

vels

tend

s to

be

less

duri

ng n

ight

wor

k sh

ifts

AC

Tca

n be

use

ful i

n st

udy-

ing

adju

stm

ent t

o sh

ift w

ork

Thi

s pa

per

is a

fur

ther

ana

ly-

sis

of d

ata

in a

n ea

rlie

r st

udy.

Cit

atio

n - A

utho

r/

Evi

denc

e L

evel

St

udy

Cri

teri

a D

esig

n /

Loc

atio

n / P

roto

col

Sam

ple

Size

(C

ompl

eted

Stud

y) /

Mea

n A

ge (

Ran

ge)

/M

edic

al C

ondi

tion

s

Com

pari

son

Mea

sure

s /

Act

igra

ph a

ppar

atus

/P

lace

men

t / E

poch

Len

gth

/Se

nsit

ivit

y / S

cori

ng

Out

com

e M

easu

res

Incl

usio

n / E

xclu

sion

/ B

ias

Stud

y C

oncl

usio

n fr

ompa

per

Com

men

ts f

rom

Rev

iew

er


Mon

k (3

1)

3C

AC

Tco

mpa

red

w/ o

ther

tech

-ni

ques

/ Sp

ace

Shut

tleC

olum

bia

/ Ent

ire

24-h

;D

iurn

al; 7

2 h

AC

T+

PSG

+lo

g;7D

not

hing

; 72

hA

CT

+PS

G+

log

4 (4

) / 4

2.5

(38-

47)

/ Hea

lthy

PSG

; log

/ A

ctill

ume

/ nd

omar

m /

1 m

in /

NS

/ 5 c

onse

cu-

tive

min

s of

0 (

slee

p) o

r no

n-ze

ro (

Won

set)

cou

nts

PSG

: SO

n, S

Off

, Sdu

r, SE

,SO

L, W

ASO

, Sle

ep s

tage

s;A

CT

: SO

n, S

Off

, Sdu

r SE

,SO

L, W

ASO

No

slee

p di

sord

ers;

2 a

stro

-na

uts,

2 p

aylo

ad s

peci

alis

ts /

NS

/ Onl

y 4

subj

ects

AC

Tdu

ring

spa

ce f

light

clea

rly

iden

tifie

d SO

n &

SO

ffbe

tter

than

log

as w

ell a

ssl

eep

dur

& S

E a

s co

mpa

red

to P

SG. E

ven

good

cor

rela

tion

of A

CT

coun

ts &

dif

fere

ntsl

eep

stag

es, b

ut A

CT

faile

dto

det

ect a

.98

min

SO

L.

Ove

rall

AC

Tis

a s

impl

e ef

fi-

cien

t mea

ns o

f ev

alua

ting

slee

p in

spa

ce w

hen

PSG

isno

t fea

sibl

e

Dur

ing

spac

e fl

ight

Ots

uka

(178

)

5D-a

Val

idat

ion

/ Lab

orat

ory;

Out

-of

-lab

hos

pita

l bed

/ E

ntir

e24

-h; 7

2+h

AC

T7

EC

G, (

also

BP

for

48h

& H

R f

or 2

4h)

44 (

44)

/ Grp

1 (2

8-46

), G

rp2

(28-

78)

/ Nor

mal

; Hea

lthy

EC

G; B

P; H

R /

Act

ivet

race

r /

wai

st /

1 se

c / 0

.01

to 0

.50g

/N

S

AC

T: A

ctiv

ity le

vel;

BP

Sim

ulta

neou

s A

CT

& B

Pca

nbe

use

d to

sho

w r

elat

ions

hip

of S

/Ww

/ BP.

Sug

gest

s S/

Wrh

ythm

s of

abo

ut 7

Ds

(cir

-ca

sept

an)

in a

dditi

on to

cir

ca-

dian

& a

3.5

D (

circ

asem

isep

-ta

n) r

hyth

m in

irre

gula

r S/

Wcy

cles

but

abl

e to

iden

tify

indi

vidu

al d

iffe

renc

es in

all

thes

e

Har

d to

pul

l dat

a ou

t of

this

artic

le; u

ses

a lo

t of

indi

vid-

ual e

xam

ples

.

Polla

k (1

8)

4C-b

Val

idat

ion;

2 A

CT

devi

ces

com

pare

d re

liabi

lity,

val

idity

,ar

tifac

t rej

ectio

n / N

S / 7

-92h

AC

T(m

ean=

41.5

)

5 (5

) / 3

3.20

(22

-47)

/ N

orm

al

Non

e / 1

. MM

L(A

MI

Mod

el20

.000

), 2

. A

ctiv

ity m

onito

r(G

aehw

iler

Ele

ctro

nics

mod

el28

0 32

k v1

) / n

dom

wri

st /

30se

c / f

or M

ini-

Mot

ionl

ogge

r-m

anuf

actu

re’s

sof

twar

e fo

rG

aehw

iler-

NS

AC

T: A

ctiv

ity c

ount

s N

S / N

S / L

ow s

ampl

e si

ze;

wid

e ra

nge

of d

urs

of A

CT

mea

sure

men

t; no

com

pari

son

mea

sure

s

Bot

h de

vice

s w

ere

relia

ble.

Rel

ated

is th

e ne

ed f

or th

ein

stru

men

t to

dete

ct s

mal

lsl

eep

mov

emen

ts a

nd in

ter-

rupt

ions

; aga

in G

was

poo

r.B

ecau

se o

f ab

ove,

G w

ould

over

est

imat

e sl

eep

and

slee

pco

ntin

uity

. AM

is b

ette

r th

anG

for

S/W

dete

ctio

n

Goo

d st

udy;

alm

ost p

ilot

stud

y; s

how

ing

need

for

sta

n-da

rdiz

atio

n of

cri

teri

a fo

rac

cept

abili

ty in

AC

Tin

stru

-m

ents

Polla

k (2

1)

3C

Val

idat

ion

& R

elia

bilit

y /

Lab

orat

ory

/ 7 D

+ N

AC

T+

PSG

in ti

me

isol

ated

, fre

e-ru

nco

nditi

on

15 (

14)

/ NS

(20

– 35

& 7

0 –

72)

/ hea

lthy,

no

slee

p pr

ob-

lem

s

PSG

/ A

ctiT

rac

& C

SAA

ctiv

ity M

onito

r / n

on-d

omw

rist

/ 30

sec

s / 0

.024

&0.

033

g / 1

) si

ngle

thre

shol

d&

2)

“log

istic

reg

ress

ion”

with

mov

ing

20 m

inut

e w

in-

dow

NS

Hea

lthy

with

no

slee

p pr

ob-

lem

s A

CT

is a

dequ

ate

for

dete

rmi-

natio

n of

S/W

circ

adia

nrh

ythm

, res

t/act

ivity

cyc

les,

and

S-co

nsol

idat

ion

but n

otot

herw

ise

as a

sub

stitu

te f

orPS

G b

ecau

se it

ove

rest

imat

esS

dur

and

SE b

ut m

isse

sW

ASO

s. N

o di

ffer

ence

sbe

twee

n th

e tw

o A

CT

appa

ra-

tus.

Sen

sitiv

ity =

86.

6% f

or N

only

, 62.

2% N

+ D

bec

ause

faile

d to

sho

w D

S.

Spec

ific

ity =

89.

6% f

or N

usin

g lo

gist

ic r

egre

ssio

n;ap

proa

ched

100

% f

or D

.A

gree

men

t rat

e (a

poo

r m

eas-

ure

in g

ener

al)

= 7

6.9%

for

D+

N, 8

2.0%

for

N o

nly.

AC

T&

PSG

hav

e po

or a

gree

men

ton

Wto

S a

nd S

to W

tran

si-

tions

. Som

e in

dica

tion

that

the

stag

es o

f sl

eep

are

refl

ect-

ed in

leve

l of A

CT

rang

ing

from

hig

h fo

r W

to s

tage

1th

en R

EM

S th

en s

tage

2 th

enSW

S at

low

end

.

Uni

que

scor

ing

and

data

pro

-ce

ssin

g. M

akes

a s

tron

g ca

sefo

r su

peri

ority

of

PSG

ove

rA

CT

for

mos

t app

licat

ions

.

Cit

atio

n - A

utho

r/

Evi

denc

e L

evel

St

udy

Cri

teri

a D

esig

n /

Loc

atio

n / P

roto

col

Sam

ple

Size

(C

ompl

eted

Stud

y) /

Mea

n A

ge (

Ran

ge)

/M

edic

al C

ondi

tion

s

Com

pari

son

Mea

sure

s /

Act

igra

ph a

ppar

atus

/P

lace

men

t / E

poch

Len

gth

/Se

nsit

ivit

y / S

cori

ng

Out

com

e M

easu

res

Incl

usio

n / E

xclu

sion

/ B

ias

Stud

y C

oncl

usio

n fr

ompa

per

Com

men

ts f

rom

Rev

iew

er


Rei

d (2

5)

3C

Val

idat

ion;

AC

Tco

mpa

red

w/

othe

r te

chni

ques

/ L

abor

ator

y/ D

iurn

al; E

ntir

e 24

-h;

AC

T+

PSG

(w

hen

slee

p) f

or1N

t ada

ptat

ion,

2D

of

12 h

Dsh

ift (

nigh

t sle

ep),

2D

12h

rni

ght s

hift

(D

sle

ep),

1 1

/2D

“off

”

32 (

32)

/ Grp

1 21

.2±2

.7, G

rp2

43.9±6

.8 /

NS

PSG

/ G

aehw

iler

/ ndo

m h

and

/ 30

sec

/ 0.1

g 12

5 m

s sa

m-

plin

g tim

e (8

kg)

Bau

dpas

sfi

lter

0.25

-3.0

kg

/ NS

PSG

: Sle

ep, W

ake,

SO

n,SO

ff; A

CT

: S, W

, SO

n, S

Off

N

S / S

mok

ers,

taki

ng m

eds,

slee

p di

sord

ers

/ Lab

shi

ftw

ork

stud

ies

may

not

com

-pl

etel

y re

flec

t rea

l wor

ld,

thei

r ol

der

subj

ects

wer

e re

al-

ly m

iddl

e-ag

ed.

AC

Tva

lid f

or S

/Wac

tivity

&sl

eep

dur

(al

thou

gh A

CT

dif-

fere

nt f

rom

PSG

for

SO

ff)

but

not a

s go

od f

or m

ore

spec

ific

mea

sure

s su

ch a

s SE

; AC

T:

agre

es m

ore

with

PSG

for

youn

g ad

ult t

han

for

mid

dle-

aged

bec

ause

mor

e qu

iet W

scor

ed a

s sl

eep

in la

tter

, as

the

likel

ihoo

d of

sle

epde

crea

ses

so d

oes

AC

Tac

cu-

racy

.

Roe

hrs

(37)

2B

Val

idat

ion:

AC

Tco

mpa

red

w/

othe

r te

chni

ques

/ L

abor

ator

y/ D

iurn

al o

nly

for

11 h

; 1D

plac

ebo-

8hr

TIB

, 2-7

D r

ecov

-er

y, 1

D p

lace

bo-4

hr T

IB, 2

-7D

rec

over

y; 1

D p

lace

bo-0

hrT

IB, 2

-7D

rec

over

y, 1

Ddi

phen

hydr

amin

e 50

mg-

8hr

TIB

; in

Lat

in S

quar

e de

sign

34 (

17)

/ 27.

9±4.

3 (1

9-35

) /

Nor

mal

M

SLT

/ MM

L/ n

dom

wri

st /

30 /

NS

/ Act

ion-

WPS

G: M

SLT,

SO

L; A

CT

:SO

L, %

inac

tivity

, cou

nts

per

activ

e ep

och

Hea

lthy,

nor

mal

S/W

patte

rns,

no s

leep

com

plai

nts,

<25

0m

g/D

caf

fein

e co

nsum

ptio

n,no

Rx

of d

rug/

alco

hol a

buse

,no

n-sm

oker

s / N

S / A

CT

scor

ing

soft

war

e no

t spe

cifi

-ca

lly d

evel

oped

to a

sses

s da

y-tim

e sl

eepi

ness

AC

Tca

n be

use

d to

sho

wch

ange

s in

day

time

epoc

hs o

fin

activ

ity d

ue to

cha

nges

insl

eepi

ness

. MSL

Tsh

ow d

if-

fere

nce

betw

een

8h, 4

h, 0

hw

hile

dip

henh

ydra

min

e in

ter-

med

iate

to &

dif

fere

d fr

ombo

th p

lace

bo-4

hr T

IB &

plac

ebo-

0hr

TIB

. Cou

nts

dur-

ing

activ

e ep

ochs

did

n’t y

ield

any

sign

ific

ant d

iffe

renc

e.M

SLT

was

mor

e se

nsiti

veth

an A

CT

to s

leep

loss

but

AC

Tm

ay r

epre

sent

mor

ere

al-w

orld

inde

x of

eff

ects

of

slee

pine

ss

AC

Tus

ed to

mea

sure

day

time

slee

pine

ss (

laps

es)

Sade

h (3

5)

4C

Com

para

tive

Tx;

AC

Tco

m-

pare

d w

/ oth

er te

chni

ques

/H

ome

/ 1 w

k A

CT

+lo

g B

L; 1

wk

or m

ore

AC

T+

log

duri

ng1

of 2

inte

rven

tions

50 (

50)

/ 14.

11±

4.21

(9-

24)

/N

t wak

ing

prob

lem

s lo

g / (

AM

I) /

NS

/ NS

/ NS

/A

SAlo

g: S

On,

Sdu

r, Sl

eep%

, nig

htaw

aken

ings

; AC

T: S

On,

Sdu

r,Sl

eep%

, nig

ht a

wak

enin

gs,

quie

t sle

ep, a

ctiv

e sl

eep

Nt w

akin

g pr

oble

ms

& w

hose

pare

nts

com

plie

d w

/ an

inte

r-ve

ntio

n / N

S / A

CT

scor

ing

soft

war

e no

t spe

cifi

cally

deve

lope

d to

ass

ess

dayt

ime

slee

pine

ss, N

o un

trea

ted

con-

trol

Grp

AC

T+

log

show

ed im

prov

e-m

ent d

urin

g tim

e a

Tx

was

appl

ied

but n

o di

ffer

ence

betw

een

Txs

; Par

enta

l log

not

as g

ood

as A

CT

re: w

heth

erch

ildre

n’s

slee

p im

prov

eddu

ring

Tx

(60%

agr

eem

ent

rate

)

AC

T+

log

show

ed im

prov

e-m

ent d

urin

g tim

e a

Tx

was

appl

ied

but n

o di

ffer

ence

betw

een

Txs

Sade

h (3

3)

4C-a

AC

Tco

mpa

red

w/ o

ther

tech

-ni

ques

/ H

ome

/ Noc

turn

alon

ly f

or N

S h.

mea

n=6D

(ran

ge: 3

-12)

AC

T+

log

66 (

66)

/ 14.

7±4.

6M (

7-26

M)

/ Hea

lthy

log

/ AM

-16

/ leg

/ N

S / N

S /

ASA

log:

SO

n, S

dur,

Slee

p pe

rcen

t,nu

m a

wak

enin

gs; A

CT

: SO

n,Sd

ur, S

%, n

um a

wak

enin

gs

Nt w

akin

g pr

oble

ms

/ NS

/pt

s al

l ref

erre

d to

sle

ep c

linic

for

nigh

t wak

ing

prob

lem

s

Bot

h A

CT

+lo

g sh

ould

be

used

in a

sses

sing

sle

ep p

rob-

lem

s of

infa

nts

Pape

r ri

ghtly

con

clud

es th

atbo

th A

CT

+lo

g sh

ould

be

used

in a

sses

sing

sle

ep p

robl

ems

ofin

fant

s be

caus

e ei

ther

alo

nedi

stor

t or

mis

s so

me

data

Sade

h (1

7)

1A

Val

idat

ion;

AC

Tco

mpa

red

w/

othe

r te

chni

ques

; rel

iabi

lity

/L

abor

ator

y &

Hom

e N

S /

Noc

turn

al; 1

. PSG

& A

CT;

2.

42-4

8h w

/ 2 A

CT

on s

ame

wri

st

44 (

44)

/ Grp

1 22

.6±

1.7

(20-

25),

Grp

2 13

.8±

1.9

(10-

16),

Grp

3 (1

2-46

) / N

S

PSG

/ A

MA

-32

/ 1. 1

dom

&1

ndom

wri

st, 2

. 2 o

n sa

me

wri

st /

1 m

in /

NS

/ zer

ocr

ossi

ng (

& b

ased

on

1st 1

0ad

ult p

ts)

PSG

& A

CT

: S, W

- M

inut

eby

min

ute

com

pari

son

Nor

mal

/ N

S / N

S S/

Wde

rive

d fr

om A

CT

isro

bust

& li

ttle

affe

cted

by

devi

ce p

lace

men

t alth

ough

activ

ity le

vels

dif

fere

dbe

twee

n do

m &

ndo

m w

rist

duri

ng S

P&

wak

eful

ness

but

resu

lting

abi

lity

to d

iscr

imi-

nate

sle

ep w

as r

elat

ivel

yun

affe

cted

by

this

.

Pape

r co

ntai

ns s

ugge

stio

nsfo

r pr

oper

use

of A

CT

Sfor

za (

39)

2B

valid

atio

n / l

abor

ator

y / n

oc-

turn

al o

nly

for

7.5

h, 2

N (

s/b

Nt?

PSG

/AC

T(n

= 1

0; C

PAP

titra

tion

on n

ight

2)

inPS

G/A

CT

(n=

25)

35 (

35)

/ 54.

8±1.

6 (3

7-72

) /

13 O

SAS,

22

ED

S or

sno

ring

or R

LS/

PLM

D

PSG

; Ant

erio

r tib

ialis

EM

G /

Gae

hwile

r / u

pper

Rt f

oot /

5se

c / 0

.1g

/ NS

PSG

: PL

M (

via

EM

G);

AC

T:

PLM

NS/

Tech

nica

l pro

blem

s du

r-in

g re

cord

ing/

Mos

t pts

Dx

w/O

SA

AC

T: E

MG

Mov

emen

ts –

leg

AC

Tno

t val

id.

R=

0.78

but

AC

Tun

dere

stim

ates

mov

e-m

ents

, esp

ecia

lly th

ose

<3

sec

and

< 5

0 m

v bu

t was

rel

iabl

eac

ross

2 n

ight

s in

8/1

0 su

b-je

cts

thus

not

val

id f

or D

XPL

MD

but

val

id f

or T

x ev

alu-

atio

n.

Con

clus

ions

dif

fer

from

thos

eof

Kaz

enw

adel

, et a

l., 1

995

due

to m

ore

soph

istic

ated

anal

ysis

Cit

atio

n - A

utho

r/

Evi

denc

e L

evel

St

udy

Cri

teri

a D

esig

n /

Loc

atio

n / P

roto

col

Sam

ple

Size

(C

ompl

eted

Stud

y) /

Mea

n A

ge (

Ran

ge)

/M

edic

al C

ondi

tion

s

Com

pari

son

Mea

sure

s /

Act

igra

ph a

ppar

atus

/P

lace

men

t / E

poch

Len

gth

/Se

nsit

ivit

y / S

cori

ng

Out

com

e M

easu

res

Incl

usio

n / E

xclu

sion

/ B

ias

Stud

y C

oncl

usio

n fr

ompa

per

Com

men

ts f

rom

Rev

iew

er


Shin

koda

(27

)

3C

AC

Tco

mpa

red

w/ o

ther

tech

-ni

ques

/ L

abor

ator

y /

Noc

turn

al; 3

Nt A

CT

+PS

G

4 (4

) / (

20-3

3) /

NS

PSG

/ A

MA

-32C

L/ n

dom

wri

st /

30s

(but

1 m

in c

om-

pare

d to

PSG

) / N

S / C

ole

etal

199

2; O

ther

: Zer

o cr

ossi

ngm

ode

PSG

: S,W

, TST

, SO

L, S

EI,

WA

SO, n

um a

wak

enin

gs;

AC

T: S

, W, T

ST, S

OL

, SE

I,W

ASO

, num

aw

aken

ings

NS

/ NS

/ ver

y lo

w s

ampl

esi

ze

AC

Tco

rrel

ates

w/ P

SG f

orT

ST, S

OL

, SE

I, W

ASO

, num

awak

enin

gs

Tik

otzk

y (3

4)

4C-a

Obs

erva

tiona

l /N

S /p

ut o

n 1

hbe

fore

sle

ep, r

emov

ed 1

haf

ter

wak

e, 4

-5 N

NS

(59)

M, 2

9, F

, 30

( 3.

8-6.

1) /n

orm

al

Slee

p lo

g-di

ary

/ AM

A-3

2;A

MI

/ non

-dom

wri

st /

NS

/N

S / S

adeh

ASA

AC

T: S

O, T

ST, %

sle

ep, #

wak

es

NS/

NS

Pare

nts

log

corr

elat

ed w

ell

with

AC

Tbu

t les

s ac

cura

te in

slee

p qu

ality

mea

sure

s. 4

1%of

kid

s ha

d fr

agm

ente

d sl

eep

Van

Som

eren

(17

9)

4C-b

Tech

nica

l con

side

ratio

ns /

Lab

orat

ory;

whi

le p

erfo

rmin

g6

task

s / N

S

25 (

25)

/ Grp

1 28

±4,

Grp

280

±9

/ NS

NS

/ Ent

ran

/ dom

wri

st /

NS

/ ±2g

/ N

S N

S N

S / N

S / N

S U

se o

f ba

ndpa

ss o

f 0.

25 to

11kg

for

AC

Tis

bet

ter

tom

easu

re a

ll m

ovem

ent.

May

unde

r re

cord

mov

emen

tses

peci

ally

in y

oung

. It a

lso

tend

s to

red

uce

“gra

vita

tiona

lar

tifac

t”.

Van

Som

eren

(14

)

5D-a

Tech

nica

l / N

S / N

S 25

(25

) / G

rp1

You

ng A

dults

,G

rp2

Eld

erly

/ N

S N

one

/ NS

NS

NS

/ NS

/ AC

Tsc

orin

g so

ft-

war

e no

t spe

cifi

cally

dev

el-

oped

to a

sses

s da

ytim

e sl

eepi

-ne

ss

The

ban

dpas

s fi

lter

of ty

pica

lA

CT

appe

ars

to b

e to

o na

rrow

& m

ay m

iss

som

e m

ovem

ents

.5-1

1Hz

may

be

bette

r. T

his

is e

spec

ially

impo

rtan

t for

stud

ies

of a

ging

sin

ceyo

unge

r te

nd to

hav

e m

ore

rapi

d m

ovem

ents

that

can

be

mis

sed

w/ t

he p

reva

iling

cut

-of

fs

Hig

hly

theo

retic

al w

/ litt

lein

form

atio

n on

whe

re th

e da

tash

own

cam

e fr

om

Ver

beek

(18

0)

3C

Val

idat

ion

/ lab

orat

ory

/ NS

20 (

20)

/ 47.

7 (3

3 –

64)

/in

som

nia

PSG

; log

/ N

S / N

S / N

S /

NS

/ Col

e et

al.,

199

2 N

S he

alth

y / N

S / N

S A

CT

over

estim

ates

TST

inin

som

niac

s by

mis

taki

ngly

ing

still

but

aw

ake

for

slee

p.PS

G b

ette

r th

an A

CT;

bot

hbe

tter

than

logs

.

Too

man

y pr

oced

ural

det

ails

not s

peci

fied

.

Vio

lani

(42

)

4C-a

Para

llel d

esig

n / L

abor

ator

y(n

octu

rnal

stu

dy);

Hom

e(d

iurn

al s

tudy

) / E

ntir

e 24

-h;

1wk

log;

1N

t PSG

+A

CT

onea

ch w

rist

& e

ach

ankl

e, 1

Nt

PSG

+A

CT

on e

ither

wri

st o

rea

ch a

nkle

, 1N

t PSG

+A

CT

inop

posi

te p

ositi

ons

from

pre

vi-

ous

nigh

t

16 (

16)

/ (19

-28)

/ N

S PS

G; l

og /

4 m

otio

n lo

gger

/ea

ch w

rist

& e

ach

ankl

e / 1

min

/ N

S / z

ero

cros

sing

Act

ion

2

AC

T: A

ctiv

ity le

vels

N

orm

al s

leep

dur

and

sch

ed-

ule,

hea

lthy

/ NS

/ NS

Dur

ing

WR

t han

d sh

ows

mor

e in

tens

e ac

tivity

than

Lt

that

dis

appe

ars

duri

ng e

arly

slee

p bu

t rea

ppea

rs d

urin

gla

ter

slee

p th

at c

anno

t be

acco

unte

d fo

r by

a d

iffe

renc

ein

aro

usal

. No

such

dif

fer-

ence

s no

ted

in a

nkle

act

ivity

.


Aro

nen

(67)

4C-b

Obs

erva

tiona

l stu

dy /

hom

e /

entir

e 24

h, 3

D A

CT

49 (

NS)

M, 2

6, F

, 23

/9.7

3(1

.39)

/ no

rmal

N

one

/ AM

I m

ini-

mot

ion

log-

ger

/ bel

t / 1

min

/ N

S / A

MI

Beh

avio

ral:

child

beh

avio

rch

eckl

ist,

teac

her

repo

rt f

orm

N

o m

eds/

no m

eds

/ sm

all

sam

ple

size

, low

pow

er, h

igh

Type

I e

rror

due

to m

ultip

lete

sts

AC

Tsl

eep

times

rel

ated

tote

ache

r-re

port

ed s

ympt

oms;

decr

ease

d sl

eep

rela

ted

tom

ore

exte

rnal

izin

g sy

mpt

oms

Cit

atio

n - A

utho

r/

Evi

denc

e L

evel

St

udy

Cri

teri

a D

esig

n /

Loc

atio

n / P

roto

col

Sam

ple

Size

(C

ompl

eted

Stud

y) /

Mea

n A

ge (

Ran

ge)

/M

edic

al C

ondi

tion

s

Com

pari

son

Mea

sure

s /

Act

igra

ph a

ppar

atus

/P

lace

men

t / E

poch

Len

gth

/Se

nsit

ivit

y / S

cori

ng

Out

com

e M

easu

res

Incl

usio

n / E

xclu

sion

/ B

ias

Stud

y C

oncl

usio

n fr

ompa

per

Com

men

ts f

rom

Rev

iew

er

Tabl

e 3—

Evi

denc

e le

vels

for

stu

dies

of

slee

p di

sord

ers

Col

e (4

4)

2B

RC

T, p

aral

lel /

Hom

e / E

ntir

e24

h 2

D B

L; 5

D T

x; 2

D p

ost

Tx

78 (

45)

/ 25±

6 / D

SPS

N

one

/ Act

illum

e / w

rist

/ N

S/ N

S / N

S

Log

; AC

T; b

ehav

iora

l; M

ood;

6-SM

TN

S / n

on D

SPS,

ser

ious

heal

th p

robl

ems,

reg

ular

med

use,

Rx/

alco

hol a

buse

, ser

ious

psyc

hiat

ric

prob

lem

s, r

ecen

ttr

avel

/shi

ft w

ork

/ NS

Acr

opha

se o

f 6-

SMT

adva

nced

by

brig

ht li

ght,

nodi

ffer

ence

at f

/u. A

dvan

cesu

stai

ned

only

in la

te-p

hase

pts.

Lat

e-ph

ase

pts

SOn

and

SOff

adv

ance

d by

bri

ght

light

.

Col

lado

-Sei

del (

73)

4C-b

Con

trol

led

clin

ical

tria

l,cr

oss-

over

des

ign

/ Hom

e /

Noc

turn

al; 5

Nt B

LA

CT;

5N

tR

x A

CT;

5N

t pla

cebo

AC

T

37 (

30)

/ 58±

10 /

PLM

D/R

LS

Que

stio

nnai

re; O

bser

vatio

nby

oth

ers

(phy

sici

an)

/M

ovop

ort (

Rim

kus)

/ f

oot /

NS

/ NS

/ NS

AC

T: P

LM

per

h o

f T

IB, t

ime

w/o

mov

emen

t; O

ther

s: Q

OL

ratin

gs; p

hysi

cian

-rat

ed c

lini-

cal g

loba

l im

pres

sion

s, S

BJ

QO

L

Impr

ovem

ent i

n Sy

mpt

oms

w/ L

-dop

a 1s

t 4

h, ≥

2 w

akes

long

er th

an 2

0 m

ins

or 1

long

er th

an 1

h, I

ncre

ase

inPL

Ms

2nd

half

of

nigh

t / N

S /

Non

e

Tx

impr

oved

: num

PL

M /

h,(p

,.001

) %

of

TIB

w/o

leg

mov

emen

ts,

(p<

.001

) SB

J Q

OL

, (p

<.0

01)

num

of

PLM

epi

sode

s,(p

<00

1) n

um o

f PL

Ms

per

epis

ode,

(p<

.001

) du

r of

PL

Mep

isod

es (

p=.0

05)

Dag

an (

57)

5D-a

Cas

e se

ries

/ H

ome

/ Ent

ire

24-h

; 4-7

D A

CT

BL

to h

elp

diag

nose

DSP

S; f

/u q

uest

ion-

nair

e ≥

1 yr

aft

er 6

-wk

mel

Tx

61 (

NS)

/ 30

.17±

11.2

6 (1

6-54

) / D

SPS

Non

e / M

ML

(AM

I) /

wri

st /

NS

/ NS

/ NS

Sade

h; O

ther

:ze

ro-c

ross

ing

mod

e

Surv

ey

No

med

s, D

SPS

Dx,

mel

Tx,

fini

shed

≥1

yr p

rior

to s

tudy

/ No

cont

rol G

rp

96.7

% r

epor

t mel

hel

ped

DSP

S, 9

1.5%

rel

apse

aft

erm

el c

essa

tion

No

valid

atio

n of

AC

Tot

her

than

pt.

repo

rt A

CT

used

onl

yto

aid

initi

al D

x of

DSP

S.O

utco

me

asse

ssed

onl

y by

ques

tionn

aire

, not

AC

T.

Dag

an (

54)

5D-b

Coh

ort s

tudy

/ H

ome

/N

octu

rnal

8 h

27

(27

) / G

rp1

31.9

±6.

31,

Grp

2 30

.5±

5.5

/ nor

mal

;PT

SD

log

/ (A

MI)

/ w

rist

/ N

S / N

S/ S

adeh

et a

l ‘89

lo

g; P

SG; H

ealth

que

stio

n-na

ire

Free

of

slee

p-af

fect

ing

Rxs

for

10-D

s / N

S / N

S N

o si

g. d

iffs

, in

AC

Tsl

eep

vari

able

b/t

PTSD

pts

& n

or-

mal

con

trol

s; n

o co

rrel

atio

nb/

t AC

Tsl

eep

vari

able

s &

AM

rep

orts

; no

corr

elat

ion

b/t

AC

Tsl

eep

vari

able

s &

sle

eppa

ram

eter

s on

hea

lth q

ues-

tionn

aire

Dri

nnan

(70

)

5D-b

AC

Tco

mpa

red

w/ o

ther

tech

-ni

ques

/ H

ome

/ Noc

turn

alon

ly f

or 6

h; 1

Nt P

SG/A

CT

40 (

36)

/ 48±

12 (

20-7

3) /

Snor

ing,

ED

S PS

G; E

pwor

th /

IC S

enso

rs /

Lw

rist

, Lan

kle

/ NS

/ NS

/C

usto

m

PSG

; AC

T; E

pwor

th

NS

/ NS

/ Sam

ple

limite

d to

pts

pres

entin

g fo

r T

x; o

nly

1N

t ass

esse

d

No

sign

ific

ant c

orre

latio

nbe

twee

n A

CT

& a

pnea

, EE

Gar

ousa

l, or

res

pira

tory

pha

se;

Lan

kle

AC

T/L

tibia

EM

Gr=

.73

(p<

.001

); L

ankl

eA

CT

/Lw

rist

AC

Tr=

.55

(p<

.001

); d

etec

tion

of li

mb

mov

emen

t pre

dict

ive

ofar

ousa

l, bu

t EM

G m

ore

than

AC

T

Elb

az (

71)

3C

AC

Tco

mpa

red

with

oth

erte

chni

ques

/lab

/ no

ctur

nal

only

for

8 h

1 N

t PSG

, AC

T

20 (

20)

M, 1

5, F

, 5 /

52 (

15)

/O

SAS

PSG

, Res

p va

riab

les

/C

ambr

idge

Act

iwat

ch /

non-

dom

wri

st /

1 m

in /

NS

/ NS

PSG

sle

ep v

aria

bles

, AC

TN

S/N

S Fo

r AC

TT

ST&

PSG

TST

,r=

.74,

p<

.000

1; f

or A

CT

RD

I&

PSG

RD

I, r

=.9

76, p

<.0

001;

for

RD

I ba

sed

on T

IB, r

= .9

4Se

nsiti

vity

& n

egat

ive

pred

ic-

tive

valu

e lo

wer

for

TIB

RD

Ith

an A

CT

RD

I in

sev

ere

OSA

patie

nts.

AC

T&

res

pira

tory

var

iabl

espr

ovid

ed g

ood

asse

ssm

ent o

fR

DI

and

was

som

ewha

t bet

ter

than

res

p va

riab

les

alon

e

Cit

atio

n - A

utho

r/

Evi

denc

e L

evel

St

udy

Cri

teri

a D

esig

n /

Loc

atio

n / P

roto

col

Sam

ple

Size

(C

ompl

eted

Stud

y) /

Mea

n A

ge (

Ran

ge)

/M

edic

al C

ondi

tion

s

Com

pari

son

Mea

sure

s /

Act

igra

ph a

ppar

atus

/P

lace

men

t / E

poch

Len

gth

/Se

nsit

ivit

y / S

cori

ng

Out

com

e M

easu

res

Incl

usio

n / E

xclu

sion

/ B

ias

Stud

y C

oncl

usio

n fr

ompa

per

Com

men

ts f

rom

Rev

iew

er


Fran

ck (

62)

4C-b

Coh

ort s

tudy

/ H

ome

/ Ent

ire

24-h

; 3D

AC

T33

(33

) / G

rp1

10.6

1±3.

5,G

rp2

10.8

7±3.

27 /

Nor

mal

,H

IV+

log;

Sel

f re

port

; Par

enta

lre

port

/ M

ML

(AA

M-3

2) /

NS

/ 2 m

ins

/ NS

/ Act

ion

3

log;

AC

TN

S / F

or c

ontr

ols:

Chr

onic

med

ical

con

ditio

ns, r

egul

arm

ed u

se /

All

infe

cted

pt’s

unde

rgoi

ng R

x th

erap

y

Pare

ntal

rep

orts

indi

cate

dH

IV-i

nfec

ted

child

ren

to h

ave

less

sle

ep, m

ore

awak

enin

gs,

& m

ore

nigh

tmar

es th

an c

on-

trol

s; c

hild

logs

sho

wed

no

diff

. in

slee

p ch

arac

teri

stic

s or

dayt

ime

fatig

ue; A

CT

show

edgr

eate

r nu

m o

f aw

aken

ings

,lo

wer

SE

, Wtim

e du

ring

the

Nt,

less

SE

for

HIV

+ p

ts

Gui

llem

inau

lt (5

1)

4C-b

NS/

Hom

e / N

octu

rnal

; 1N

tPS

G s

cree

ning

, 4w

k T

x; 4

Nt

AC

T; 7

Nt l

og

32 (

30)

/ Grp

1 44

±8,

Grp

244

±8,

Grp

3 44

±8

/ Ins

omni

a Q

uest

ionn

aire

; log

/ M

ML

/do

m a

rm /

2 m

ins

/ NS

/ NS

log;

AC

T; S

elf-

repo

rted

sle

ep:

TST

, SL

, num

WSL

> 3

0min

or

TST

<36

0min

, No

Rx

seda

tive-

hyp-

notic

use

/ N

S / N

S

No

diff

for

SH

or

SH +

Exe

rcis

e, f

or S

H +

lig

ht, T

SThi

gher

, SL

low

er,

Wlo

wer

TST

from

logs

< A

CT

TST

,SL

logs

> S

LA

CT,

Wlo

gs <

WA

CT

Gui

llem

inau

lt (1

81)

5D-b

Cas

e se

ries

/ L

abor

ator

y an

dho

me

/ Noc

turn

al o

nly

for

8h;

1 N

t PSG

; 7 N

t log

and

AC

T

184

(184

) / M

34±

8 (1

8-52

),F

39±

12.5

(18

-54)

/H

ead/

Nec

k tr

aum

a an

d hy

per-

som

nia

PSG

, M

SLT,

Epw

orth

, SSS

,lo

g / N

S / N

S / N

S / N

S / N

S L

og; P

SG: M

SLT,

AH

I,SO

RE

MPs

; Beh

avio

ral v

ari-

able

s; M

ood

vari

able

s

NS

/ NS

/ sel

f-se

lect

ed s

am-

ple

ED

S as

soci

ated

w/im

pair

edda

ytim

e fu

nctio

n. 2

4-h

com

a,he

ad f

ract

ure,

or

imm

edia

tene

uros

urgi

cal i

nter

vent

ion

asso

ciat

ed w

/ ESS

> 1

6 an

dM

SLT

<5.

Sle

ep a

pnea

ass

o-ci

ated

w/ w

hipl

ash.

AC

Tha

d lit

tle r

ole

in r

esul

tsor

con

clus

ions

.

Hay

es (

182)

4C-b

Cro

ss-s

ectio

nal s

tudy

/ H

ome

/ Noc

turn

al o

nly

for

9 h;

1N

tA

CT

30 (

27)

/ Grp

1 80

.9m

o±7.

2SE

M /

Nor

mal

T

ime-

laps

e vi

deo

/E

lect

rost

atic

bed

pad

/he

ad/s

houl

der

& b

utto

cks

/ 1se

c / N

S / F

FT, P

erio

dgra

m

AC

T: A

FFT

Nor

mal

sle

eper

; mid

-inf

ancy

to p

re-p

uber

ty /

NS

/ Non

e M

ovem

ent i

nten

sity

& m

ove-

men

t bou

t str

uctu

re in

tegr

itydu

ring

sle

ep d

ecre

ased

w/

age;

dec

line

in b

out d

ur w

/ag

e; in

crea

se in

bou

t fre

q. w

/ag

e

Her

ing

(63)

5D-b

NS

/ Hom

e / E

ntir

e 24

-h; 3

DA

CT

NS

(NS)

/ G

rp1

8.0±

3.0,

Grp

2 8.

0±2.

3 / N

orm

al,

Inso

mni

a, A

utis

m

log

/(A

MI)

/ w

rist

/ N

S / N

S /

Sade

h ‘8

9 lo

g; A

CT

NS

/ NS

/ NS

log

of p

aren

ts s

how

ed d

iffe

r-en

ces

in A

M W

time,

ear

ly N

tar

ousa

ls, &

mul

tiple

Nt

arou

sals

Jean

-Lou

is (

53)

5D-b

Obs

erva

tiona

l stu

dy /

Hom

e /

Ent

ire

24-h

; 3D

AC

T27

3 (N

S) /

51 (

40-6

4) /

Nor

mal

N

one

/ Act

illum

e / w

rist

/ 1

min

/ N

S / A

ctio

n 3

Moo

d: Q

WB

sca

le, C

ES-

D

NS

/ NS

/ Mea

n ag

e so

me-

wha

t hig

h (N

50)

to b

e re

pre-

sent

ativ

e of

the

adul

t pop

ula-

tion;

use

d pt

s re

ceiv

ed f

rom

rand

om te

leph

one

dial

ing-

thos

e w

ho c

onse

nted

may

be

mor

e lik

ely

to h

ave

prob

lem

s

AC

T-m

easu

red

slee

p va

ri-

able

s no

t sig

nifi

cant

ly c

orre

-la

ted

w/ Q

WB

or

CE

S-D

scor

es

Jean

-Lou

is (

16)

3C

Val

idat

ion;

AC

Tco

mpa

red

w/

othe

r te

chni

ques

/ L

abor

ator

y;H

ome

/; G

rp 1

Noc

turn

al;

Ent

ire

24 h

1N

t AC

T+

log

inho

me,

1N

t AC

T&

PSG

inla

b; G

rp I

I. N

octu

rnal

; Ent

ire

24 h

1 D

AC

T+

log+

SSS

inho

me,

3N

t AC

T+

PSG

in la

b

46 (

46)

/ Grp

1 30

±9.

0, G

rp2

46.5

±10

.8 /

Grp

2 In

som

nia

PSG

/ G

rp1

Gae

hwile

r, G

rp2

(AM

I) /

Grp

1 do

m a

rm, G

rp2

NS

/ NS

/ NS

/ AD

AS

PSG

: TST

; AC

T: T

STG

rp1

Nor

mal

/ N

S / N

S A

CT

is v

alid

for

ass

essi

ngS/

W; A

CT

is u

sefu

l to

asse

ssS/

Win

inso

mni

acs;

AD

AS

isa

valid

sof

twar

e fo

r AC

Tin

diff

eren

t typ

es o

f ap

para

tus

Jean

-Lou

is (

177)

1A

AC

Tsc

orin

g so

ftw

are

/L

abor

ator

y; H

ome

/N

octu

rnal

Ent

ire

24-h

; 1 w

kA

CT

at h

ome

+ S

SS; 3

Nt

PSG

+A

CT

(onl

y 1

nigh

tPS

G+

AC

Tan

alyz

ed)

26 (

26)

/ 46.

4±10

.8 /

NS

SSS

/ (A

MI)

/ N

S /

30se

c/1

min

/ N

S / A

DA

S; O

ther

:ze

ro-c

ross

ing

PSG

: TST

, SE

; AC

T: s

leep

thre

shol

d, W

ASO

, TST

, SE

In

som

niac

/ N

S / N

S A

CT

:PSG

in in

som

niac

s;A

CT

“is

an e

xcel

lent

tool

for

unob

trus

ive

docu

men

tatio

n of

S/W

activ

ity in

indi

vidu

als

w/…

inso

mni

a”

Aro

usal

s af

ter

SOn

defi

ned

aslo

nger

than

3 m

ins

scor

ed a

sW

; sev

eral

dif

fere

nt r

val

ues

repo

rted

for

sam

e da

ta

Cit

atio

n - A

utho

r/

Evi

denc

e L

evel

St

udy

Cri

teri

a D

esig

n /

Loc

atio

n / P

roto

col

Sam

ple

Size

(C

ompl

eted

Stud

y) /

Mea

n A

ge (

Ran

ge)

/M

edic

al C

ondi

tion

s

Com

pari

son

Mea

sure

s /

Act

igra

ph a

ppar

atus

/P

lace

men

t / E

poch

Len

gth

/Se

nsit

ivit

y / S

cori

ng

Out

com

e M

easu

res

Incl

usio

n / E

xclu

sion

/ B

ias

Stud

y C

oncl

usio

n fr

ompa

per

Com

men

ts f

rom

Rev

iew

er


Kaz

enw

adel

(38

)

1A

Val

idat

ion

/ Lab

orat

ory

/N

octu

rnal

; 2w

k B

L, 4

wks

levo

dopa

& le

nser

azid

e, 4

wks

plac

ebo

in r

ando

miz

edcr

osso

ver

desi

gn; 2

Nt

AC

T+

PSG

w/ E

MG

at e

nd o

fB

L(1

st w

as a

dapt

atio

n ni

ght)

then

1N

t AC

T+

PSG

w/ E

MG

at e

nd o

f ea

ch T

x pe

riod

30 (

29)

/ 51.

0 (2

9-74

) /

PLM

D/R

LS

PSG

/ M

OV

OPO

RT

/ top

of

Rt f

oot b

etw

een

1st &

2nd

toes

on

pts

repo

rted

mos

taf

fect

ed le

g / 0

.5 s

ec /

NS

/co

mpu

ter

dich

otom

izin

g re

la-

tive

to a

thre

shol

d fo

llow

edby

man

ual m

odif

icat

ions

PSG

: PL

M, T

IB, S

EI;

AC

T:

PLM

, TIB

R

LS

+ P

LM

/ N

S / N

S M

easu

rem

ent o

f PL

MD

by

AC

Tis

pos

sibl

e w

/ 1/2

-sec

-on

d ep

ochs

. Med

mad

e no

diff

eren

ce in

EM

G &

AC

Tco

rrel

atio

ns

Met

hod

requ

ires

con

side

rabl

em

anua

l adj

ustm

ent o

f co

m-

pute

r an

alyz

ed A

CT

data

toav

oid

unde

rest

imat

ion.

Mov

emen

ts o

f on

ly o

ne le

gre

cord

ed b

y A

CT

Ker

khof

(56

)

4C-b

Cor

rela

tiona

l / H

ome

/ 14D

oral

tem

p, V

AS

SBJ

aler

tnes

s;14

Nt l

og, V

AS

SQ.;

11D

AC

T

80 (

80)

/ 34.

8±10

.1 /

Inso

mni

a lo

g; T

emp

/ Gae

hwile

r / n

dom

hand

/ 30

sec

/ 0.

1g /

cust

om

log;

Tem

p; A

CT

: mea

n ac

tivi-

ty c

ount

(M

R),

imm

obili

ty(I

MM

), f

ragm

enta

tion

(FR

)

6 m

os. S

erio

us s

leep

com

-pl

aint

s / N

S / N

S Si

gnif

ican

t dif

fere

nce

in M

Rb/

t ear

ly &

late

tem

p ph

ase

pts

no d

iffe

renc

e fo

r FR

or

IMM

q(p

) va

lues

gre

ater

for

earl

y ph

ase

Grp

Kra

mer

(68

)

4C-b

Cro

ss-s

ectio

nal s

tudy

/ hom

e /

14 D

sle

ep lo

gs, 1

1 D

AC

T,14

D o

ral t

emp

40 (

40)

Grp

1 M

21.

Grp

2M

, 19

/ Grp

1 6

5.1

(59-

74(4

.4)

Grp

2 2

0.8

18-2

6 (2

.2)

/no

rmal

Slee

p lo

g, d

iary

/ Gae

whi

ler

/no

n-do

m w

rist

/ 30

sec

/ 0.

1g/ N

S

Slee

p di

ary,

log;

AC

TE

xclu

sion

: psy

chia

tric

, neu

ro-

logi

cal d

isea

se, c

ardi

ovas

cula

rdi

seas

e, d

rug

abus

e / N

S

You

ng s

ubje

cts

had

mor

e T

IBva

riab

ility

than

eld

erly

sub

-je

cts;

p<

.001

. E

lder

ly s

ub-

ject

s ha

d ad

vanc

ed s

leep

phas

e re

lativ

e to

you

nger

sub

-je

cts.

Eld

erly

sub

ject

s ha

dm

ore

mid

nigh

t aw

aken

ings

than

you

ng s

ubje

cts.

Sle

eplo

gs s

how

ed le

ss T

STan

d SE

for

elde

rly

subj

ects

.

Kun

z (1

83)

4C-b

Unb

linde

d, n

onra

ndom

ized

/L

abor

ator

y, H

ome

/ Noc

turn

alon

ly 8

h; 2

Nt P

SG B

L; 1

4 N

tA

CT

BL

; 2 N

t PSG

pos

t Tx;

14 N

t Tx

9 (9

) / 5

7 (4

0-71

) / P

LM

D,

Dep

ress

ion,

RSB

D,

Park

inso

n’s

dysa

uton

omia

PSG

, log

/ 2A

K /

wri

st /

NS

/N

S / N

S

Log

; PSG

; AC

TN

S / R

LS

/ sm

all s

ampl

e T

x im

prov

ed w

ell b

eing

in 7

of 9

pts

, PSG

mov

emen

tpa

ram

eter

s im

prov

ed w

/ Tx,

AC

Tm

easu

red

mov

emen

tre

duce

d by

Tx

No

mea

sure

men

t of

slee

pva

riab

les

w/ A

CT

Kus

hida

(19

)

2B

Val

idat

ion

/ Lab

orat

ory

/N

octu

rnal

8 h

1N

t PSG

, AC

T,lo

g

100

(100

) / 4

9±14

.7 /

OSA

S,na

rcol

epsy

, ins

omni

a,PL

MD

/RL

S, U

AR

S

PSG

; log

/ A

W4

MM

/ nd

omw

rist

/ 30

s / .

01 g

/ O

akle

y‘9

7

log;

PSG

; AC

TN

S / N

S / s

elf-

refe

rred

pts

,m

ixtu

re o

f D

x A

CT

over

est

imat

ed T

STby

1.0-

1.8

h; lo

g ov

eres

timat

edT

STby

0.3

h; n

um o

f aw

ak-

enin

g m

ore

accu

rate

for

AC

Tth

an lo

g; A

CT

high

thre

shol

dal

gori

thm

: sen

sitiv

ity =

.98;

spec

ifyi

ng =

.76

accu

racy

=.2

8

Mid

delk

oop

(69)

4C-b

Val

idat

ion

/ Hom

e / 1

Nt A

CT,

log

167

(116

) / 5

3.6±

10.7

/ O

SAS

log;

Oro

nasa

l the

rmis

try

/G

aehw

iler

/ ndo

m a

rm /

15se

c / N

S / %

epo

chs

coun

t>0;

Oth

er: C

ount

s/ep

och,

dur

of

unin

terr

upte

d ac

tivity

, dur

of

imm

obili

ty (

DIP

), f

ragm

enta

-tio

n in

dex

Log

; AC

T; R

espi

ratio

n (a

pnea

inde

x)

Hab

itual

sno

ring

w/ e

xces

sive

dayt

ime

slee

pine

ss a

nd/o

rno

ctur

nal r

espi

rato

ry a

rres

ts /

NS

/ A

pnea

of

pts

was

mild

,m

ay h

ave

led

to lo

wer

dis

-cr

imin

atio

n

AI ≥

5 G

rp. G

reat

er th

an A

I<

1 &

AI

< 5

gro

ups

for

mov

emen

t ind

ex &

fre

quen

cyIn

dex.

DIP

sig

diff

in 3

Grp

s,E

TO

H r

elat

ed to

DIP

, DIP

corr

elat

ed w

/ AI

Nag

tega

al (

61)

1A

Con

trol

led

clin

ical

tria

l, D

B,

cros

s-ov

er d

esig

n /

Lab

orat

ory,

Hom

e /

Noc

turn

al, E

ntir

e 24

-h; 1

Dre

ct te

mp

(pre

Tx)

, 1N

t PSG

(Pla

cebo

mel

), 3

D A

CT

(pla

cebo

), 1

4D A

CT

(mel

),1D

rec

t tem

p (p

ost T

x)

30 (

25)

/ 37.

3±15

.3 /

CR

dis

-or

der

PSG

; log

; Tem

p / N

S / N

S /

NS

/ NS

/ NS

Log

; tem

p; P

SG; A

CT

NS

/ Und

er a

ge 1

2, p

rior

use

of m

el, l

iver

dis

ease

, ren

alfa

ilure

, sev

ere

neur

olog

ical

or

psyc

hiat

ric

diso

rder

, pre

gnan

-cy

/ N

S

Tem

p m

arke

rs s

how

edad

vanc

e af

ter

Tx;

pts

mor

ere

fres

hed

(log

s) w

/ Tx

com

-pa

red

to p

lace

bo

Cit

atio

n - A

utho

r/

Evi

denc

e L

evel

St

udy

Cri

teri

a D

esig

n /

Loc

atio

n / P

roto

col

Sam

ple

Size

(C

ompl

eted

Stud

y) /

Mea

n A

ge (

Ran

ge)

/M

edic

al C

ondi

tion

s

Com

pari

son

Mea

sure

s /

Act

igra

ph a

ppar

atus

/P

lace

men

t / E

poch

Len

gth

/Se

nsit

ivit

y / S

cori

ng

Out

com

e M

easu

res

Incl

usio

n / E

xclu

sion

/ B

ias

Stud

y C

oncl

usio

n fr

ompa

per

Com

men

ts f

rom

Rev

iew

er


Oka

wa

(58)

4C-b

Com

para

tive

Tx

/ Hom

e /

Ent

ire

24-h

/ 14

D A

CT,

bod

yte

mp

BL

, Tx

(tim

e no

t ind

i-ca

ted)

11 (

11)

/ Grp

1 32

.3 (

16-4

6),

Grp

2 28

.4 (

17-3

4) /

CR

dis

or-

der

Log

; tem

p / (

AM

I) /

ndom

wri

st /

NS

/ NS

/ NS

L

og; t

emp;

AC

TN

S / N

S / S

mal

l sam

ple

size

6/

11 p

ts r

espo

nded

to m

el T

x;te

mp

phas

e sh

ifte

d fi

rst,

fol-

low

ed b

y sh

ift i

n S/

Wcy

cle

No

stat

istic

al a

naly

sis

repo

rt-

ed, n

o co

ntro

ls

Sade

h (6

6)

4C-b

Cro

ss-s

ectio

nal s

tudy

/ ho

me

/4-

5 D

AC

Ton

sch

ool n

ight

s;sl

eep

logs

, sle

ep h

abits

que

s-tio

nnai

re

140

(140

) M

72,

F 6

8 G

rp 1

N=

50; G

rp 2

N=

37;

Grp

3 N

= 5

3 / g

rp 1

7.0

(7.

2-8.

6(o

.34)

; Grp

2 9

.7 (

9.3-

10.4

(o.3

0); G

rp 3

11.

8 (9

.9-1

2.7

(0.4

5) /

norm

al

Que

stio

nnai

re, s

leep

log/

diar

y / A

MI A

MA

-32

/ non

-do

m w

rist

/ 1

min

/ N

S / A

SA

Slee

p di

ary/

log,

AC

TE

xclu

sion

: no

acut

e ph

ysic

alill

ness

or

beha

vior

al p

robl

ems

Nig

ht –

to-n

ight

rel

iabi

lity

for

AC

T>

.70

for

mos

t mea

sure

s.O

lder

sub

ject

s ha

d de

laye

dsl

eep

onse

t tim

es, s

hort

ersl

eep

peri

ods,

and

sho

rter

slee

p tim

es th

an y

oung

er s

ub-

ject

s.

Gir

ls h

ad lo

nger

sle

eptim

es a

nd m

ore

mot

ionl

ess

slee

p th

an b

oys;

incr

ease

dfa

mily

str

ess

corr

elat

ed w

ithpo

orer

sle

ep q

ualit

y, in

crea

sed

dayt

ime

slee

pine

ss a

ssoc

.w

ith g

reat

er a

ge a

nd s

hort

ersl

eep

peri

od p

er A

CT

Sade

h (6

4)

4C-b

Obs

erva

tiona

l stu

dy /

out –

of-

lab

hosp

ital b

ed /

entir

e 24

H,

1 D

AC

Tan

thro

pom

etri

cm

easu

res

262

(220

) M

-115

, F-1

05.

Grp

1, 1

02,

Grp

2, 1

18 /

20.4

and

20.4

/ no

rmal

and

oth

er g

esta

-tio

nal d

iabe

tes

Non

e / A

MI A

MA

-32

/ Rt

ankl

e / 1

min

/ N

S / A

SAA

CT

and

Oth

ers,

ant

hrop

o-m

etri

c m

easu

res

NS

/ NS

New

born

s sl

ept t

wic

e as

muc

h du

ring

nig

httim

e ho

urs

than

day

time.

Inf

ants

of

ges-

tatio

nal d

iabe

tic m

othe

rs(I

GD

M)

had

sign

ific

ant c

or-

rela

tions

bet

wee

n sk

info

ldm

easu

rem

ents

and

qui

etsl

eep.

Lat

er g

esta

tiona

l age

asso

c. w

ith in

crea

sed

quie

tsl

eep

perc

ent

Sfor

za (

39)

2B

Val

idat

ion

/ lab

orat

ory

/ noc

-tu

rnal

onl

y fo

r 7.

5 h,

PSG

/AC

T(n

= 1

0; C

PAP

titra

-tio

n on

nig

ht 2

) 1

ntPS

G/A

CT

(n=

25)

35 (

35)

/ 54.

8±1.

6 (3

7-72

) /

13 O

SAS,

22

ED

S or

sno

ring

or R

LS/

PLM

D

PSG

; Ant

erio

r tib

ialis

EM

G /

Gae

hwile

r / u

pper

Rt f

oot /

5se

c / 0

.1g

/ NS

PSG

: PL

M (

via

EM

G);

AC

T:

PLM

NS/

Tech

nica

l pro

blem

s du

r-in

g re

cord

ing/

Mos

t pts

Dx

w/O

SA

AC

T: E

MG

Mov

emen

ts –

leg

AC

Tno

t val

id.

R=

0.78

but

AC

Tun

dere

stim

ates

mov

e-m

ents

, esp

ecia

lly th

ose

<3

sec

and

< 5

0 m

v bu

t was

rel

iabl

eac

ross

2 n

ight

s in

8/1

0 su

b-je

cts

thus

not

val

id f

or D

XPL

MD

but

val

id f

or T

x ev

alu-

atio

n.

Con

clus

ions

dif

fer

from

thos

eof

Kaz

enw

adel

, et a

l., 1

995

due

to m

ore

soph

istic

ated

anal

ysis

Tre

nkw

alde

r (7

2)

1A

Con

trol

led

clin

ical

tria

l, D

B,

cros

s-ov

er d

esig

n /

Lab

orat

ory,

Hom

e /

Noc

turn

al; 1

Nt P

SG/A

CT

+2N

t PSG

BL

, 1N

t PSG

/AC

T+

2N

t PSG

Tx

(L-D

opa)

, 1N

tPS

G/A

CT

+ 2

Nt P

SG P

L(P

lace

bo)

32 (

28)

/ Grp

1 53

±9

(37-

73),

Grp

2 49

±11

(29

-66)

/ R

LS,

Ure

mia

PSG

, log

, Sel

f re

port

,O

bser

vatio

n by

phy

sici

an in

char

ge /

Mor

opor

t, R

imku

s /

leg

/ NS

/ NS

/ NS

log,

PSG

, AC

T, S

BJ

ratin

gs

NS

/ Oth

er s

leep

dis

orde

rs,

psyc

hotr

opic

med

s, R

x ab

use

Hx

/ Sm

all G

rp s

ize

decr

ease

d po

wer

of

betw

een-

Grp

com

pari

sons

No

diff

. b/t

idio

path

ic &

ure

-m

ic R

LS,

L-D

opa

only

eff

ec-

tive

duri

ng 1

st 4

h o

f sl

eep

AC

Tsy

stem

atic

ally

und

eres

ti-m

ated

PL

Ms

rela

tive

to P

SG,

AC

Tco

nfir

med

PSG

fin

ding

of d

imin

ishe

d ef

fect

iven

ess

afte

r 4

h.

Cit

atio

n - A

utho

r/

Evi

denc

e L

evel

St

udy

Cri

teri

a D

esig

n /

Loc

atio

n / P

roto

col

Sam

ple

Size

(C

ompl

eted

Stud

y) /

Mea

n A

ge (

Ran

ge)

/M

edic

al C

ondi

tion

s

Com

pari

son

Mea

sure

s /

Act

igra

ph a

ppar

atus

/P

lace

men

t / E

poch

Len

gth

/Se

nsit

ivit

y / S

cori

ng

Out

com

e M

easu

res

Incl

usio

n / E

xclu

sion

/ B

ias

Stud

y C

oncl

usio

n fr

ompa

per

Com

men

ts f

rom

Rev

iew

er


Wic

klow

(55

)

4 C

-a

Obs

erva

tiona

l stu

dy /

hom

e /

3D A

CT

audi

o re

cord

ing

ofin

trus

ive

thou

ghts

at b

edtim

e,sl

eep

diar

y

Ns

(NS)

M, 7

, F, 1

4/ 3

6 (1

9-60

; 10.

8) /

inso

mni

a Sl

eep

log,

dia

ry /

Cam

brid

geA

ctiw

atch

/ w

rist

/ 1

min

/ N

S/ N

S

Slee

p di

ary,

log

/ AC

T, o

ther

s;se

lf-r

epor

t of

obtr

usiv

eth

ough

ts, p

re-s

leep

aro

usal

scal

e

Exc

lusi

on; r

ecei

ving

tx f

orsl

eep

diso

rder

, med

ical

pro

b-le

ms

affe

ctin

g sl

eep,

psy

-ch

opat

holo

gy, n

o sl

eep

onse

t pr

oble

ms/

sub

ject

s r

ecru

ited

from

gen

eral

pop

ulat

ion,

not

pres

entin

g pa

tient

s

Mea

n A

CT

slee

p la

tenc

y <

mea

n di

ary

slee

p la

t, p

< .0

01.

Mea

n A

CT

SE >

mea

n di

ary

SE, p

< .0

08.

Mea

n A

CT

TST

> m

ean

diar

y T

ST,

p<.0

04.

AC

T/ d

iary

sle

epla

tenc

y, r

=0.

419,

p<

.001

.A

CT

/dia

ry S

E r

= 0

.194

(ns

).A

CT

/dia

ry T

STr

= 0

.526

, p<

.001

. A

CT

slee

p la

tenc

yco

rrel

ated

with

rehe

arsa

l/pla

nnin

g th

ough

tsan

d th

ough

ts a

bout

aut

onom

icfu

nctio

ns.

No

corr

elat

ion

betw

een

diar

y sl

eep

lat a

ndan

y th

ough

t cat

egor

y.

Wils

on (

52)

5D-b

Val

idat

ion,

AC

Tco

mpa

red

w/

othe

r te

chni

ques

/ H

ome

/N

octu

rnal

; 2D

AC

T/lo

g

40 (

40)

/ 44.

9±7.

9 / I

nsom

nia,

Chr

onic

pai

n Se

lf-r

epor

t, Q

uest

ionn

aire

,lo

g / M

ML

/ ndo

m w

rist

/ 15

sec

/ NS

/ AM

I ‘9

4

log,

AC

TN

S / F

ibro

mya

lgia

, oth

erm

edic

al p

robl

ems

/ Non

e A

CT

& lo

g bo

th s

how

ed lo

wSE

, lon

g W

ASO

, low

TST

;N

o di

ff o

n A

CT

vari

able

s b/

thi

gh s

ever

ity &

low

sev

erity

pain

Grp

s


Anc

oli-

Isra

el (

112)

4C-b

Unb

linde

d, n

onra

ndom

ized

,ob

serv

atio

nal s

tudy

/ N

H /

Ent

ire

24-h

s; 3

D A

CT

NS

(77)

/ G

rp1

85±

7.9

(60-

100)

Grp

2 87

±5.

6 (7

4-96

) /

NH

res

iden

ts

Non

e / A

ctill

ume

/ wri

st /

1m

in / ≥

.003

g / C

ole,

Kri

pke

et a

l 199

2

AC

T: t

otal

min

s sl

eep,

%sl

eep,

tota

l min

s aw

ake,

%aw

ake,

num

aw

aken

ings

,le

ngth

of

each

aw

aken

ing,

mes

or, a

crop

hase

, am

plitu

de,

circ

adia

n qu

otie

nt; M

ood:

Ger

iatr

ic D

epre

ssio

n Sc

ale;

Oth

ers:

MM

SE

NS

/ NS

/ Sub

ject

sel

ectio

ncr

iteri

a N

S SD

G s

lept

mor

e du

ring

Nt

and

D th

an M

MN

DG

; SD

Gha

d lo

wer

act

ivity

mes

or,

mor

e bl

unte

d am

plitu

de, a

ndw

ere

mor

e ph

ase-

dela

yed

than

MM

ND

G

Cit

atio

n - A

utho

r/

Evi

denc

e L

evel

St

udy

Cri

teri

a D

esig

n /

Loc

atio

n / P

roto

col

Sam

ple

Size

(C

ompl

eted

Stud

y) /

Mea

n A

ge (

Ran

ge)

/M

edic

al C

ondi

tion

s

Com

pari

son

Mea

sure

s /

Act

igra

ph a

ppar

atus

/P

lace

men

t / E

poch

Len

gth

/Se

nsit

ivit

y / S

cori

ng

Out

com

e M

easu

res

Incl

usio

n / E

xclu

sion

/ B

ias

Stud

y C

oncl

usio

n fr

ompa

per

Com

men

ts f

rom

Rev

iew

er

Tabl

e 4—

Evi

denc

e le

vels

for

stu

dies

invo

lvin

g ci

rcad

ian

rhyt

hms

Anc

oli-

Isra

el (

110)

4C-b

RC

T, u

nblin

ded,

par

alle

l / N

H/ E

ntir

e 24

hs;

18

D A

CT,

10

D T

x w

/eith

er m

orni

ng b

righ

tlig

ht, e

veni

ng b

righ

t lig

ht,

even

ing

dim

red

ligh

t, da

y-tim

e sl

eep

rest

rict

ion

118

(77)

/ 85

.7±

7.3

(60-

100)

/D

emen

ted

NH

pts

N

one

/ Act

illum

e / w

rist

/ 1

min

/ N

S / A

ctio

n3 s

leep

5pa

ram

eter

ext

ende

d co

sine

AC

T: D

sle

ep, N

t sle

ep, A

CT

acro

phas

e, m

esor

, cir

cadi

ango

odne

ss o

f fi

t

NS

/ NS

/ NS

No

impr

ovem

ents

in N

t sle

epor

D a

lert

ness

with

Tx.

Mor

ning

bri

ght l

ight

del

ayed

AC

Tpe

ak, i

ncre

ased

mes

oran

d st

reng

then

ed r

hyth

mic

ity

Bin

kley

(92

)

4C-b

Obs

erva

tiona

l stu

dy /

tran

s-m

erid

ian

trav

el /

Ent

ire

24-h

r,17

-32

D A

CT

incl

udin

g D

sbe

fore

, dur

ing

and

afte

r tr

avel

6 (6

) / 4

1.8

(27-

56)

/ Nor

mal

,17

rec

ords

in 6

peo

ple,

eas

t-w

est v

s. n

orth

-sou

th v

s. n

otr

avel

none

/ M

otio

nlog

ger

/ wri

st /

5 m

ins

/ 5-m

ins,

acr

opha

se /

daily

act

ivity

ons

et, o

ffse

t,m

otio

ns/

AC

T: P

hase

shi

ft o

f da

ilyac

tivity

ons

et, o

ffse

t and

acro

phas

e. M

agni

tude

of

mot

ions

/5-m

ins

and

activ

itydu

r (“

alph

a”)

NS/

NS

/ con

veni

ence

sam

-pl

e, lo

w s

ampl

e si

ze, n

o co

n-tr

ol G

rp

Act

ivity

pha

se s

hift

ed in

sam

edi

rect

ion,

but

oft

en n

ot s

ame

amou

nt, a

s tim

e zo

ne c

hang

e.L

ower

act

ivity

mea

n an

d du

rat

des

tinat

ion.

Ver

y hi

gh r

(R

squ

ared

=0.

939)

bet

wee

n tim

e zo

nesh

ift a

nd a

ctiv

ity a

crop

hase

shif

t; ho

wev

er, n

ot c

ompa

red

to a

ny c

irca

dian

ref

eren

cest

anda

rd.

Bla

grov

e (8

7)

3C

AC

TC

ompa

red

w/ o

ther

tech

niqu

es; F

orce

d de

syn-

chro

ny /

Lab

orat

ory

(dor

mito

-ry

use

d as

lab)

/ E

ntir

e 24

-hs;

BL

8Nt s

leep

mid

nigh

t-08

00;

Slee

p D

ep.1

: 26h

s; F

orce

dde

sync

hron

y: 1

7 cy

cles

(27

hrD

) sl

eep

9 hr

, W18

hr;

Sle

epD

ep.2

: 26h

r; R

ecov

ery

slee

p:9h

r; c

ontin

uous

AC

T

9 (9

) / N

S (1

9-20

) / N

orm

al

log;

(te

mp

repo

rted

els

e-w

here

) / G

aew

hile

r / n

dom

wri

st /

30 s

ec /

NS

/A

CC

OR

D s

oftw

are

(UK

) +

Hor

ne e

t al 1

994

algo

rith

m +

cust

om a

lgor

ithm

s

Log

: BT,

SO

L, W

ASO

, SO

ff,

SBJ

SQ; A

CT

: SO

n, S

Off

,T

ST, m

ovem

ent i

ndex

, fre

q.of

mov

emen

t ons

ets

Hea

lthy,

no

slee

p di

sord

ers/

NS

/ low

num

of

subj

ects

, all

F, n

ot b

lind

to ti

me

of D

Mov

emen

t fre

q. (

wea

kly)

pre

-di

cts

SBJ

SE, S

Q; C

irca

dian

time

of g

oing

to s

leep

aff

ect-

ed A

CT

TST

& S

BJ

SE &

qual

ity (

all r

educ

ed w

hen

star

ting

slee

p be

twee

n 10

00h

and

1300

h), b

ut d

id n

ot a

ffec

tm

ovem

ent i

ndex

or

freq

.

AC

Tap

pear

ed to

det

ect

expe

cted

red

uctio

n of

TST

indu

ced

by f

orce

d de

syn-

chro

ny p

roto

col (

poor

er s

leep

whe

n ou

t of

phas

e w

/ tem

prh

ythm

), s

ugge

sts

AC

Tca

nde

tect

a d

istu

rban

ce in

duce

dby

cir

cadi

an p

acem

aker

, but

no r

efer

ence

sta

ndar

d.

Car

skad

on (

118)

2B

Non

rand

omiz

ed, C

ontr

olle

dcl

inic

al T

rial

, unb

linde

d,cr

oss-

over

des

ign

/L

abor

ator

y an

d H

ome

/ Ent

ire

24 h

s; c

ontin

uous

AC

Tth

roug

hout

stu

dy, 7

D h

ome,

self

sel

ecte

d sc

hedu

le (

sali-

vary

DL

MO

last

nig

ht),

8D

hom

e, f

ixed

ligh

t-da

rk s

ched

-ul

e (s

aliv

ary

DL

MO

last

nigh

t), 3

D lo

ng (

14 h

) N

tw

/PSG

, ~36

hs

mod

ifie

d co

n-st

ant r

outin

e w

/ MSL

Tan

dPS

G

19 (

14)

/ M 1

2.7±

1.0

(11.

2-14

.1)

F 13

.1±

0.7

(12.

2-14

.4)

/no

rmal

PSG

, mel

/ M

ini A

CT

AM

A-

32 (

AM

I) /

ndom

wri

st /

NS

/N

S / S

adeh

et a

l ‘94

Log

; mel

; end

ocri

ne m

easu

res

cort

isol

; PSG

: SO

n, S

Off

;A

CT

: SO

n, S

Off

; MSL

T

NS

/ irr

egul

ar s

leep

, sle

ep d

is-

orde

rs, i

llnes

s, p

sych

iatr

icdi

sord

er /

NS

Phas

e of

SO

n, S

Off

, DL

MO

less

dis

pers

ed a

fter

fix

edlig

ht-d

ark

than

sel

f-se

lect

edlig

ht-d

ark.

AC

TSO

n to

SO

ffr=

0.72

, AC

TSO

n to

DL

MO

r=0.

82, A

CT

SOff

to D

LM

Or=

0.76

dur

ing

self

-sel

ecte

dbu

t not

fix

ed li

ght-

dark

. Mel

offs

et s

igni

fica

ntly

cor

rela

ted

with

age

(r=

0.62

) an

d ta

nner

stag

e (r

=0.

62).

AC

Tto

PSG

r S

On>

0.80

in11

of

14 c

ases

and

rSO

ff>

0.80

in 1

0 of

14.

Alth

ough

mai

n st

udy

desi

gnno

t blin

d, c

ompa

riso

ns o

fA

CT

to D

LM

O a

nd P

SGw

ere

blin

d. 7

1 %

of A

CT

slee

p of

fset

s w

/in 1

8 m

in o

fPS

G s

leep

off

sets

.

Car

skad

on (

119)

3C

Obs

erva

tiona

l stu

dy /

labo

ra-

tory

and

hom

e / E

ntir

e 24

hs;

14 D

AC

Tan

d lo

g an

d ph

one

mes

sage

mac

hine

at S

Off

, 1sa

livar

y D

LM

O, P

SG, M

SLT,

repe

at in

9th

and

10t

h gr

ade

w/ 1

h e

arlie

r sc

hool

sta

rttim

e in

10t

h.

40 (

26)

/ 15±

0.5

/ nor

mal

L

og /

Min

i-A

CT

(AM

I) /

NS

/N

S / N

S / S

adeh

et a

l ‘94

A

CT

: SO

n, S

Off

, TST

NS

/ sle

ep d

isor

ders

, illn

ess,

psyc

hopa

thol

ogy

/ NS

SOff

but

not

SO

n, D

LM

Ola

ter

in 1

0th,

mor

e sl

eepi

ness

on s

leep

ons

et R

EM

in 1

0th

AC

Tda

ta s

cora

ble

on 9

of

10N

ts. A

CT

SOn

and

SOff

cor

-re

late

d 0.

39 to

0.5

1 w

/DL

MO

on s

choo

l Nt,

but r

’s N

S on

wee

kend

.

Cit

atio

n - A

utho

r/

Evi

denc

e L

evel

St

udy

Cri

teri

a D

esig

n /

Loc

atio

n / P

roto

col

Sam

ple

Size

(C

ompl

eted

Stud

y) /

Mea

n A

ge (

Ran

ge)

/M

edic

al C

ondi

tion

s

Com

pari

son

Mea

sure

s /

Act

igra

ph a

ppar

atus

/P

lace

men

t / E

poch

Len

gth

/Se

nsit

ivit

y / S

cori

ng

Out

com

e M

easu

res

Incl

usio

n / E

xclu

sion

/ B

ias

Stud

y C

oncl

usio

n fr

ompa

per

Com

men

ts f

rom

Rev

iew

er


Col

e (4

4)

4C-b

RC

T, s

ingl

e bl

inde

d / h

ome

/E

ntir

e 24

hs;

7D

AC

TB

L, 5

DA

CT

Tx

(las

t 5D

of

26 D

Tx

peri

od),

2D

AC

Tf/

u

78 (

59 a

ssig

ned

to T

x) /

25(1

4-34

) / D

SPS-

SOn

befo

reor

aft

er 0

200h

s.

Log

, mel

,/ A

ctill

ume

/ wri

st /

NS

/ NS

/ lab

dev

elop

edm

el 6

-SM

T; A

CT

18-4

0 yr

s, I

CSD

cri

teri

a fo

rD

SPS

/ non

DSP

S sl

eep

dis-

orde

r, se

riou

s he

alth

pro

blem

,m

eds,

alc

ohol

abu

se, R

x, s

eri-

ous

psyc

hiat

ric

prob

lem

s,re

cent

shi

ft w

ork

or je

t lag

/N

S

Bri

ght l

ight

and

beh

avio

ral T

xad

vanc

ed th

e 6-

SMT

acro

phas

e vs

. dim

ligh

t pla

ce-

bo T

x, b

ut p

ost-

Tx

phas

esw

ere

liste

d ea

rlie

r. H

owev

er,

pts

with

late

6-S

MT

acro

phas

-es

did

hav

e ph

ase

adva

nces

(vs.

pla

cebo

) of

6-S

MT

and

SOn

as w

ell a

s de

crea

sed

AM

slee

pine

ss.

AC

Tus

ed to

det

erm

ine

BL

slee

p ph

ase

and

post

-Tx

slee

pph

ase.

Tx:

bri

ght/d

im li

ght

(26

D)

and

beha

vior

al T

x(s

yste

mat

ic a

dvan

ce o

f be

d-tim

e an

d tim

e of

ari

sing

,av

oid

dayt

ime

naps

, min

imiz

eaf

tern

oon/

even

ing

light

).L

ight

mas

k: 2

700

lux

/ 57

lux

whe

n ey

elid

clo

sed.

Dag

an (

57)

5D-a

Cas

e se

ries

/ H

ome

/ Ent

ire

24-h

s; 4

-7D

AC

TB

Lto

hel

pdi

agno

se D

SPS;

f/u

que

stio

n-na

ire ≥

1 yr

aft

er 6

-wk

mel

Tx

61 (

NS)

/ 30

.17±

11.2

6 (1

6-54

) / D

SPS

Non

e / M

ML

/ wri

st /

NS

/N

S / N

S Sa

deh;

Oth

er: z

ero-

cros

sing

mod

e

Surv

ey

No

med

s , D

SPS

Dx,

mel

Tx,

fini

shed

≥1

yr p

rior

to s

tudy

/ No

cont

rol G

rp

96.7

% r

epor

t mel

hel

ped

DSP

S, 9

1.5%

rel

apse

aft

erm

el c

essa

tion

No

valid

atio

n of

AC

Tot

her

than

pt.

repo

rt A

CT

used

onl

yto

aid

initi

al D

x of

DSP

S.O

utco

me

asse

ssed

onl

y by

ques

tionn

aire

, not

AC

T.

Dau

rat (

97)

4C-b

Con

trol

led

clin

ical

tria

l; D

B /

Hot

el r

oom

s se

t up

as la

b /

Ent

ire

24-h

s; 6

D A

CT

BL

, 1D

tem

p B

L, f

light

, 6D

AC

Tpo

stfl

ight

, 1+

1D te

mp

post

flig

ht,

Zop

iclo

ne o

r Pl

aceb

o be

fore

bed

Nts

1-4

pos

t flig

ht

36 (

24)

/ 51.

2±2.

2 / N

orm

al

Tem

p (n

=19

) / A

ctiw

atch

/nd

om w

rist

/ 1

min

/ N

S /

Act

isom

(P.

Den

ise,

Fra

nce)

-sl

eep

visu

ally

sco

red,

cos

inor

for

phas

e

Tem

p; A

CT

: sle

ep d

ur, a

ctiv

i-ty

inde

x, A

CT

acro

phas

e &

ampl

itude

; Moo

d: V

AS

“moo

d”; J

et la

g Sx

VA

S“t

ired

”, “

ill-b

eing

”, “

dige

s-tiv

e”, “

ener

gy”

Hea

lthy,

no

med

s x3

mos

, no

time

zone

trav

el /

Cor

e te

mp

not u

nmas

ked

Zop

iclo

ne im

prov

es A

CT

iden

tifie

d sl

eep

afte

r tr

ans-

mer

idia

n tr

avel

F(1

,22)

=6.

3,p<

.05;

The

gre

ater

the

dysy

n-ch

roni

zatio

n of

CR

s po

st-

flig

ht th

e sh

orte

r th

e sl

eep

dur.

Zop

iclo

ne d

id n

otim

prov

e SB

J je

t lag

AC

Tde

tect

ed b

oth

circ

adia

nsh

ift a

nd s

leep

dis

turb

ance

Daw

son

(93)

4C-b

RC

T, p

aral

lel d

esig

n (b

lindi

ngno

t men

tione

d) /

Lab

/ E

ntir

e24

-hs

appa

rent

ly, 2

Nt D

LM

OB

L(N

t sle

ep)

& c

ore

tem

p,3D

AC

T(N

t wor

k, D

sle

ep)

& c

ore

tem

p, 2

4hs

DL

MO

&co

re te

mp

(sle

ep n

otde

scri

bed)

Ran

dom

ass

ign.

tobr

ight

ligh

t, di

m li

ght,

mel

or

plac

ebo

duri

ng s

hift

wor

k D

s

36 (

36)

/ 23.

6±3.

9 (1

8-30

) /

Nor

mal

N

one

/ Gae

hwile

r / n

dom

wri

st /

30 s

ec /

NS

/ Roo

tm

ean

squa

re (

RM

S) a

ctiv

itytim

es d

ur

Tem

p; m

el; D

LM

O, A

CT

:m

ovem

ent i

ndex

, tot

al e

nerg

y,en

ergy

dur

ing

arou

sal,

ener

gydu

ring

non

-aro

usal

;B

ehav

iora

l: co

gniti

ve p

er-

form

ance

NS

/ NS

/ NS

Bri

ght l

ight

shi

fted

DL

MO

,re

duce

d co

re te

mp

duri

ng D

slee

p, im

prov

ed A

CT

SQ b

et-

ter

than

mel

Tx

or p

lace

bo.

Mel

did

n’t s

hift

DL

MO

, but

impr

oved

sle

ep &

red

uced

core

tem

p so

mew

hat.

AC

Tva

riab

les

show

ed s

igni

f-ic

ant d

iffe

renc

es b

etw

een

light

and

pla

cebo

and

oft

enbe

twee

n lig

ht a

nd m

el T

x du

r-in

g D

sle

ep in

sim

ulat

ed s

hift

wor

k.

Dijk

(32

)

3C

Con

trol

led

clin

ical

tria

l, D

B,

nonr

ando

miz

ed /

Spac

e sh

ut-

tle, p

re, p

ost f

light

/ E

ntir

e 24

hs; A

CT

: 1-2

D 2

mos

pre

flig

ht; 1

-2 D

1 m

o pr

e fl

ight

;0-

7 D

1 w

k pr

e fl

ight

; 10-

16D

in f

light

; 4 D

PSG

in f

light

;5

D A

CT

post

flig

ht; 3

D P

SGpo

st f

light

; 0-3

D o

ther

mea

s-ur

es p

ost f

light

5 (5

) / (

37-4

6) /

norm

al

PSG

, log

, mel

uri

ne, t

emp

core

and

inge

stib

le s

enso

r,ur

inar

y co

rtis

ol /

MM

Lan

dA

ctill

umes

/ nd

om w

rist

/ N

S/ N

S / C

ole/

Kri

pke

Log

; AC

T: S

Ptim

e, T

ST;

neur

obeh

avio

ral A

sses

smen

tB

atte

ry

All

astr

onau

ts /

NS

/ Can

not

dist

ingu

ish

effe

cts

of s

pace

flig

ht f

rom

thos

e of

wor

ksc

hedu

le; s

mal

l sam

ple

Spac

e fl

ight

ass

ocia

ted

w/

redu

ced

AC

TSP

time,

SB

JSQ

, per

form

ance

and

del

ayed

cort

isol

rhy

thm

rel

ativ

e to

sche

dule

d sl

eep.

AC

TSd

urlo

nger

on

PSG

rec

ordi

ng N

t;m

ight

ref

lect

gre

ater

adh

er-

ence

to s

leep

sch

edul

e on

PSG

Nt.

No

bene

fit o

f m

el o

nsl

eep

obse

rved

.

AC

Tde

tect

ed a

ppar

ent b

ias

inPS

G s

leep

mea

sure

men

t

Eis

sa (

131)

5D-a

Obs

erva

tiona

l stu

dy, C

ase

seri

es /

Hom

e / E

ntir

e 24

-hs;

1D A

CT

1D a

mbu

lato

ry B

Pm

onito

ring

46 (

46)

/ 42.

9±21

.8 /

Hyp

erte

nsio

n B

P/ M

ML

/ ndo

m w

rist

/ N

S/ N

S / C

ole

AC

T: W

vs. s

leep

dic

hoto

my

Con

secu

tive

hype

rten

sion

pts

./ P

ossi

ble

dayt

ime

rem

oval

artif

act c

ould

hav

e ov

eres

ti-m

ated

D s

leep

(na

ps)

Est

imat

es o

f ci

rcad

ian

orsl

eep-

indu

ced

BP

redu

ctio

n(“

dipp

ing”

) di

ffer

whe

n “a

ctu-

al s

leep

” is

def

ined

by

AC

Tth

an w

hen

it is

def

ined

by

fixe

d tim

e-of

-D c

rite

ria

Act

igra

ph-i

dent

ifie

d sl

eep

assu

med

to b

e “t

rue”

sle

ep b

yau

thor

s

Cit

atio

n - A

utho

r/

Evi

denc

e L

evel

St

udy

Cri

teri

a D

esig

n /

Loc

atio

n / P

roto

col

Sam

ple

Size

(C

ompl

eted

Stud

y) /

Mea

n A

ge (

Ran

ge)

/M

edic

al C

ondi

tion

s

Com

pari

son

Mea

sure

s /

Act

igra

ph a

ppar

atus

/P

lace

men

t / E

poch

Len

gth

/Se

nsit

ivit

y / S

cori

ng

Out

com

e M

easu

res

Incl

usio

n / E

xclu

sion

/ B

ias

Stud

y C

oncl

usio

n fr

ompa

per

Com

men

ts f

rom

Rev

iew

er


Eva

ns (

88)

4C-a

Obs

erva

tiona

l stu

dy /

Hom

e /

Ent

ire

24-h

s; 2

D A

CT

& lo

g 14

(14

) / 8

1.2±

5.9

(71-

91)

/N

orm

al

log

/ Mot

ion

logg

er /

ndom

wri

st /

NS

/ NS

/ (A

MI)

sof

t-w

are

log;

AC

T: S

On,

SO

ff, T

ST,

num

nap

s, n

ap m

ins,

num

arou

sals

Hea

lthy

elde

rly

/ sl

eep

med

s,tr

anqu

ilize

rs, s

leep

dis

orde

rs,

neur

o or

psy

chia

tric

pro

blem

s/ A

rtif

act r

ejec

tion

not m

en-

tione

d so

pos

sibl

e ov

eres

tima-

tion

of D

sle

ep; s

ubje

cts

sele

cted

for

no

slee

p co

m-

plai

nts,

so

find

ing

of s

atis

fac-

tion

w/ s

leep

to b

e ex

pect

ed

Eld

erly

hav

e fr

eque

ntar

ousa

ls, r

educ

ed S

EI,

sho

rtsl

eep,

nap

s m

ore

freq

uent

than

exp

ecte

d; n

aps

unde

rre-

port

ed; s

atis

fied

w/ s

leep

Res

ults

cou

ld m

ean

that

AC

Tis

val

uabl

e fo

r de

tect

ing

naps

not r

epor

ted

in lo

g, b

ut p

ossi

-bl

e th

at w

akef

ul in

activ

ityw

as m

issc

ored

as

slee

p by

AC

T; f

indi

ngs

of f

ragm

ente

dno

ctur

nal s

leep

and

gre

ates

tna

p fr

eque

ncy

in a

fter

noon

cons

iste

nt w

/ oth

er s

tudi

es’

find

ings

w/ P

SG in

eld

erly

Glo

d (1

07)

4C-b

Cas

e-co

ntro

l stu

dy /

Hom

e /

Ent

ire

24-h

s; 3

D A

CT,

com

-pa

re A

CT

rhyt

hms

in S

AD

vs.

norm

al c

hild

ren

26 (

26)

/ Grp

1 11

.0±

3.3,

Grp

211

.6±

3.7

/ Grp

1 SA

D, G

rp2

Nor

mal

NS

/ Mot

ion

logg

er /

Bel

t / 1

or 5

min

s / N

S / N

S A

CT

: cos

inor

24h

& 1

2h h

ar-

mon

ic a

nd p

erio

dogr

am

SAD

Dx,

med

-fre

e, h

ealth

y /

NS

/ NS

Chi

ldre

n w

/ SA

D h

ave

less

robu

st c

irca

dian

act

ivity

rhyt

hms

& lo

wer

cir

cadi

anam

plitu

de th

an n

orm

al c

on-

trol

s, b

ut n

o ph

ase

dela

y of

activ

ity

AC

Trh

ythm

dis

tingu

ishe

dch

ildre

n w

/ a p

sych

iatr

ic d

is-

turb

ance

fro

m c

ontr

ols;

Dep

ende

nt v

aria

ble

was

act

iv-

ity le

vel (

belt-

wor

n m

onito

r)no

t sle

ep

Gru

ber

(113

)

4C-b

Cas

e-co

ntro

l stu

dy /

Hom

e /

5N A

CT

102

(NS)

/ G

rp1

9.6±

2.7

(6-

14),

Grp

2 9.

9±1.

7 (7

.5-1

1.5)

/A

DH

D v

s. c

ontr

ol

Log

/ N

S / N

S / N

S / N

S /

Sade

h L

og; A

CT

: SO

n, S

P, S

E, T

ST,

long

est s

leep

, qui

et s

leep

(no

mot

ion)

, Nt a

wak

enin

gs

DSM

-IV

AD

HD

/ N

S / N

S M

ore

inst

abili

ty o

f AC

TSO

n,SP

dura

tion,

and

TST

inA

DH

D th

an c

ontr

ol. N

o di

f-fe

renc

e in

mea

n va

lues

. Onl

yA

CT,

not

log,

det

ecte

d hi

gher

stan

dard

dev

iatio

ns.

Gui

llem

inau

lt (1

21)

3C

NS

/ Hom

e / 2

4-72

hs

oral

tem

p at

bir

th e

very

3 h

s, A

t3,

6,8,

16, a

nd 2

0 w

eeks

: 60

hsto

7D

AC

Tan

d re

ctal

tem

per-

atur

e

12 (

NS)

/ ne

wbo

rns

/ nor

mal

PS

G /

Vita

log

/ wri

st /

2 m

ins

/ NS

/ vis

ually

sco

red

AC

T: l

onge

st in

activ

ity

NS

/ NS

/ som

e lo

st d

ata.

Rec

tal t

emp

endo

geno

usrh

ythm

mas

ked

by r

est-

activ

i-ty

rhy

thm

.

Rec

tal t

emp

rhyt

hm e

stab

-lis

hed

by 6

wee

k ag

e in

2 o

f12

infa

nts

and

by 1

0 w

eek

in12

of

12. L

onge

st A

CT

inac

-tiv

ity ‘

clos

ely

rela

ted’

tolo

nges

t PSG

SP.

Low

est t

emp

occu

rred

at t

ime

of lo

nges

tA

CT

inac

tivity

. Con

solid

ated

Won

ly o

ccur

red

afte

r re

ctal

tem

p rh

ythm

est

ablis

hed.

Hei

kkila

(12

0)

5D-a

Cas

e-co

ntro

l stu

dy /

Lab

orat

ory

/ 5D

AC

Tan

d lo

g,24

hs

seru

m m

el a

nd c

ortis

olan

d ax

illar

y te

mp

24 /

Grp

1 24

(16

-32)

, Grp

2 7

(3-1

0), G

rp3

12 G

rp4

NS

/N

euro

nal C

eroi

d-L

ipo-

fusc

i-no

sis

(NC

L),

juve

nile

NC

L,

infa

ntile

NC

L, J

ansk

y-B

iels

chaw

ski d

isea

se, N

orm

alco

ntro

l

Mel

, tem

p, c

ortis

ol /

(AM

I) /

wri

st /

1 m

in /

NS

/ Col

eK

ripk

e

Mel

; End

ocri

ne-c

ortis

ol;

AC

T: S

On,

% s

leep

N

S / N

S / P

ossi

ble

mas

king

of m

el b

y lig

ht a

nd te

mp

byac

tivity

Slee

p-w

ake

rhyt

hm g

ross

lydi

stur

bed,

but

mel

, cor

tisol

and

tem

p rh

ythm

s us

ually

norm

al in

NC

Lpa

tient

s.

No

stat

istic

s on

sle

ep

Hon

ma

(184

)

5D-a

Obs

erva

tiona

l stu

dy /

Men

tal

Hos

pita

l / E

ntir

e 24

-hs;

≥10

DA

CT

13 (

8) /

84.9

±7.

8 (7

4-96

) /

Dem

entia

& D

elir

ium

N

S / m

odel

not

spe

cifi

ed(A

MI)

/ nd

om w

rist

/ 1

min

/N

S / v

isua

l & c

hi s

quar

e pe

ri-

odog

ram

AC

T: d

iurn

al p

atte

rn, d

ompe

riod

N

S / N

S / S

mal

l sam

ple,

hig

hdr

opou

t rat

e, S

BJ

anal

ysis

(exc

ept p

erio

dogr

am)

Iden

tifie

d 4

circ

adia

n “t

ypes

”of

pts

, act

ivity

pat

tern

s va

ried

w/ c

linic

al m

anif

esta

tions

of

delir

ium

; dom

per

iod

near

24h

in a

ll ca

ses,

(so

me

had

seco

ndar

y 12

h pe

ak)

Act

igra

ph id

entif

ied

24h

rhyt

hm in

8 o

f 8

case

s,de

spite

sev

ere

beha

vior

al d

is-

turb

ance

Hua

ng (

116)

4C-b

Obs

erva

tiona

l stu

dy /

Hom

e /

Ent

ire

24-h

; 5-7

D A

CT

65 (

65)

/ you

ng 2

4±4,

mid

dle-

aged

42±

3, o

ld 6

8±6,

old

est

83±

4 /

none

Non

e / A

ctiw

atch

-L-p

lus

(Cam

brid

ge N

euro

tech

nolo

gy,

Cam

brid

ge, U

K/ w

rist

/ 1

min

/ NS

/ Rhy

thm

wat

ch a

ndSl

eep

Ana

lysi

s 98

Sof

twar

e(C

ambr

idge

Neu

rote

chno

logy

)

Slee

p di

ary,

mea

n ill

umi-

nanc

e, A

CT

TST

, SE

, SO

L,

wak

e nu

m, n

um n

aps

in D

,fr

agm

enta

tion

inde

x, in

terd

ai-

ly s

tabi

lity

(IS)

, int

rada

ilyva

riab

ility

(IV

), le

ast-

activ

e 5

h (L

5), n

onpa

ram

etri

c ci

rcad

i-an

am

plitu

de

Hea

lthy

/ phy

sica

l, ps

ychi

atri

cor

neu

rolo

gica

l illn

ess,

cog

ni-

tive

diso

rder

s, in

som

nia,

alc

o-ho

l or

drug

abu

se, e

xtre

me

mor

ning

or

even

ing

type

Com

pare

d to

you

ng a

nd m

id-

dle-

aged

vol

unte

ers,

old

and

olde

st v

olun

teer

s ha

d lo

wer

TST

, SE

, and

cir

cadi

an a

mpl

i-tu

de, l

onge

r SO

L, a

nd m

ore

awak

enin

gs, s

leep

fra

gmen

ta-

tion,

IV

and

naps

. IS

did

not

diff

er b

etw

een

the

four

grou

ps, s

ugge

stin

g si

mila

rsy

nchr

oniz

atio

n to

Zei

tgeb

ers.

Cit

atio

n - A

utho

r/

Evi

denc

e L

evel

St

udy

Cri

teri

a D

esig

n /

Loc

atio

n / P

roto

col

Sam

ple

Size

(C

ompl

eted

Stud

y) /

Mea

n A

ge (

Ran

ge)

/M

edic

al C

ondi

tion

s

Com

pari

son

Mea

sure

s /

Act

igra

ph a

ppar

atus

/P

lace

men

t / E

poch

Len

gth

/Se

nsit

ivit

y / S

cori

ng

Out

com

e M

easu

res

Incl

usio

n / E

xclu

sion

/ B

ias

Stud

y C

oncl

usio

n fr

ompa

per

Com

men

ts f

rom

Rev

iew

er


Jean

-Lou

is (

143)

4C-b

Unb

linde

d, n

onra

ndom

ized

,ob

serv

atio

nal s

tudy

, cro

ss-

sect

iona

l stu

dy /

Hom

e /

Ent

ire

24-h

urs;

3D

AC

T

NS

(273

) / M

51±

7, F

52±

7(A

ll 40

-64)

/ C

omm

unity

dwel

ling

resi

dent

s of

San

Die

go id

entif

ied

by r

ando

mte

leph

one

surv

ey.

Non

e / A

ctill

ume

(AM

I) /

wri

st /

1 m

in /

NS

/ Act

ion3

(Col

e et

al 1

992

w/ W

ebst

er’s

re-s

cori

ng r

ules

)

AC

T:T

IB, T

ST, S

OL

, SE

,sl

eep

(am

plitu

de, m

esor

, and

phas

e), a

ctiv

ity (

ampl

itude

,m

esor

, and

pha

se),

illu

min

a-tio

n (a

mpl

itude

, m

esor

, and

phas

e); S

BJ

moo

d

NS

/ NS

/ Com

orbi

dity

NS

Sign

ific

ant g

ende

r di

ffer

-en

ces,

men

had

sho

rter

TST

,lo

wer

SE

, sho

rter

TIB

, low

erSl

eep

ampl

itude

, hig

her

illu-

min

atio

n am

plitu

de a

nd h

igh-

er il

lum

inat

ion

mes

or; s

igni

fi-

cant

whi

te v

s. m

inor

ity d

iffe

r-en

ces,

whi

te s

ampl

e ha

dlo

nger

TST

, lon

ger

SE, s

hort

-er

SO

L, g

reat

er s

leep

am

pli-

tude

, and

hig

her

slee

p m

esor

.To

tal s

ampl

e av

erag

e T

STw

as 6

.22

hs.

Aut

hors

ref

er to

thei

r un

pub-

lishe

d w

ork

com

pari

ng w

rist

AC

Tto

PSG

in w

omen

age

d51

-77

w/ 8

9% m

in-b

y-m

inag

reem

ent,

r =

.90.

Jean

-Lou

is (

124)

5D-b

Cro

ss-s

ectio

nal a

t var

ious

ages

/ ho

me

/ 3d

AC

TG

rps

1a +

1b

(3 x

24

hs);

7d

AC

TG

rp 2

(7x

24

hs)

NS

/ NS

/ Grp

1a 8

0F (

19-6

2),

Grp

1b 1

44F

(40-

64),

Grp

214

9F (

50-8

1) /

norm

al

Log

/ A

ctill

ume

/ wri

st /

NS

/N

S / N

S A

CT

Grp

2 w

ere

post

men

opau

se /

NS

/ NS

No

age-

rela

ted

decl

ine

in a

cti-

grap

hic

slee

p du

r.; n

o ag

e-re

late

d ch

ange

in C

R p

aram

e-te

rs e

xcep

t for

gra

dual

dec

line

in le

vel a

nd a

mpl

itude

.

AC

Tus

ed a

s in

dex

of s

leep

gave

no

refe

renc

e st

anda

rd.

Jean

-Lou

is (

122)

4C-b

Unb

linde

d, n

onra

ndom

ized

,ob

serv

atio

nal s

tudy

/ H

ome

/E

ntir

e 24

-hs;

5D

AC

T

NS

(32)

/ 44

.76±

20.6

4 /

Hea

lthy

norm

al v

olun

teer

s SS

S, lo

g / G

aehw

iler

Ele

ctro

nics

(H

ombr

echt

ikon

,Sw

itzer

land

) / d

om w

rist

/ 60

sec

/ ≥.1

g /

AD

AS

AC

T: T

ST, S

E in

dex,

WA

SO,

SOL

, fre

quen

cy o

f tr

ansi

tions

betw

een

slee

p an

d w

akef

ul-

ness

, day

time

activ

ity le

vel,

auto

- r

(am

plitu

de o

f ac

tivity

)

NS

/ NS

/ Sm

all s

ampl

e si

ze

Wom

en h

ad a

bet

ter

slee

ppr

ofile

than

men

by

AC

TR

elat

ivel

y sm

all s

ampl

e

Jock

ovic

h (1

05)

5D-b

Con

trol

led

clin

ical

tria

l, D

B,

cros

s-ov

er d

esig

n /h

ome

/diu

rnal

onl

y fo

r sl

eep

peri

od.

1 m

g m

el o

r pl

aceb

o 30

-60

min

bef

ore

day

slee

p a

fter

nigh

t wor

k. T

wo

seri

es o

f =

3ni

ght s

hift

s se

para

ted

by =

1w

eek.

AC

Tdu

ring

day

sle

ep

19 (

19)

/ NS

/ nor

mal

N

one

/ NS

/ NS

/ NS

/ NS

/N

S

AC

T; S

E, T

ST, S

OL

:B

ehav

iora

l var

iabl

es; S

SS

(Sta

nfor

d Sl

eepi

ness

Sca

le)

:M

ood

; PO

MS

(pro

file

of

Moo

d St

ates

)

emer

genc

y m

edic

al r

esid

ents

wor

king

nig

ht s

hift

s / h

eavy

alco

hol o

r ca

ffei

ne, o

pioi

ds,

benz

odia

zepi

nes

/ m

el tx

tim

-in

g no

t opt

imiz

ed f

or c

irca

di-

an e

ffec

t

No

effe

cts

of M

el T

x on

Dsl

eep

or N

t sle

epin

ess

orm

ood

Kar

io (

185)

5D-b

NS

/ Hom

e / E

ntir

e 24

hs

NS

/ 48±

8.6

(33-

66)

/ mild

,un

trea

ted

hype

rten

sion

N

one

/ (A

MI)

/ w

aist

whi

leaw

ake,

wri

st w

hile

asl

eep

/N

S / N

S / N

S

AC

T: w

eigh

ted

aver

age

activ

-ity

6 m

ins

befo

re e

ach

BP

mea

sure

men

t (ev

ery

15 m

ins

duri

ng W

, eve

ry 6

0 m

ins

dur-

ing

slee

p); A

mbu

lato

ry B

P

NS

/ car

diov

ascu

lar

even

ts o

rus

ed a

nti-

hype

rten

sive

med

s /

NS

Phys

ical

act

ivity

(i.e

. AC

Tm

otor

act

ivity

is o

ne o

f th

ede

term

inan

ts o

f am

bula

tory

BP

and

its d

iurn

al v

aria

tions

.N

o di

pper

s ex

hibi

ted

grea

ter

slee

p ac

tivity

than

ext

rem

edi

pper

s.

Kub

ota

(98)

5D-b

NS

/ Hom

e; L

abor

ator

y / D

imlig

ht (

150

lux)

vs.

bri

ght l

ight

(300

0 lu

x) f

rom

19

– 21

.30

each

eve

ning

for

5 d

ays.

6 (N

S) /

26 (

21-3

5) /

Nor

mal

N

S / (

AM

I) /

NS

/ NS

/ NS

/N

S

Tem

p N

S / N

S / N

S E

veni

ng b

righ

t lig

ht e

xpos

ure

for

2 ½

hs

dela

ys te

mp

nadi

rfr

om 0

4:08

to 0

5:29

and

dis

-tu

rbed

sub

ject

ive

slee

p.

Lea

ry (

129)

4C-b

Cas

e se

ries

/ C

linic

/ 24

hA

CT

+ a

mbu

lato

ry B

Pm

oni-

tori

ng

434

(434

) / 4

7.9

/ hyp

erte

n-si

on

Non

e / G

aehw

iler

/ dom

wri

st/ 1

0s /

0.1

g / N

S A

CT;

Noc

turn

al f

all (

‘dip

’) in

syst

olic

and

dia

stol

ic B

PC

onse

cutiv

e pt

s re

ferr

ed f

orev

alua

tions

of

hype

rten

sion

/N

S / N

S

Day

time

mot

or a

ctiv

ity(A

CT

) w

as p

ositi

vely

cor

re-

late

d w

/ noc

turn

al d

ip in

BP.

Hig

her

Nt m

otor

act

ivity

was

nega

tivel

y co

rrel

ated

w/ t

heno

ctur

nal d

ip.

AC

Tus

ed to

qua

ntif

y D

& N

tac

tivity

leve

ls. A

CT

was

not

an o

bjec

t of

stud

y.

Lem

ke (

134)

4C-b

Obs

erva

tiona

l stu

dy /

out-

of-

lab

/ 72

hr

16 (

16)

/ 54

(24-

65)

/ maj

orde

pres

sion

epi

sode

w/ m

elan

-ch

olic

fea

ture

s

NS

/ Aco

tmet

er, Z

ak,

Ger

man

y / n

dom

wri

st /

2m

ins

/ 0.1

g /

NS

AC

T: m

ean

activ

ity le

vel 7

- 9

AM

vs.

7-8

PM

; Moo

d: m

ul-

tiple

aff

ectiv

e ad

ject

ive

chec

klis

t

NS/

Par

kins

on’s

& o

ther

mov

emen

t dis

orde

rs /

NS

Dep

ress

ed in

-pts

dis

play

edsi

gnif

ican

tly g

reat

er m

otor

activ

ity in

the

mor

ning

com

-pa

red

to e

veni

ng, b

ut s

ubje

cts

felt

mor

e ac

tive

in P

M, a

ndm

ore

tired

& d

epre

ssed

in th

eA

M.

Cit

atio

n - A

utho

r/

Evi

denc

e L

evel

St

udy

Cri

teri

a D

esig

n /

Loc

atio

n / P

roto

col

Sam

ple

Size

(C

ompl

eted

Stud

y) /

Mea

n A

ge (

Ran

ge)

/M

edic

al C

ondi

tion

s

Com

pari

son

Mea

sure

s /

Act

igra

ph a

ppar

atus

/P

lace

men

t / E

poch

Len

gth

/Se

nsit

ivit

y / S

cori

ng

Out

com

e M

easu

res

Incl

usio

n / E

xclu

sion

/ B

ias

Stud

y C

oncl

usio

n fr

ompa

per

Com

men

ts f

rom

Rev

iew

er


Loc

kley

(29

)

3C

AC

Tco

mpa

red

w/ o

ther

tech

-ni

ques

/ H

ome

/ Ent

ire

24-h

s;m

ean

nigh

ts/s

ubje

ct=

23±

7(r

ange

6-3

5) o

f AC

T+

log

49 (

49)

/ 46.

6±12

.2 /

Blin

d lo

g; m

el; U

rine

sam

ples

/M

otio

n lo

gger

s or

MM

L/

wri

st /

1m /

NS

/ Act

ion

3;O

ther

: Zer

o cr

ossi

ng m

ode

log:

SO

L, S

On,

SO

ff, N

umaw

aken

ings

, dur

aw

aken

ings

,nu

m n

aps,

dur

nap

s; A

CT

:SO

L, S

On,

SO

ff, N

um a

wak

-en

ings

, dur

aw

aken

ings

, num

naps

, tot

al n

ap d

ur

Med

s in

flue

ncin

g sl

eep

orm

el /

NS

/ NS

AC

Tan

d lo

gs y

ield

ed s

imila

rre

sults

for

som

e as

pect

s of

slee

p bu

t not

oth

ers.

Prop

ortio

n of

pts

sho

win

g di

f-fe

renc

es b

etw

een

AC

Tan

dlo

g gr

eate

r th

an th

ose

show

-in

g no

dif

fere

nces

.

Uni

que

use:

to s

ee if

sle

ep(d

aytim

e na

p nu

m &

dur

&ni

ght s

leep

dur

) gr

eatly

alte

red

by C

R ty

pe (

norm

alen

trai

ned,

abn

orm

alen

trai

ned,

or

free

run

)

Low

den

(18

6)

4C-b

Con

trol

led

clin

ical

tria

l,un

blin

ded,

ran

dom

ized

,cr

osso

ver

desi

gn /

NS

/ ent

ire

24 h

. Tw

o tr

ips

each

with

1tx

in c

ount

erba

lanc

ed o

rder

.T

x 1:

mai

ntai

n ho

me

slee

ptim

e. T

x 2:

ado

pt lo

cal s

leep

time.

10

D A

CT

(3 D

BL

), 1

D a

ir tr

avel

9 h

eas

t, 2

D la

y-ov

er, 4

D f

/u

23 (

19)

/ 42

(31

-59)

M, 1

5;F,

4 /

NS

NS

/ AM

I / n

on-d

om w

rist

/ 1

/ NS

/ Act

ion

1.24

Sl

eep

diar

y/lo

g, A

ct: B

T,w

ake-

up ti

me,

tim

e aw

ake,

naps

, TST

; Beh

avio

ral;

Kar

olin

ska

Slee

pine

ss S

cale

;O

ther

s: je

t lag

rat

ing

NS

/NS

Stay

ing

on h

ome

time

grea

tlyre

duce

d je

t lag

sym

ptom

s an

dsl

eepi

ness

dur

ing

layo

ver

but

not a

fter

ret

urni

ng h

ome

AC

Tde

tect

ed n

umer

ous

effe

cts

of f

light

pat

tern

and

timin

g of

pre

dict

ed s

leep

-w

ake

and

dete

cted

trea

tmen

tef

fect

on

time

spen

t aw

ake

befo

re m

ain

slee

p

Lub

oshi

tzky

(18

7)

4C-b

Cas

e-co

ntro

l / H

ome

/ Ent

ire

24 h

s; 4

8 h

urin

e 6S

MT,

5 D

AC

T, 5

D li

ght m

easu

rem

ent

46 (

NS)

/ G

rp1

72.7

±6.

1,G

rp2

61.0

±5.

7, G

rp3

33.3

±8.

4 / A

lzhe

imer

’s d

is-

ease

, hea

lthy

elde

rly,

hea

lthy

youn

g

Mel

/ M

ini-

AC

TA

MA

-32

(AM

I) /

wri

st /

NS

/ NS

/A

CT

Scor

ing

Ana

lysi

s, o

ther

:lig

ht m

eter

on

shir

t

AC

T: S

On,

SO

ff, S

Ptim

e,T

ST, S

E, l

onge

st c

ontin

uous

slee

p, W

ASO

, min

inac

tivity

;B

ehav

iora

l: M

MSE

; lig

htex

posu

re

NS

/ NS

/ 6SM

Tpo

oled

into

all D

and

all

Nt s

ampl

es s

olo

w r

esol

utio

n

6SM

Tlo

wer

in A

D a

nd n

or-

mal

eld

erly

than

you

ng.

Com

pare

d to

eld

erly

and

youn

g no

rmal

s, A

D p

ts h

ave

poor

er s

leep

. No

rela

tion

betw

een

6SM

Tan

d sl

eep.

SOn

and

SOff

ear

lier

in A

Dan

d el

derl

y no

rmal

than

youn

g no

rmal

.

Stud

y no

t des

igne

d to

mea

s-ur

e 6S

MT

phas

e. A

CT

not

adeq

uate

ly c

ompa

red

to r

efer

-en

ce s

tand

ard.

Lun

a (1

03)

4C-a

Obs

erva

tiona

l stu

dy /

Wor

kpla

ce /

Ent

ire

24-h

s;21

D A

CT,

ora

l tem

p ev

ery

4h,

slee

p lo

ss, m

ood

and

perf

orm

-an

ce r

ated

dai

ly a

t mid

-shi

ft

14 (

9) /

NS

/ Nor

mal

shi

ftw

orke

rs

log

/ ‘m

odel

#32

’, (

AM

I) /

wri

st /

NS

/ NS

/ Gen

eral

activ

ity a

naly

sis

prog

ram

(Els

mor

e)

Log

: TST

tem

p: v

isua

l ins

pect

ion

ofpl

ot, A

CT

: tot

al a

ctiv

ity,

Beh

avio

ral:

colle

cted

insu

ffi-

cien

t dat

a, M

ood:

PO

MS

Rap

id r

otat

ion

shif

t wor

k (a

irtr

affi

c co

ntro

l), P

rese

nt f

ordu

r of

stu

dy /

NS

/ 27%

of

AC

Tda

ta lo

st d

ue to

tech

ni-

cal d

iffi

culti

es; t

emp

mas

ked;

prob

lem

s w

/ dat

a re

duct

ion

for

hom

e sl

eep

anal

ysis

Mas

ked

tem

p re

tain

ed d

iurn

alor

ient

atio

n on

Nt s

hift

.Su

bjec

ts f

elt m

ore

fatig

ue &

conf

usio

n an

d le

ss v

igor

on

Nt s

hift

, act

ivity

mea

n lo

wer

on N

t shi

ft, M

ore

AC

Tid

enti-

fied

sle

ep a

t wor

k on

Nt t

han

on D

or

swin

g sh

ift

AC

Tm

ay h

ave

iden

tifie

dun

repo

rted

on-

duty

nap

s in

Nt

shif

t air

traf

fic

cont

rolle

rs.

AC

T&

sel

f-re

port

agr

eed

ther

e w

as m

ore

slee

p du

ring

Nt w

ork

than

on

othe

r sh

ifts

.D

sle

ep a

fter

Nt s

hift

was

not

wor

se th

an s

leep

aft

er o

ther

shif

ts, p

ossi

bly

due

to s

cori

ngm

etho

dolo

gy.

Lus

hing

ton

(188

)

4C-b

Lon

gitu

dina

l stu

dy /

NS

/ 2w

ks lo

g &

AC

TN

S (N

S) /

23.5

(18

-31)

/ no

r-m

al

NS

/ NS

/ wri

st /

NS

/ NS

/G

aehi

ler

Ele

ctro

nics

M

el u

rina

ry; l

og

NS

/ NS

/ NS

Uri

nary

mel

ons

et f

rom

a s

in-

gle

Nt c

an b

e us

ed to

pre

dict

subs

eque

nt o

nset

tim

es w

/ in

± 9

7 m

ins.

Acl

ose

tem

pora

lre

latio

nshi

p w

as a

lso

form

edbe

twee

n m

el o

nset

and

SO

n

Log

use

d to

det

erm

ine

SOn

times

& th

ese

wer

e th

en“c

onfi

rmed

” fr

om A

CT

times

Man

soor

(12

8)

4C-b

NS

/ NS

/ NS

NS

(NS)

/ 57

(10

) / u

ntre

ated

hype

rten

sion

N

one/

MM

L(A

MI)

/ do

mw

rist

/ 1

min

/ N

S / N

S A

CT

: mea

n &

pea

k A

CT

befo

re e

ach

BP/

HR

rea

ding

(eve

ry 5

min

s); A

mbu

lato

ryB

P, H

R

NS

/ NS

/ NS

Cor

rela

tion

of m

otor

act

ivity

,B

Pan

d H

R is

hig

hly

vari

able

from

pt t

o pt

. Non

dipp

ers

have

hig

her

slee

p ac

tivity

than

dip

pers

.

Mar

tin (

109)

5D-b

NS

/ NH

/ A

gita

ted

Beh

avio

rR

atin

g Sc

ale

(AB

RS)

x 6

0.5

h; A

CT

x 3D

(72

h)

NS

(74)

/ 82

.5±7

.6 (

61-9

9) /

Alz

heim

er’s

dis

ease

N

S /A

ctill

umes

(A

MI)

/ N

S /

1 m

in /

NS

/ Act

ion

3 (A

MI)

A

CT

: max

+ m

ean

activ

ity;

Agi

tate

d B

ehav

ior

Rat

ing

Scal

e; a

nd I

llum

inat

ion

Lev

el

NS

/ st

roke

, psy

chia

tric

dis

-or

der,

pre-

datin

g de

men

tia /

NS

The

mea

n ac

roph

ase

for

agi-

tatio

n w

as 1

4:38

. Onl

y 2

pts

(2.4

%)

wer

e “s

undo

wne

rs”

Cit

atio

n - A

utho

r/

Evi

denc

e L

evel

St

udy

Cri

teri

a D

esig

n /

Loc

atio

n / P

roto

col

Sam

ple

Size

(C

ompl

eted

Stud

y) /

Mea

n A

ge (

Ran

ge)

/M

edic

al C

ondi

tion

s

Com

pari

son

Mea

sure

s /

Act

igra

ph a

ppar

atus

/P

lace

men

t / E

poch

Len

gth

/Se

nsit

ivit

y / S

cori

ng

Out

com

e M

easu

res

Incl

usio

n / E

xclu

sion

/ B

ias

Stud

y C

oncl

usio

n fr

ompa

per

Com

men

ts f

rom

Rev

iew

er


Mar

tin (

132)

4C-b

Obs

erva

tiona

l stu

dy /

NS

/A

CT

x 3D

; ent

ire

24-h

s N

S (N

S) /

58.3±9

.8 (

45-7

6) /

Schi

zoph

reni

a L

og /

Act

illum

e (A

MI)

/ no

n-do

m w

rist

/ N

S / N

S / A

ctio

n3

(AM

I)

AC

T: S

leep

, wak

e; M

MSE

,Q

WB

, Bri

ef P

sych

iatr

icR

atin

g Sc

ale,

SA

PS, S

AN

S,A

IMS,

EPS

, neu

rops

ycho

log-

ical

exa

min

atio

ns, l

ight

exp

o-su

re

NS/

NS

/ NS

The

re w

ere

impo

rtan

t dis

tur-

banc

es o

f C

Rs

and

S/W

,w

hich

wer

e re

late

d, c

ogni

tive

func

tioni

ng a

nd lo

w le

vels

of

illum

inat

ion

expo

sure

Mid

delk

oop

(41)

4C-b

Val

idat

ion

/ Hom

e / 4

5 co

n-se

cutiv

e hs

sta

rtin

g at

12:

00;

45 h

s A

CT

+lo

g

20 (

20)

/ 24.

1±3.

7 / N

orm

al

NS

/ GA

HW

ILE

R e

lect

roni

cC

H-8

634

Hom

brec

htik

on /

Lt

wri

st, R

t wri

st, L

t ank

le, R

tan

kle,

trun

k (n

avel

) / 5

s / N

S/ N

S

AC

T: A

ctiv

ity le

vel

NS

/ NS

/ Hea

lthy

youn

gad

ults

onl

y W

rist

pla

cem

ents

det

ecte

dm

ore

activ

ity c

ount

s th

anan

kle

or tr

unk

plac

emen

ts.

dom

wri

st p

lace

men

t yie

lded

grea

ter

diur

nal a

ctiv

ity c

ount

sth

an n

dom

. All

site

s cl

earl

ysh

owed

cir

cadi

an s

leep

-Wdi

ffer

ence

s. S

ugge

sts

mor

est

udy

w/ p

lace

men

ts c

on-

com

itant

w/ P

SG

Wri

st p

lace

men

t sup

erio

r to

ankl

e or

trun

k. D

om w

rist

appe

ars

bette

r fo

r di

scri

min

at-

ing

leve

l of

wak

ing

activ

ity.

Mid

dlet

on (

89)

2B

RC

T, D

B, c

ross

over

des

ign

/L

ab /

2x30

D f

ree-

run

in 4

lux;

mel

Tx

firs

t 15

Ds

at 2

0:00

,cr

osso

ver

to p

lace

bo T

x fo

r2n

d 15

Ds.

Sep

arat

e 30

D w

/pl

aceb

o 1s

t 15

days

.C

ontin

uous

AC

T, r

ecta

l tem

p,ur

inar

y m

el s

ulph

atox

y, lo

gs

10 (

8) /

23.9

±0.

75 /

Nor

mal

M

el s

ulph

atox

y, c

ore

tem

p(d

emas

ked)

/ M

ML

(AM

I) /

wri

st /

20 s

ec /

NS

/ Cos

inor

& s

pect

ral a

naly

sis;

Act

ion3

slee

p an

alys

is C

ole

log;

cor

e te

mp-

(dem

aske

d);

mel

sul

phat

oxy

acro

phas

e an

dpe

riod

; AC

T: a

crop

hase

, SO

n,SO

ff

Nor

mal

mel

leve

l & ti

min

g /

NS

/ Sm

all s

ampl

e, b

ut p

rob-

lem

off

set b

y go

od e

xper

i-m

enta

l des

ign

Mel

Tx

phas

e-sh

ifts

sle

ep &

core

tem

p rh

ythm

s. M

el T

xus

ually

syn

chro

nize

d th

e S/

Wrh

ythm

s bu

t onl

y in

cons

is-

tent

ly s

ynch

roni

zed

the

core

tem

p r

hyth

m

Cir

cadi

an p

hase

of

wri

stac

tivity

and

dem

aske

d co

rete

mp

gene

rally

agr

eed,

pro

-vi

ding

OB

J ev

iden

ce th

atA

CT

can

prov

ides

use

ful c

ir-

cadi

an p

hase

mea

sure

men

ts

Mid

dlet

on (

90)

2B

Obs

erva

tiona

l stu

dy /

Lab

/E

ntir

e 24

-hs;

21D

fre

e-ru

n in

L/L

4 lu

x &

kno

wle

dge

ofcl

ock

time

cont

inuo

us A

CT,

rect

al te

mp,

uri

ne e

very

4h,

perf

orm

ance

eve

ry 3

h w

hile

awak

e

6 (6

) / 2

6±2.

7 / N

orm

al

log;

mel

sul

phat

oxy;

cor

ete

mp

/ MM

L(A

MI)

/ w

rist

/20

-30

sec

/ NS

/ Col

e, r

egre

s-si

on o

n co

sino

r ac

roph

ases

,sp

ectr

al a

naly

sis

log;

tem

p; m

el s

ulph

atox

y;A

CT

: SO

n, S

Off

, TIB

, TST

,W

ASO

, SE

I, a

ctiv

ityac

roph

ase;

Beh

avio

ral:

per-

form

ance

NS

/ NS

/ Tem

p no

tde

mas

ked,

sm

all s

ampl

e M

el, t

emp

& a

ctiv

ity r

hyth

ms

free

-ran

in 5

of

6 in

divi

dual

s.In

the

6th,

onl

y m

el f

ree-

ran.

Tem

p m

ay h

ave

rem

aine

d at

24h

peri

od d

ue to

mas

king

by

the

rest

-act

ivity

cyc

le.

Act

ivity

rhy

thm

usu

ally

agre

ed w

/ the

mel

& te

mp

rhyt

hms.

Agr

eem

ent w

/ the

mel

rhy

thm

pro

vide

s O

BJ

evid

ence

that

AC

Tca

n be

aus

eful

pha

se m

arke

r.A

gree

men

t w/ t

emp

prov

ides

wea

ker

evid

ence

bec

ause

itm

ay b

e du

e to

mas

king

.

Mis

him

a (9

9)

4C-b

RC

T, u

nblin

ded,

cro

ss-o

ver

desi

gn /

NH

/ E

ntir

e 24

-hs;

cont

inuo

us A

CT

for

1 w

k pr

e-T

x, 2

wks

Tx,

1 w

k po

st-T

x,≥

4 w

ks w

asho

ut c

ross

-ove

r;T

x=5-

8000

lux

9-11

am;

Con

trol

=30

0 lu

x 9-

11am

22 (

NS)

/ G

rp1

81,

Grp

2 78

/ Grp

1 V

ascu

lar

dem

entia

,G

rp2

Alz

heim

er’s

dem

entia

Non

e / (

AM

I) /

ndom

wri

st /

1 m

in /

NS

/ act

ivity

cou

nts

used

, sle

ep n

ot s

core

d

AC

T: T

otal

, day

time

& n

ight

-tim

e ac

tivity

, % n

ight

/tota

lac

tivity

DSM

IV

Dx

of v

ascu

lar

dem

entia

or A

lzhe

imer

’s /

mix

ed d

emen

tia e

xclu

ded

/U

nabl

e to

blin

d T

x, s

mal

l N

Vas

cula

r D

emen

tia: d

aily

brig

ht li

ght r

educ

es n

ight

time

activ

ity; A

lzhe

imer

’sD

emen

tia: b

righ

t lig

ht d

oes

not a

ffec

t act

ivity

rhy

thm

Show

s A

CT

dete

cted

Tx

effe

ct in

wel

l-de

sign

ed, c

on-

trol

led

tria

l. S

ugge

st A

CT

usef

ul to

det

ect o

utco

me

inC

R T

x st

udy

Mis

him

a (1

25)

4C-b

NS

/ NS

/ Ent

ire

24 h

s; 7

+24

hr

Ds.

SD

AT

& M

ID g

rps

com

pare

d

41 (

NS)

/ G

rp1

6.4±

7.6,

Grp

279

.1±5

.6 /

SDA

T(N

=20

),M

ID (

N=

21)

Tem

p am

bula

tory

Rec

tal /

MM

L(A

MI)

/ no

ndom

Wri

st/ 1

min

/ N

S / N

S

Tem

p; A

CT

: mea

n to

tal d

aily

activ

ity, m

ean

D a

ctiv

ity,

mea

n N

t act

ivity

, % N

t to

Dac

tivity

NS

/ mix

ed (

SDA

Tan

d M

ID)

dem

entia

, sev

ere

mot

or d

is-

turb

ance

s, s

leep

dis

orde

rs /N

S

The

SD

AT

grp

show

ed p

osi-

tive

corr

elat

ion

betw

een

activ

ity (

tota

l dai

ly a

ctiv

ityan

d %

Nt a

ctiv

ity)

and

dem

en-

tia s

ever

ity.

Cit

atio

n - A

utho

r/

Evi

denc

e L

evel

St

udy

Cri

teri

a D

esig

n /

Loc

atio

n / P

roto

col

Sam

ple

Size

(C

ompl

eted

Stud

y) /

Mea

n A

ge (

Ran

ge)

/M

edic

al C

ondi

tion

s

Com

pari

son

Mea

sure

s /

Act

igra

ph a

ppar

atus

/P

lace

men

t / E

poch

Len

gth

/Se

nsit

ivit

y / S

cori

ng

Out

com

e M

easu

res

Incl

usio

n / E

xclu

sion

/ B

ias

Stud

y C

oncl

usio

n fr

ompa

per

Com

men

ts f

rom

Rev

iew

er


Mor

mon

t (15

0)

4C-b

Unb

linde

d, n

onra

ndom

ized

,ob

serv

atio

nal s

tudy

, coh

ort

stud

y, lo

ngitu

dina

l stu

dy /

Hom

e / E

ntir

e 24

-hs;

3D

AC

T

200

(192

) / 5

8 (2

0-75

) /

Am

bula

tory

met

asta

tic c

ol-

orec

tal c

ance

r pt

s re

ferr

ed f

orch

rono

mod

ulat

ed c

hem

othe

r-ap

y

Non

e / A

CT

(AM

I) /

NS

/ 1m

in /

NS

/ NS

End

ocri

ne m

easu

res:

cir

cadi

-an

cha

nges

in c

ortis

ol &

WB

C; A

CT

: aut

o-r

at 2

4h &

adi

chot

omy

inde

x co

mpa

ring

amou

nts

of a

ctiv

ity w

hen

inbe

d &

out

of

bed,

mea

n ac

tiv-

ity; M

ood:

HA

DS

(sca

le o

fan

xiet

y an

d de

pres

sion

);Q

LQ

-C30

- Q

ualit

y of

Lif

eSc

ale

for

Eur

opea

nO

rgan

izat

ion

for

Res

earc

h &

Tre

atm

ent o

f C

ance

r

NS

/ Poo

r ge

nera

l hea

lth(W

orld

hea

lth O

rgan

izat

ion

perf

orm

ance

sta

tus

72)

/ NS

Pts

w/ m

arke

d re

st/a

ctiv

ityrh

ythm

s ha

d a

5-fo

ld h

ighe

rsu

rviv

al r

ate

at 2

yrs

, had

a 5

-fo

ld h

ighe

r su

rviv

al r

ate

at 2

yrs,

had

bet

ter

QO

L&

rep

ort-

ed le

ss f

atig

ue. R

est/a

ctiv

ityrh

ythm

rem

aine

d a

sign

ific

ant

pred

icto

r of

sur

viva

l in

mul

ti-va

riat

e an

alys

is.

Nag

tega

al (

60)

3C

Cas

e re

port

/ ho

me

/ ent

ire

24h;

24

h A

CT

befo

re T

x w

/m

el, a

fter

Tx

w/ m

elat

onin

at

03 3

0 &

aft

er T

x at

mid

nigh

t

1 (1

) / 1

5 (N

S) /

head

inju

ry

Self

rep

ort,

mel

, tem

p; a

ppa-

ratu

s: G

aew

iler

Ele

ctro

nic;

nond

om w

rist

; NS

Tem

p, m

el, A

CT

NS

/ NS

/NS

Etio

logy

of

DSP

S w

as p

re-

sum

ed to

be

head

inju

ry.

DSP

S re

spon

ded

favo

rabl

y to

mel

AC

Tw

as u

sed

to “

quan

tify

her

S/W

beha

vior

,” b

ut n

oqu

antit

ativ

e an

alys

is w

asdo

ne. B

y vi

sual

insp

ectio

nA

CT

peri

od o

f lo

w a

ctiv

ityco

rres

pond

ed to

per

iod

of m

else

cret

ion

and

low

rec

tal t

emp

Ots

uka

(178

)

5D-a

Val

idat

ion

/ Lab

orat

ory;

Out

-of

-lab

hos

pita

l bed

/ E

ntir

e24

-hs;

72+

hr A

CT

7 E

CG

,(a

lso

BP

for

48hs

& H

R f

or24

hs)

44 (

44)

/ Grp

1 (2

8-46

), G

rp2

(28-

78)

/ Nor

mal

; Hea

lthy

EC

G; B

P; H

R /

Act

ivet

race

r /

wai

st /

1 se

c / 0

.01

to 0

.50g

/N

S

AC

T: A

ctiv

ity le

vel;

BP

Sim

ulta

neou

s A

CT

& B

Pca

nbe

use

d to

sho

w r

elat

ions

hip

of S

/Ww

/ BP.

Sug

gest

s S/

Wrh

ythm

s of

abo

ut 7

Ds

(cir

-ca

sept

an)

in a

dditi

on to

cir

ca-

dian

& a

3.5

D (

circ

asem

isep

-ta

n) r

hyth

m in

irre

gula

r S/

Wcy

cles

but

abl

e to

iden

tify

indi

vidu

al d

iffe

renc

es in

all

thes

e

Har

d to

pul

l dat

a ou

t of

this

artic

le; u

ses

a lo

t of

indi

vid-

ual e

xam

ples

.

Park

(10

6)

4C-b

Obs

erva

tiona

l stu

dy/

hom

e/en

tire

24 h

12

(N

S) M

/32

.4 ±

6.8

(23

-44

) / r

otat

ing

3 sh

ift w

orke

rs,

age

< 2

5, 2

6-35

, >36

Non

e/A

MA

32 c

l by

AM

I /

non-

dom

inan

t & w

rist

/1 m

in/ N

S /C

ole/

Kri

pke

and

othe

rw

as z

ero

cros

sing

mod

e

AC

T: T

ST, B

T, w

ake-

up,

num

nap

, nap

dur

, am

plitu

de,

activ

ity o

n du

ty

NS

/ Sm

all s

ampl

e T

STon

nt s

hift

< D

shi

ft <

even

ing

shif

t. T

STde

crea

ses

with

age

Aut

hors

sta

te th

at A

CT

resu

ltsco

rres

pond

to th

eir

prev

ious

PSG

res

ults

in n

t wor

kers

Polla

k (1

23)

4C-b

Cas

e-co

ntro

l stu

dy /

NS

/E

ntir

e 24

hs;

9D

AC

TN

S (8

6) /

Grp

1 80

.7±

7.9,

Grp

2 73

.7±

7.2,

Grp

37.

3±10

.2, G

rp4

58.1

±16

.0 /

NS

NS

/ MM

L(A

MI)

/ nd

omw

rist

/ N

S / N

S / N

S N

S A

ge ≥

65, o

ccur

renc

e of

dis

-ru

ptiv

e no

ctur

nal b

ehav

iors

/N

S / N

S

Dem

ente

d ol

der

peop

le w

ere

sign

ific

antly

less

act

ive

in th

eda

ytim

e th

an th

eir

care

give

rs,

and

circ

adia

n re

st–a

ctiv

ityam

plitu

des

wer

e sm

alle

r

Poyu

rovs

ky: (

133)

4C-b

Cas

e-co

ntro

l stu

dy /

NS

/E

ntir

e 24

hs;

AC

Tx

24 h

s N

S (N

S) /

Grp

1 36

.4 (

19-5

0),

Grp

2 29

.6 (

18-4

9) /

Schi

zoph

reni

a w

/ or

w/o

neu

-ro

lept

ic in

duce

d ak

athi

sia

Non

e / A

CT

AM

A32

(A

MI)

/N

S / 1

min

/ N

S / 0

.1 g

/ N

S A

CT

: ove

rall

mot

or a

ctiv

ity,

SL, s

leep

dur

, sle

ep c

ontin

u-ity

, SE

; Bar

nes

akat

hisi

a sc

ale

NS

/ Psy

chot

ic a

gita

tion

/ NS

Schi

zoph

reni

c in

-pts

w/ n

eu-

role

ptic

indu

ced

akat

hisi

aw

ere

mot

oric

ally

mor

e ac

tive

from

11:

30 to

14:

15 a

nd f

rom

18:0

0 to

21:

00 th

an th

ose

w/o

neur

olep

tic a

kath

isia

.

Que

ra-S

lava

(94

)

4C-b

Non

rand

omiz

ed /

wor

kpla

ce /

5-7

D

NS

(40)

/ G

rp1

36±7

, Grp

235±7

/ no

rmal

N

S / G

aehw

iler

/ wri

st /

NS

/N

S / N

S lo

g; m

el (

urin

ary

6-su

lfat

oxy

mel

); A

CT

NS

/ NS

/ NS

Nig

ht-s

hift

wor

kers

sle

ptm

ore

on D

s of

f. (

AC

Tin

ac-

tivity

). S

ome

nigh

t-sh

ift

wor

kers

are

abl

e to

sw

itch

acro

phas

e of

uri

nary

mel

(to

1208

hr,

mea

n)

Que

ra-S

alva

(95

)

4C-b

NS

/ lab

orat

ory

(2N

t) /

NS

40 (

40)

/ Grp

1 36±7

, Grp

235±7

/ no

rmal

; 20

on f

ixed

nigh

t shi

ft, 2

0 on

fix

ed D

shif

t

log

/ act

igra

ph/p

hoto

met

er(G

aehw

iler

Ele

ctro

nic,

Phys

ioco

m, P

aris

, Fra

nce)

/nd

om W

rist

/ 1

min

/ N

S /

Act

ison

(A

xon.

Phy

sio,

com

.Pa

ris,

Fra

nce)

log;

mel

(ur

inar

y su

lfat

oxy

–mel

); A

CT

: TST

;Pe

rfor

man

ce (

Stem

berg

reco

very

test

for

sev

en le

tters

;4-

choi

ce r

eact

ion

time

test

.U

rine

sam

ples

(Q

2h x

24

hr)

25-5

5 yr

s of

age

goo

d he

alth

;N

o R

xs a

ffec

ting

mel

, not

anxi

ous,

dep

ress

ed /

NS

/ NS

6/20

(30

%)

of n

ight

shi

ftnu

rses

wer

e ph

ysio

logi

cally

able

to a

dapt

to a

fas

t-sh

iftin

gS/

Wsc

hedu

le. T

his

shif

t was

asso

ciat

ed w

/ a c

hang

e in

the

acro

phas

e of

6-s

ulfa

toxy

mel

Cit

atio

n - A

utho

r/

Evi

denc

e L

evel

St

udy

Cri

teri

a D

esig

n /

Loc

atio

n / P

roto

col

Sam

ple

Size

(C

ompl

eted

Stud

y) /

Mea

n A

ge (

Ran

ge)

/M

edic

al C

ondi

tion

s

Com

pari

son

Mea

sure

s /

Act

igra

ph a

ppar

atus

/P

lace

men

t / E

poch

Len

gth

/Se

nsit

ivit

y / S

cori

ng

Out

com

e M

easu

res

Incl

usio

n / E

xclu

sion

/ B

ias

Stud

y C

oncl

usio

n fr

ompa

per

Com

men

ts f

rom

Rev

iew

er


Rei

d (2

5)

3C

Val

idat

ion;

AC

Tco

mpa

red

w/ o

ther

tech

niqu

es /

Lab

orat

ory

/ Diu

rnal

; Ent

ire

24-h

s; A

CT

+PS

G (

whe

nsl

eep)

for

1N

t ada

ptat

ion,

2D

of 1

2 hr

D s

hift

(ni

ght s

leep

),2D

12h

r ni

ght s

hift

(D

sle

ep),

1 1/

2D “

off”

32 (

32)

/ Grp

1 21

.2±2

.7, G

rp2

43.9±6

.8 /

NS

PSG

/ G

aehw

iler

/ ndo

m h

and

/ 30

sec

/ 0.1

g 12

5 m

s sa

m-

plin

g tim

e (8

kg)

Bau

dpas

sfi

lter

0.25

-3.0

kg

/ NS

PSG

: Sle

ep, w

ake

SOn,

SO

ff;

AC

T: S

leep

, wak

e, S

On,

SO

ff

NS

/ Sm

oker

s, ta

king

med

s,sl

eep

diso

rder

s / L

ab s

hift

wor

k st

udie

s m

ay n

ot c

om-

plet

ely

refl

ect r

eal w

orld

,th

eir

olde

r su

bjec

ts w

ere

real

-ly

mid

dle-

aged

.

AC

Tva

lid f

or S

/Wac

tivity

&sl

eep

dur

(alth

ough

AC

Tdi

f-fe

rent

fro

m P

SG f

or S

Off

) bu

tno

t as

good

for

mor

e sp

ecif

icm

easu

res

such

as

SE; A

CT

:ag

rees

mor

e w

ith P

SG f

oryo

ung

adul

t tha

n fo

r m

iddl

e-ag

ed b

ecau

se m

ore

quie

t Wsc

ored

as

slee

p in

latte

r, as

the

likel

ihoo

d of

sle

ep d

ecre

ases

so d

oes

AC

Tac

cura

cy.

Saku

rai (

108)

5D-a

Obs

erva

tiona

l stu

dy, A

CT

vs.

Lig

ht /

Hom

e / E

ntir

e 24

-hs;

3-4D

AC

T&

ligh

t & lo

gs,

nurs

e in

terv

iew

at h

ome

35 (

35)

/ (65

-95)

/ N

orm

al

log,

illu

min

atio

n / A

ctill

ume

/nd

om w

rist

/ N

S / N

S / C

ole

et a

l. &

Cos

inor

(A

ctio

n3)

AC

T: a

ctiv

ity m

esor

, am

pli-

tude

, con

tinui

ty o

f ac

tivity

;ill

umin

atio

n (l

ux)

Hea

lthy

elde

rly

/ NS

/ No

men

tion

of e

xclu

sion

of

off-

wri

st a

rtif

act,

all M

s

activ

ity m

esor

and

am

plitu

deco

rrel

ate

nega

tivel

y w

/ age

in65

-95

rang

e, d

ecre

ased

“sl

eep

ampl

itude

” in

80-

95 r

ange

,ab

out 1

/2 o

f su

bjec

ts w

hosh

ow “

disc

ontin

uous

mov

e-m

ent”

hav

e lo

w li

ght e

xpo-

sure

Mes

or r

esul

ts c

lear

, but

oth

erre

sults

not

exp

lain

ed in

suf

fi-

cien

t det

ail t

o in

terp

ret.

Phas

e&

goo

dnes

s of

cir

cadi

an f

itN

S

Sam

el (

189)

4C-b

NS

/ lab

orat

ory

/ Ent

ire

24 h

s;29

D A

CT

cond

ition

s: n

orm

alC

O2

conc

entr

atio

n an

d el

e-va

ted

CO

2

4 (4

) / (

23-2

9) /

norm

al

Non

e / p

iezo

elec

tric

acce

lero

met

er /

ndom

wri

st /

NS

/ 1.0

g /

NS

Tem

p: le

vel,

circ

adia

n, a

mp.

Acr

opha

se; A

CT

: sdu

r., a

ctiv

-ity

leve

l; m

ood:

fat

igue

que

s-tio

nnai

re; s

aliv

ary

sam

ples

urin

ary

cort

isol

, cat

e-ch

olam

ines

, (6O

H m

el s

ul-

phat

e)

NS

/ NS

/ NS

CO

2 le

vels

up

to 1

.2 %

(as

occu

r du

ring

man

ned

spac

em

issi

ons)

do

not i

mpa

ir c

irca

-di

an te

mp

or S

/Wpl

aytim

esbu

t do ↓

D m

ean

activ

ityle

vel

& D

man

tem

p an

d ci

r-ca

dian

am

plitu

de

Satli

n (9

1)

3C

AC

Tco

mpa

red

w/ o

ther

tech

-ni

ques

/ H

ospi

tal b

ed /

Ent

ire

24-h

r; 7

2 hr

AC

Tan

d re

ctal

tem

p

Grp

1 28

(28

) G

rp2

10 (

10)

/G

rp1

71.4

±5.

4 (6

1-82

), G

rp2

72.8

±5.

9 (6

7-80

) / G

rp1

Alz

heim

er’s

, Grp

2 no

rmal

Rec

tal t

emp

/ (A

MI)

act

i-gr

aph,

mod

el N

S / G

rp1

ankl

e, G

rp2

wai

st /

5 m

ins

/N

S / m

ean

D a

nd N

t act

ivity

,co

sino

r, va

rian

ce s

pect

ra,

inte

rdai

ly s

tabi

lity,

cir

cadi

anco

rrel

atio

n

AC

T: m

ean

and

% D

and

Nt

activ

ity, c

irca

dian

var

iabi

lity,

acro

phas

e, m

esor

, am

plitu

de,

devi

atio

n fr

om 2

4-hr

rhy

thm

Prob

able

Alz

heim

er’s

/ ps

y-ch

iatr

ic, n

euro

logi

cal,

acut

em

edic

al d

isor

ders

/ di

ffer

ent

actig

raph

pla

cem

ent i

n pt

s vs

.co

ntro

ls, t

emp

rhyt

hm m

aske

dby

act

ivity

Alz

heim

er’s

tem

p rh

ythm

dela

yed

but n

orm

al a

mpl

itude

and

24-h

r en

trai

nmen

t.A

lzhe

imer

’s a

ctiv

ity r

hyth

mde

laye

d, m

ore

vari

able

, low

eram

plitu

de, m

ore

noct

urna

lac

tivity

.In

pts

w/ l

arge

pha

se a

ngle

betw

een

activ

ity a

nd te

mp,

mor

e sl

eep

frag

men

tatio

n an

dlo

wer

tem

p am

plitu

de

PLM

s co

uld

acco

unt f

or s

ome

find

ings

bec

ause

onl

y pt

s ha

dac

tigra

ph o

n an

kle.

Bot

hac

tivity

and

cor

e te

mp

acro

phas

es w

ere

dela

yed

inpt

s, b

ut n

ot c

lear

if s

ourc

e is

circ

adia

n pa

cem

aker

or

mas

k-in

g.

Sche

r (8

6)

5D-b

NS

/ NS

/ Noc

turn

al 2

Nt A

CT

NS

(NS)

/ 1

yr±

14D

/ no

rmal

N

one

/ MM

L(A

MI)

/ L

ankl

e/ N

S / N

S / N

S A

CT

: SO

T, S

dur,

num

of

awak

enin

gs, a

ctiv

ity le

vel,

SE; T

emp

ratin

g

Nor

mal

, ful

l-te

rm in

fant

s / N

S/ N

S R

esul

ts d

id n

ot s

uppo

rt a

gen

-er

al li

nk b

etw

een

S/W

regu

la-

tion

in in

fanc

y an

d te

mpe

ra-

men

t cha

ract

eris

tics

Shap

iro

(127

)

5D-b

Obs

erva

tiona

l stu

dy; l

ongi

tu-

dina

l stu

dy /

hom

e /

2 D

AC

T(4

8hs)

NS

(104

) / 6

7.0

(55-

79)

/ NS

Non

e / M

ML

(AM

I) /

dom

wri

st /

1 m

in /

NS

/ NS

Am

bula

tory

BP,

HR

, dia

ry(t

ime,

pos

ture

, act

ivity

) ze

ro-

cros

sing

mod

e

Hea

lthy

+ a

ctiv

e / n

euro

logi

-ca

l car

diov

ascu

lar,

rena

l,en

docr

ine

+ p

sych

iatr

icD

isor

ders

, & m

ed a

ffec

ting

card

iova

scul

ar s

yste

m /

NS

Act

ivity

was

not

cor

rela

ted

w/

BP

or H

R b

etw

een

subj

ects

,w

akin

g or

sle

epin

g. W

ithin

subj

ects

, act

ivity

was

wea

kly

corr

elat

ed w

/ HR

& B

P

Shoc

hat (

161)

4C-b

Obs

erva

tiona

l stu

dy, A

CT

vs.

Lig

ht e

xpos

ure

/ NH

/ E

ntir

e24

-hs;

3D

AC

Tan

d ill

umin

a-tio

n m

onito

ring

77 (

66)

/ 85.

76±

7.3

/In

stitu

tiona

lized

eld

erly

,de

men

tia (

all e

xcep

t 3 o

f th

eco

mpl

eter

s)

Illu

min

atio

n, D

emen

tia r

atin

gsc

ale

/ Act

illum

e / w

rist

/ 1

min

w/ 1

0 se

c su

b-ep

ochs

for

max

act

ivity

(i.e

. max

10

sec/

min

) / N

S / N

S, b

utA

ncol

i-Is

rael

et a

l. 19

97 N

Hal

gori

thm

impl

ied

AC

T: %

sle

ep &

W, n

umna

ps, m

ins

Wbe

twee

n m

aps,

num

nig

ht a

wak

enin

gs, d

ur o

fea

ch a

wak

enin

g; m

edia

n &

mea

n ill

umin

atio

n, m

in >

1k

lux

& >

2k

lux

NS

/ NS

/ NS

Low

illu

min

atio

n in

NH

pts

,hi

gher

ligh

t in

D a

ssoc

iate

dw

/ few

er N

t aw

aken

ings

, but

not h

ighe

r D

act

ivity

, nor

Dw

akef

ulne

ss, s

ever

e de

men

tiapr

edic

ted

mor

e D

sle

ep, l

ight

acro

phas

e co

rrel

ates

w/ a

ctiv

-ity

acr

opha

se, m

ore

min

s/D

brig

ht li

ght p

redi

cts

late

rac

tivity

acr

opha

se

Cit

atio

n - A

utho

r/

Evi

denc

e L

evel

St

udy

Cri

teri

a D

esig

n /

Loc

atio

n / P

roto

col

Sam

ple

Size

(C

ompl

eted

Stud

y) /

Mea

n A

ge (

Ran

ge)

/M

edic

al C

ondi

tion

s

Com

pari

son

Mea

sure

s /

Act

igra

ph a

ppar

atus

/P

lace

men

t / E

poch

Len

gth

/Se

nsit

ivit

y / S

cori

ng

Out

com

e M

easu

res

Incl

usio

n / E

xclu

sion

/ B

ias

Stud

y C

oncl

usio

n fr

ompa

per

Com

men

ts f

rom

Rev

iew

er


Sieg

mun

d (8

5)

4C-b

Obs

erva

tiona

l stu

dy /

hom

e /

Ent

ire

24 h

s, 7

D A

CT

39 (

39)

/ (4w

ks-6

2yrs

) / n

or-

mal

O

bser

vatio

n, ta

pe r

ecor

ding

s,ph

otog

raph

s, v

ideo

/ ac

tom

e-te

r, Z

AK

, (G

mbl

t, Si

mba

ch,

Ger

man

y) /

ndom

Wri

st /

2m

ins

/ NS

/ AK

TO

GR

APH

ZA

K G

mbl

t, Si

mba

ch,

Ger

man

y

AC

T: n

o fo

rmal

var

iabl

esde

scri

bed

NS/

NS

/ NS

In in

fant

s ci

rcad

ian

rest

-act

iv-

ity p

atte

rns

deve

lop

out o

ful

trad

ian

com

pone

nts.

Adu

ltrh

ythm

s w

ell r

elat

ed to

nat

u-ra

l lig

ht-d

ark

cycl

e.V

aria

bilit

y of

sle

ep/r

est t

erm

i-na

tion

smal

ler

than

its

onse

t.M

ean

sl d

ur. O

f in

fant

s ag

ed<

11

mos

9-1

2 h/

D; a

dults

7-

10 h

/D. W

omen

oft

en s

lept

long

er th

an m

en

Van

Som

eren

(10

0)

4C-b

NS

/ out

-of-

lab

hosp

ital b

ed /

Ent

ire

24 h

s; 5

D A

CT

brig

htam

bien

t lig

ht (

mea

n 11

36 lu

x)vs

. BL

(436

lux)

29 (

22)

/ 79±

2 (6

4-97

) /

Dem

entia

(16

AD

, 3 M

ID, 2

Alc

ohol

ism

, 1 n

orm

al p

res-

sure

hyd

roce

phal

us s

ever

evi

sual

def

icie

ncie

s in

5 p

ts

Non

e / s

elf-

mad

e / N

S / N

S /

1.0

g / N

S

AC

T: “

Inte

rdai

ly s

tabi

lity”

.(I

S) “

Inte

rdai

ly v

aria

bilit

y”,

(IV

) am

plitu

de o

f re

st-a

ctiv

ityrh

ythm

(A

MP)

SDG

pts

/ N

S / N

S B

righ

tene

d w

hole

-D li

ght

(436→

1136

lux)

↑IS

(↑

cou-

plin

g of

res

t-ac

tivity

rhy

thm

sto

env

iron

men

tal z

eitg

eber

s),

↓IV

(↓fr

agm

enta

tion)

mor

est

able

res

t-ac

tivity

rhy

thm

but

no c

hang

e in

AM

P. T

hese

resp

onse

s pr

even

ted

by s

ever

evi

sual

def

icits

.

No

refe

renc

e to

sta

ndar

d

Van

Som

eren

(10

1)

4C-b

Lon

gitu

dina

l stu

dy /

Hom

e /

Bef

ore

aero

bic

trai

ning

5 ½

DA

CT;

Aer

obic

Tra

inin

g fo

r 3

mos

(10

Sub

ject

s/ n

o tr

aini

ng8

cont

rols

); A

fter

trai

ning

5 ½

D A

CT;

1 y

r af

ter

trai

ning

5½

D A

CT

NS

(10)

/ 73

±1.

5 / n

orm

al

Non

e / s

elf-

mad

e / w

rist

/ N

S/ N

S / N

S A

CT

: Dai

ly +

hour

ly v

aria

bili-

ty o

f ac

tivity

& a

mp.

Of

cir-

cadi

an r

est/a

ctiv

ity r

hyth

m

Had

to b

e he

alth

y / N

S / N

S A

erob

ic tr

aini

ng r

educ

es“f

ragm

enta

tion”

(h-

to-h

var

i-ab

ility

) of

the

rest

- ac

tivity

rhyt

hm in

hea

lthy

elde

rly

men

.

AC

Tda

ta a

re in

adeq

uate

lyan

alyz

ed. P

aper

was

poo

rly

refe

rred

.

Van

Som

eren

(19

0)

4C-b

RC

T, p

aral

lel,

SB /

NH

/E

ntir

e 24

-hr,

4D A

CT

BL

, 4D

AC

Taf

ter

6 w

k T

x, 4

D A

CT

at 6

wk

follo

w-u

p; T

x =

TE

NS

or p

lace

bo

Grp

1 19

(14

), G

rp2

8 (8

) /

Grp

1 84

±1.

5, G

rp2

77±

3.5

/G

rp1

Alz

heim

er’s

, Grp

2N

orm

al

none

/ A

ppar

atus

: sel

f-m

ade;

wri

st; N

S; S

cori

ng: i

nter

daily

stab

ility

(IS

), in

trad

aily

var

i-ab

ility

(IV

), r

elat

ive

ampl

i-tu

de (

RA

)

AC

T: I

S, I

V, R

AIn

clud

e ea

rly

stag

e pr

obab

leA

lzhe

imer

’s /

Exc

lude

neu

-ro

lept

ic m

eds,

vis

ual d

efic

ien-

cies

/low

sam

ple

size

Hig

her

IV, l

ower

RA

, and

tren

d fo

r lo

wer

IS

inA

lzhe

imer

’s v

s. n

orm

al e

lder

-ly

. TE

NS

incr

ease

d IS

inA

lzhe

imer

’s, b

ut d

id n

otim

prov

e IV

or R

A.

No

refe

renc

e st

anda

rd.

Van

Som

eren

(11

1)

4C-b

Ope

n tr

ial/

NH

/ com

pare

dda

ta a

naly

sis

met

hods

for

2st

udie

s: S

tudy

1: 2

8D A

CT

duri

ng 5

D B

L, 1

0D b

righ

tlig

ht tx

, 13

D F

/U/ e

ntir

e 24

h

4 an

d 17

(N

S) /

NS/

dem

ente

d N

one/

1) A

ctill

ume;

2)

hom

em

ade/

1)

non-

dom

wri

st; 2

)no

n-do

m w

rist

/NS

/ NS

/Sl

eep

NS

AC

T: C

ompa

red

cosi

nor,

com

plex

dem

odul

atio

n pe

ri-

odog

ram

, aut

ocor

rela

tion,

inte

rdai

ly s

tabi

lity,

intr

adai

lyva

riab

ility

, rel

ativ

e am

plitu

de

NS

/ NS

Non

-par

amet

ric

vari

able

s,es

peci

ally

inte

rdai

ly s

tabi

lity

and

24-h

aut

ocor

rela

tion

are

mor

e se

nsiti

ve to

cir

cadi

andi

stur

banc

e at

res

t-ac

tivity

rhyt

hm th

an p

aram

etri

c an

aly-

ses

such

as

cosi

nor

Whi

te (

130)

4C-b

DB

; ran

dom

ized

; cro

ss-o

ver

desi

gn /

hom

e / E

ntir

e 24

hs

85 (

75)

/ 57.

8±9.

1 / S

tage

I o

rII

hyp

erte

nsio

n N

one

/ MM

L(A

MI)

/ w

rist

/N

S / N

S / C

ole

et. a

l.

AC

T: s

leep

vs.

W;

Am

bula

tory

BP,

HR

II

hyp

erte

nsio

n, s

ysto

lic B

P>

200,

dia

stol

ic B

P>

110

,B

rady

card

ia, T

achy

card

ia,

Rec

ent s

trok

e or

MI,

ren

al o

rhe

patic

dis

; unc

ontr

olle

d di

a-be

tic /

NS

/ NS

Mor

n. &

eve

n. T

imes

of

adm

inis

trat

ion

of n

isol

dipi

ne(a

long

-act

ing

dihy

drop

yri-

dine

Ca+

+ c

hann

el b

lock

er)

have

sim

ilar

effe

cts

on 2

4 hr

BP

and

HR

. How

ever

, com

-pa

riso

n of

sle

ep &

Wpe

riod

sre

veal

ed d

iffe

rent

ial B

Pan

dH

R e

ffec

ts f

or m

orn.

Vs.

even

. dos

ing

AC

Tw

as u

sed

to d

eter

min

esl

eep

& W

times

by

the

built

-in

alg

orith

m o

f th

e A

MI

reco

rder

or

by u

se o

f an

eve

ntm

arke

r bu

ilt o

n ac

tivat

ed b

y a

pt w

hen

retir

ing

or a

wak

enin

g

Wir

z-Ju

stic

e (8

1)

5D-a

Obs

erva

tiona

l stu

dy, C

ase

seri

es /

Hos

pita

l or

Hom

e /

Ent

ire

24-h

s; 3

-7 w

k A

CT

7 (N

S) /

50.0

±6.

5 (3

8-57

) /

Schi

zoph

reni

a N

one

/ Gah

wile

r / n

on-d

omw

rist

/ 1

min

/ N

S / p

eri-

odog

ram

Vis

ual i

nspe

ctio

n of

act

ivity

plot

, “be

st ta

u,”

(cir

cadi

anpe

riod

), “

best

om

ega”

(ci

rca-

dian

am

plitu

de)

sing

le-d

rug

ther

apy

for

schi

z-op

hren

ia f

or a

t lea

st 1

yr,

com

plia

nt w

ith a

ctig

raph

y /

NS

/ sm

all s

ampl

e si

ze, T

xno

t ran

dom

ly a

ssig

ned,

no

plac

ebo

Four

pat

ient

s ta

king

cla

ssic

alne

urol

eptic

s ha

d di

stur

bed

circ

adia

n rh

ythm

s, th

ree

tak-

ing

cloz

apin

e ha

d hi

ghly

reg

-ul

ar r

hyth

ms

Cit

atio

n - A

utho

r/

Evi

denc

e L

evel

St

udy

Cri

teri

a D

esig

n /

Loc

atio

n / P

roto

col

Sam

ple

Size

(C

ompl

eted

Stud

y) /

Mea

n A

ge (

Ran

ge)

/M

edic

al C

ondi

tion

s

Com

pari

son

Mea

sure

s /

Act

igra

ph a

ppar

atus

/P

lace

men

t / E

poch

Len

gth

/Se

nsit

ivit

y / S

cori

ng

Out

com

e M

easu

res

Incl

usio

n / E

xclu

sion

/ B

ias

Stud

y C

oncl

usio

n fr

ompa

per

Com

men

ts f

rom

Rev

iew

er


You

ngst

edt (

43)

1A

RC

T, u

nblin

ded

para

llel

desi

gn/ H

ome

/ E

ntir

e 24

-h,

Hom

e: 5

-7 D

AC

T, li

ght m

on-

itori

ng, a

nd lo

g, 2

x 2

4-h

mel

urin

e 6-

SMT;

lab:

30

H u

rine

6-sm

t, 5

D P

SG u

nder

ran

-do

mly

ass

igne

d lig

htin

g co

n-di

tions

Grp

1 72

(72

), G

rp2

30 (

30)

/G

rp1

68.0

±4.

3 (6

0-79

), G

rp2

NS

(20-

40)

/ Grp

1 el

derl

y w

/in

som

nia

or d

epre

ssio

n, G

rp2

youn

g no

rmal

Log

, mel

(6-

SMT

) / A

ctill

ume

(AM

I) /

wri

st /

NS

/ NS

/ Jea

nL

ouis

200

1

Log

; PSG

: SO

L, T

ST, W

ASO

,A

HI,

myo

clon

us in

dex;

AC

T:

SOL

, TST

, WA

SO, B

T, W

times

, mid

-sle

ep ti

me;

Beh

avio

ral:

Inso

mni

a se

lf-r

at-

ing,

SB

J sl

eep;

Moo

d:D

epre

ssio

n C

ES-

D; O

ther

:ill

umin

atio

n ac

roph

ase

and

illum

inat

ion

mea

n 4

h be

fore

BT,

4 h

aft

er a

risi

ng

You

ng: h

ealth

y go

od s

leep

ers,

elde

rly:

inso

mni

a or

dep

res-

sion

/ ap

nea,

acu

te h

ealth

prob

lem

s, h

igh

use

of m

eds

that

aff

ecte

d m

el /

Res

ults

for

elde

rly

w/ i

nsom

nia

orde

pres

sion

may

not

be

sam

eas

for

gen

eral

eld

erly

pop

ula-

tion

Eld

erly

w/ i

nsom

nia

orde

pres

sion

had

poo

rer

syn-

chro

niza

tion

betw

een

mel

and

slee

p (b

oth

hom

e A

CT

and

lab

PSG

), e

arlie

r se

lf-s

elec

ted

slee

p tim

es (

only

mea

sure

d at

hom

e w

/ AC

T, c

orre

late

d w

/ea

rlie

r m

el a

crop

hase

), lo

wer

TST

and

high

er W

ASO

(bo

thho

me

AC

Tan

d la

b PS

G)

Cir

cadi

an m

alsy

nchr

oniz

atio

nco

rrel

ated

w/ p

oore

r sl

eep

inla

b.

Dir

ectly

com

pare

d A

CT

tom

el r

efer

ence

sta

ndar

d fo

r C

R(e

vide

nce

leve

l 1A

); in

dire

ct-

ly c

ompa

red

AC

Tto

PSG

(lev

el 3

C).

Hom

e A

CT

phas

eva

lidat

ed b

y ag

reem

ent w

/m

el p

hase

. Hom

e A

CT

slee

pre

sults

gen

eral

ly a

gree

d w

/la

b PS

G r

esul

ts, e

xcep

t on

SOL

.

Yoo

n (1

02)

4C-b

RC

T, u

nblin

ded,

cro

ss-o

ver

desi

gn /

wor

kpla

ce /

Diu

rnal

;4N

t nig

ht w

ork,

Tx

duri

ng N

t1,

2,3;

$ D

AC

Tdu

ring

day

slee

p pe

rfor

man

ce te

sts

N 1

,3,

and

4; 4

Nt a

lert

ness

rat

ings

;re

peat

ed f

or e

ach

of 3

trea

t-m

ents

, 1 m

o ap

art:

1. R

oom

light

, 2. B

righ

t lig

ht, 3

. Bri

ght

light

and

a.m

. sun

glas

ses

12 (

NS)

/ (2

1-24

) / n

orm

alsh

ift w

orke

rs

Non

e / M

ML

/ lef

t wri

st /

NS

/ NS

/ Act

ion3

A

CT

: SP

time,

SL

, TST

, SE

;B

ehav

iora

l: B

ackw

ard

Mas

king

Tes

t, D

igit

sym

bol

subs

titut

ion

test

; Ale

rtne

ssV

AS

Shif

t wor

k nu

rses

/ N

S / v

ol-

unte

ers

not b

lind

to d

iffe

r-en

ces

betw

een

3 T

x

Day

sle

ep a

nd a

lert

ness

dur

-in

g N

t wor

k im

prov

ed m

ost

by b

righ

t lig

ht p

lus

a.m

. sun

-gl

asse

s, f

ollo

wed

by

brig

htlig

ht a

lone

. No

effe

ct o

n pe

r-fo

rman

ce.

AC

Tid

entif

ied

slee

p sh

owed

sign

ific

ant e

ffec

t of

circ

adia

nrh

ythm

Tx;

AC

Tre

sults

in D

slee

p ag

reed

w/ S

BJ

aler

tnes

sre

sult

in N

t wor

k.


Ale

ssi (

162)

4C-b

RC

T, u

nblin

ded,

par

alle

lde

sign

/ N

H /

Noc

turn

al o

nly

for

13 h

s; 2

Nt A

CT

BL

, 2N

tA

CT

fina

l wk

inte

rven

tion

65 (

65)

/ Grp

1 84

.4±

7.2,

Grp

285

.1±

7.6

/ Inc

ontin

ence

N

one

/ 1C

Sen

sors

/ do

mw

rist

/ 2

min

s / N

S / N

S A

CT

: TST

, % s

leep

, dur

of

slee

p ep

isod

es, l

onge

st s

leep

epis

odes

In p

hysi

cal r

estr

aint

s, in

cont

i-ne

nt /

Com

a, in

abili

ty to

resp

ond,

com

bativ

enes

s, te

r-m

inal

illn

ess

/ Onl

y pt

s w

/in

cont

inen

ce o

r in

phy

sica

lre

stra

ints

No

impr

ovem

ent i

n sl

eep

asso

ciat

ed w

/ im

prov

ed p

hys-

ical

fun

ctio

n

Can

’t g

ener

aliz

e to

oth

er N

Hpo

pula

tions

Cit

atio

n - A

utho

r/

Evi

denc

e L

evel

St

udy

Cri

teri

a D

esig

n /

Loc

atio

n / P

roto

col

Sam

ple

Size

(C

ompl

eted

Stud

y) /

Mea

n A

ge (

Ran

ge)

/M

edic

al C

ondi

tion

s

Com

pari

son

Mea

sure

s /

Act

igra

ph a

ppar

atus

/P

lace

men

t / E

poch

Len

gth

/Se

nsit

ivit

y / S

cori

ng

Out

com

e M

easu

res

Incl

usio

n / E

xclu

sion

/ B

ias

Stud

y C

oncl

usio

n fr

ompa

per

Com

men

ts f

rom

Rev

iew

er

Tabl

e 5—

Evi

denc

e le

vels

for

oth

er c

linic

al s

tudi

es

Ale

ssi (

163)

5D-b

Obs

erva

tiona

l stu

dy /

NH

/N

octu

rnal

onl

y fo

r 13

hs;

2N

tA

CT

186

(176

) / G

rp1

86.2

±7.

1,G

rp2

86.1

±9.

1 / I

ncon

tinen

ce

Non

e / N

S / d

om w

rist

/ 2

min

s / N

S / N

S A

CT

: TST

, % s

leep

, mea

n du

rsl

eep

epis

odes

, pea

k du

rep

isod

es

Inco

ntin

ence

/ C

omat

ose,

unab

le to

res

pond

, com

bativ

e/ O

nly

inco

ntin

ent p

ts

Pts

on m

eds

had

high

erm

eans

for

sle

ep b

ut n

ot s

ig-

nifi

cant

AC

Tus

ed ju

st a

t nig

ht; o

bser

-va

tions

of

slee

p us

ed d

urin

gth

e D

Ale

ssi (

164)

4C-b

RC

T; u

nblin

ded;

par

alle

lde

sign

/ N

H /

Noc

turn

al o

nly

for

12 h

s; 5

Nt A

CT

BL

, 5D

Obs

erva

tions

BL

, 5N

t AC

Tf/

u, 5

D O

bser

vatio

n f/

u;In

terv

entio

n: p

hysi

cal a

ctiv

itydu

ring

D a

nd e

xtra

qui

te a

ndda

rk a

t nig

ht w

/ dec

reas

edin

terr

uptio

ns to

cha

nge

dia-

pers

29 (

NS)

/ G

rp1

88.

6±10

.4,

Grp

2 8

8.3±

5.7

/ Inc

ontin

ence

O

bser

vatio

n / N

S / D

om w

rist

/ 2 m

ins

/ NS

/ NS

AC

T: %

sle

ep, m

ax d

ur o

fsl

eep

epis

ode,

mea

n du

rsl

eep

epis

ode

Inco

ntin

ence

/ C

oma,

sev

ere

aggr

essi

on s

tay

< 3

mos

/ A

llsu

bjec

ts in

cont

inen

t; le

ads

toqu

estio

n of

gen

eral

izab

ility

In s

ubsa

mpl

e of

10

subj

ects

,va

lidat

ed A

CT

w/ o

bser

va-

tions

: 92%

agr

eem

ent.

At f

/u,

inte

rven

tion

Grp

had

↑%

of

slee

p

In s

ubsa

mpl

e of

10

subj

ects

,va

lidat

ed A

CT

w/ o

bser

va-

tions

: 92%

agr

eem

ent

Anc

oli-

Isra

el (

112)

4C-b

Unb

linde

d, n

onra

ndom

ized

,ob

serv

atio

nal s

tudy

/ N

H /

Ent

ire

24-h

s; 3

D A

CT

NS

(77)

/ G

rp1

85±

7.9

(60-

100)

Grp

2 87

±5.

6 (7

4-96

) /

NH

res

iden

ts

Non

e / A

ctill

ume

/ wri

st /

1m

in / ≥

.003

g / C

ole,

Kri

pke

et a

l 199

2

AC

T: t

otal

min

s sl

eep,

%sl

eep,

tota

l min

s aw

ake,

%aw

ake,

num

aw

aken

ings

,le

ngth

of

each

aw

aken

ing,

mes

or, a

crop

hase

, am

plitu

de,

circ

adia

n qu

otie

nt; M

ood:

Ger

iatr

ic D

epre

ssio

n Sc

ale;

Oth

ers:

MM

SE

NS

/ NS

/ Sub

ject

sel

ectio

ncr

iteri

a N

S SD

G s

lept

mor

e du

ring

Nt

and

D th

an M

MN

DG

; SD

Gha

d lo

wer

act

ivity

mes

or,

mor

e bl

unte

d am

plitu

de, a

ndw

ere

mor

e ph

ase-

dela

yed

than

MM

ND

G

Anc

oli I

srae

l (15

9)

5D-b

Unb

linde

d, n

onra

ndom

ized

,ob

serv

atio

nal s

tudy

/ N

H /

Ent

ire

24-h

s; 1

D A

CT

25 (

25)

/ M 8

9.0±

4.2,

F 8

6.5±

6.2

/ NH

res

iden

ts

Non

e / A

ctill

ume

/ wri

st /

NS

/ ≥.0

03g

/ Am

bula

tory

Mon

itori

ng (

Act

illum

e) s

oft-

war

e

AC

T: m

ins

awak

e, m

ins

asle

ep, %

tim

e aw

ake,

% ti

me

asle

ep, m

ean

leng

th o

f aw

ak-

enin

gs, m

ean

lux

expo

sure

Nur

sing

hom

e re

side

nts

/ NS

/lo

w s

ampl

e si

ze, s

ubje

ctse

lect

ion

crite

ria

NS

Min

utes

aw

ake:

555

D, 3

96N

t;M

inut

es a

slee

p: 1

30D

, 325

Nt;

%T

ime

awak

e: 8

1%D

,56

%N

t; %

tim

e as

leep

:19

%D

, 44%

Nt;

num

of

tran

si-

tions

fro

m w

ake

to s

leep

:22

D, 3

7Nt;

Mea

n le

ngth

of

awak

enin

g (m

ins)

: 33D

,10

Nt;

Mea

n lu

x: 6

3D, 2

Nt

Bak

er (

191)

4C-b

Unb

linde

d; n

onra

ndom

ized

;ob

serv

atio

nal s

tudy

; cas

e-co

n-tr

ol s

tudy

/ H

ome

/ Ent

ire

24-

hs; A

CT

1 w

k

NS

(28)

/ 46

.8 (

40-5

5) /

Men

opau

se

Que

stio

nnai

re; l

og /

Gae

hwile

r / n

dom

wri

st /

30se

c / N

S / r

ef to

old

er p

aper

,bu

t no

deta

ils

log;

AC

T: a

rous

al/n

on-a

rous

-al

; Moo

d: P

OM

S, S

TAI

NS

/ OSA

, PL

MS

/ Pos

sibl

ese

lect

ion

bias

, unc

lear

cau

seno

t wel

l des

crib

ed

Men

opau

se p

ts h

ad m

ore

arou

sals

& g

reat

er s

leep

dis

-ru

ptio

n

Rat

her

than

res

t or

slee

p,ca

lled

vari

able

“ar

ousa

l”

Ber

ger

(151

)

4C-b

Unb

linde

d; n

onra

ndom

ized

;ob

serv

atio

nal s

tudy

; pro

spec

-tiv

e, d

escr

iptiv

e re

peat

edm

easu

re /

Hom

e / E

ntir

e 24

-hs

; AC

T96

hs c

hem

o 1,

AC

T72

hs m

idpt

che

mo

cycl

e,re

peat

ed f

or 3

cyc

les

ofch

emo

72 (

60)

/ 49.

5 (3

0-69

) / B

reas

tC

ance

r N

one

/ NS

/ ndo

m /

NS

/ NS

/N

S A

CT

: mes

or, a

mpl

itude

, num

wak

es; O

ther

: Pip

er F

atig

ueSc

ale

NS

/ NS

/ NS

Fatig

ue h

ighe

r du

ring

che

mo;

fatig

ue n

egat

ivel

y co

rrel

ated

w/ a

ctiv

ity

No

norm

al c

ontr

ols

for

com

-pa

riso

n

Ber

ger

(148

)

4C-b

Unb

linde

d, n

onra

ndom

ized

,ob

serv

atio

nal s

tudy

, coh

ort

stud

y, lo

ngitu

dina

l stu

dy,

repe

ated

mea

sure

s / H

ome

/E

ntir

e 24

-hs;

AC

Tpe

rfor

med

6 tim

es, 4

D A

CT

at b

egin

ning

of c

hem

o fo

r 3

cycl

es, 3

DA

CT

at m

idpt

bet

wee

n ch

emo

for

3 cy

cles

72 (

60)

(30-

47)

/ 49

.5±

8.64

(33-

69)

/ Nor

mal

, Bre

ast c

an-

cer

pts

Que

stio

nnai

re -

Fat

igue

/M

ML

/ nd

om h

and

/ 5

sec

ever

y m

in /

NS

/ Act

ion3

(AM

I)

AC

T: m

esor

, am

plitu

de, p

eak

activ

ity, n

ight

time

awak

en-

ings

; Rev

ised

Pip

er F

atig

ueSc

ale

(to

mea

sure

can

cer-

rela

ted

fatig

ue)

Stag

e I

or I

I br

east

can

cer,

sche

dule

d to

beg

inch

emot

hera

py a

fter

bre

ast

surg

ery,

Eng

lish-

spea

king

,K

arno

fsky

sco

re ≥

60 /

NS

/N

S D

rop-

outs

had

mos

tse

vere

sym

ptom

s

The

num

of

nigh

ttim

e aw

ak-

enin

gs h

ad th

e st

rong

est

asso

c. w

/ can

cer-

rela

ted

fatig

ue. S

ubje

cts

w/ h

ighe

rfa

tigue

had

low

er a

mpl

itude

& lo

wer

pea

k ac

tivity

Did

not

look

at s

tand

ard

mea

sure

s of

sle

ep

Cit

atio

n - A

utho

r/

Evi

denc

e L

evel

St

udy

Cri

teri

a D

esig

n /

Loc

atio

n / P

roto

col

Sam

ple

Size

(C

ompl

eted

Stud

y) /

Mea

n A

ge (

Ran

ge)

/M

edic

al C

ondi

tion

s

Com

pari

son

Mea

sure

s /

Act

igra

ph a

ppar

atus

/P

lace

men

t / E

poch

Len

gth

/Se

nsit

ivit

y / S

cori

ng

Out

com

e M

easu

res

Incl

usio

n / E

xclu

sion

/ B

ias

Stud

y C

oncl

usio

n fr

ompa

per

Com

men

ts f

rom

Rev

iew

er


Cor

doba

(15

4)

4C-b

Unb

linde

d, n

onra

ndom

ized

,ob

serv

atio

nal s

tudy

, cas

e-co

n-tr

ol s

tudy

/ H

ome

/ Ent

ire

24-

hs; A

CT

5D, M

-F (

no w

eek-

ends

)

NS

(40)

/ G

rp1

51 (

37-6

9),

Grp

2 50

(N

S), G

rp3

52±

2,G

rp4

52±

2 / C

irrh

osis

Que

stio

nnai

re /

Act

illum

e /

Wri

st /

1 m

in s

ampl

ed 2

0 se

c/ N

S / A

ctio

n 3

AC

T: T

IB, S

E, n

um w

akes

,W

ASO

N

S / S

hift

wor

k, a

lcoh

ol /

Low

sam

ple

in th

e su

b-gr

oup

of A

CT

pts

Com

pare

d to

nor

mal

s: m

otor

activ

ity ↓

in p

ts, f

ragm

ente

dsl

eep ↑

in p

ts,

rhyt

hm d

amp-

ened

in p

ts

Cor

kum

(16

7)

5D-b

Unb

linde

d, n

onra

ndom

ized

,ob

serv

atio

nal s

tudy

/ H

ome

/E

ntir

e 24

-hs;

7D

AC

T

50 (

50)

/ Grp

1 9.

1±1.

4 (

7-11

), G

rp2

9.7±

1.3

(7-1

1) /

Grp

1 A

DH

D, G

rp2

Nor

mal

cont

rols

Chi

ld S

leep

Que

stio

nnai

re-

Pare

nt v

ersi

on (

CSQ

-P);

log

com

plet

ed b

y pa

rent

/ M

ML

/nd

om w

rist

/ N

S /

>.0

1g /

Act

ionW

2

log;

AC

T: t

otal

sle

ep d

ur,

SOn,

num

Nt a

wak

enin

gs,

rest

less

ness

; CSQ

-P: S

On

dif-

ficu

lties

, Nt w

akin

g, d

iffi

cul-

ties

aris

ing,

res

tless

ness

, BT

resi

stan

ce

NS

/ ver

bal I

Q &

per

form

-an

ce I

Q<

80, b

rain

inju

ry, p

er-

vasi

ve d

evel

opm

enta

l dis

or-

der,

autis

m, p

sych

osis

, PT

SD,

prim

ary

diso

rder

of

anxi

ety

oraf

fect

/ N

S

CSQ

P: A

DH

D G

rp h

adlo

nger

sle

ep d

urs,

mor

e di

ffi-

culty

w/ S

On;

mor

e A

DH

Dsu

bjec

ts w

ere

“res

tless

sle

ep-

ers”

had

mor

e B

Tre

sist

ance

;A

CT

: no

stat

istic

ally

sig

nifi

-ca

nt d

iffe

renc

es b

etw

een

the

two

Grp

s; lo

g: A

DH

D G

rpha

d lo

nger

sle

ep d

ur &

mor

eB

Tre

sist

ance

AC

Tre

sults

wer

e no

t com

-pa

red

to C

SQ-P

or lo

g fi

nd-

ings

Cru

ise

(165

)

4C-b

Obs

erva

tiona

l, pr

ospe

ctiv

est

udy

/ NS

/ Noc

turn

al o

nly

for

10 h

s; 2

Nt (

non-

cons

ecu-

tive)

276

(225

) / 8

4.9±

9.8

/In

cont

inen

ce

NS

/ NS

/ wri

st /

2 m

ins

/ NS

/ NS

AC

T: T

ST, %

sle

ep, p

eak

slee

p, m

ean

dur;

bod

y m

ove-

men

t

>65

yrs

, inc

ontin

ence

, no

indw

ellin

g ca

thet

er /

NS

/ Non

e 42

% o

f w

akin

g ep

isod

es w

ere

asso

ciat

ed w

/ noi

se, l

ight

or

inco

ntin

ence

car

e

Dag

an (

192)

4C-b

Unb

lend

ed, n

onra

ndom

ized

,ob

serv

atio

nal s

tudy

/hom

e /

noct

urna

l onl

y fo

r N

S h.

3 N

tA

CT

24 (

24)

/ Grp

1 M

, 12;

Grp

2M

, 12

/ Grp

1, 1

9.6

(6

-12,

SD

= 1

.6)

Grp

2, 7

.9(6

-9.6

, SD

= 1

.2)

/ Grp

1 =

AD

HD

Que

stio

nnai

re (

pare

nt)

/A

ctig

raph

– A

MI

/ han

d / N

S/ N

S / a

utom

atic

sco

ring

anal

ysis

pro

gram

(C

AM

I)

AC

T; S

E, A

ctiv

ity le

vel,

‘qui

et’s

leep

per

cent

age,

SON

, Sdu

r; O

ther

s: S

/Wqu

estio

nnai

re v

aria

bles

NS

Incl

usio

n: G

rp 1

=A

DH

D.

Grp

2, h

ealth

y ch

ildre

n /

smal

l sam

ple

size

. Con

trol

ssi

gnif

ican

tly y

oung

er th

anca

ses

AD

HS

child

ren

had

low

erSC

, hig

her

activ

ity le

vel,

and

low

er ‘

quie

t’sl

eep

perc

enta

geth

an c

ontr

ols.

No

diff

eren

ces

betw

een

grou

ps o

n su

bjec

tive

pare

ntal

rep

orts

of

slee

p.

Subj

ectiv

e pa

rent

al r

epor

ts o

fsl

eep

not c

ompa

red

to A

CT

Dau

rat (

97)

4C-b

Con

trol

led

clin

ical

tria

l; D

B /

Hot

el r

oom

s se

t up

as la

b /

Ent

ire

24-h

s; 6

D A

CT

BL

, 1D

tem

p B

L, f

light

, 6D

AC

Tpo

stfl

ight

, 1+

1D te

mp

post

flig

ht,

Zop

iclo

ne o

r Pl

aceb

o be

fore

bed

Nts

1-4

pos

t flig

ht

36 (

24)

/ 51.

2±2.

2 / N

orm

al

Tem

p (n

=19

) / A

ctiw

atch

/nd

om w

rist

/ 1

min

/ N

S /

Act

isom

(P.

Den

ise,

Fra

nce)

–sle

ep v

isua

lly s

core

d, c

osi-

nor

for

phas

e

Tem

p; A

CT

: sle

ep d

ur, a

ctiv

i-ty

inde

x, A

CT

acro

phas

e &

ampl

itude

; Moo

d: V

AS

“moo

d”; J

et la

g Sx

VA

S“t

ired

”, “

ill-b

eing

”, “

dige

s-tiv

e”, “

ener

gy”

Hea

lthy,

no

med

s x3

mos

, no

time

zone

trav

el /

Cor

e te

mp

not u

nmas

ked

Zop

iclo

ne im

prov

es A

CT

iden

tifie

d sl

eep

afte

r tr

ans-

mer

idia

n tr

avel

F(1

,22)

=6.

3,p<

.05;

The

gre

ater

the

dysy

n-ch

roni

zatio

n of

CR

s po

st-

flig

ht th

e sh

orte

r th

e sl

eep

dur.

Zop

iclo

ne d

id n

otim

prov

e SB

J je

t lag

AC

Tde

tect

ed b

oth

circ

adia

nsh

ift a

nd s

leep

dis

turb

ance

Din

ges

(193

)

5D-b

Con

trol

led

clin

ical

tria

l,un

blin

ded,

non

rand

omiz

ed,

subj

ects

ser

ved

as th

eir

own

cont

rols

/ L

abor

ator

y (i

n th

eU

niv.

Gen

. Clin

. Res

. Ctr

) /

Ent

ire

24-h

s; 1

0-12

D A

CT

cons

ecut

ive

(2D

BL

, 7-8

Dsl

eep

rest

rict

ion,

1-2

D r

ecov

-er

y sl

eep)

20 (

16)

/ 22.

9 (N

S) /

Nor

mal

M

SLT

on D

2 o

f B

L&

D 5

of

slee

p re

stri

ctio

n; S

SS; l

og w

/V

AS

of S

Q a

nd s

ever

al o

ther

mea

sure

s; O

bser

vatio

n by

othe

rs (

none

wer

e co

mpa

red

to A

CT

) / N

S / w

rist

/ N

S /

NS

/ NS

log;

AC

T; M

ood:

PO

MS;

PVT,

PR

MT

NS

/ PSG

scr

eeni

ng to

ens

ure

they

had

no

slee

p di

sord

ers,

MSL

Tto

ens

ure

thei

r da

ytim

esl

eep

prop

ensi

ties

wer

ebe

twee

n 8

& 2

0 m

ins

/ low

sam

ple

size

AC

Tda

ta n

ot s

peci

fica

llyre

port

ed.

Agr

eem

ent b

etw

een

AC

T&

oth

er s

leep

mea

sure

sw

as N

S.

No

spec

ific

AC

Tda

ta r

epor

t-ed

.

Duk

a (1

39)

5D-a

Con

trol

led

clin

ical

tria

l, D

B,

nonr

ando

miz

ed, c

ross

-ove

rde

sign

, pla

cebo

-con

trol

led

/L

abor

ator

y / N

octu

rnal

onl

yfo

r N

S h;

2N

t AC

T(1

Nt A

CT

plac

ebo,

14D

was

hout

, 1N

tA

CT

Tx

or 1

Nt A

CT

Tx,

14D

was

hout

, 1N

t AC

Tpl

aceb

o)

8 (8

) / 2

7.1±

0.5

(21-

34)

/H

ealth

y

PSG

(N

ihon

-Koh

den

17-

chan

nel,

EE

G, E

OG

, EM

G);

Tem

p (r

ecta

l); V

AS

/A

ctom

eter

ZA

K-G

MB

H /

dom

wri

st /

2 m

ins

/ >

.1G

End

ocri

ne m

easu

res-

plas

ma

prol

actin

, GH

cor

tisol

, AC

T:

freq

uenc

y of

mov

emen

t,in

tens

ity o

f m

ovem

ent;

VA

S

NS

/ Ext

rem

e m

orni

ng &

even

ing

type

s, n

o ac

ute

orch

roni

c ill

ness

es, n

o m

eds

for

4wks

, no

h/o

slee

p di

stur

-ba

nces

, no

benz

odia

zepi

nes

/L

ow s

ampl

e si

ze

B-c

arbo

line

ZK

934

26 (

ben-

zodi

azep

ine

anta

goni

st w

/w

eak

inve

rse

agon

ist a

ctiv

ity)

indu

ces

activ

atio

n m

easu

red

by A

CT

& d

istu

rbs

slee

pm

easu

red

by P

SG

AC

Tw

as n

ot c

ompa

red

to th

eot

her

slee

p m

easu

res

Cit

atio

n - A

utho

r/

Evi

denc

e L

evel

St

udy

Cri

teri

a D

esig

n /

Loc

atio

n / P

roto

col

Sam

ple

Size

(C

ompl

eted

Stud

y) /

Mea

n A

ge (

Ran

ge)

/M

edic

al C

ondi

tion

s

Com

pari

son

Mea

sure

s /

Act

igra

ph a

ppar

atus

/P

lace

men

t / E

poch

Len

gth

/Se

nsit

ivit

y / S

cori

ng

Out

com

e M

easu

res

Incl

usio

n / E

xclu

sion

/ B

ias

Stud

y C

oncl

usio

n fr

ompa

per

Com

men

ts f

rom

Rev

iew

er


Dur

sun

(152

)

5D-a

Unb

linde

d, n

onra

ndom

ized

,ob

serv

atio

nal s

tudy

/ H

ome

/N

octu

rnal

onl

y fo

r N

S h;

5N

tA

CT

24 (

24)

/ Grp

1 36

.1±

9.2,

Grp

235

.1±

11.5

, Grp

3 33

.8±

11.6

/G

rp1:

sch

izop

hren

ia o

nri

sper

idon

e; G

rp2:

sch

izo-

phre

nia

on a

“ty

pica

l”an

tipsy

chot

ic (

not r

ispe

ri-

done

); G

rp3:

nor

mal

con

trol

;G

rps1

&2:

DSM

IV

Dx

ofsc

hizo

phre

nia

for

at le

ast 2

yrs.

VA

S /A

ctig

raph

/ R

t wri

st /

NS

/ NS

/ Act

plan

and

Act

stat

soft

war

e (S

witz

erla

nd)

AC

T: m

ovem

ent i

ndex

(M

I)=

tota

l num

of

poin

ts w

/ mov

e-m

ent ÷

tota

l num

of

poin

tsre

cord

ed; V

AS

ratin

g of

SQ

and

mor

ning

sle

epin

ess

NS

/ Rxs

that

aff

ect 5

-HT

conc

entr

atio

ns; c

hron

ic a

lco-

holis

m; C

NS

infe

ctio

ns; c

an-

cer;

med

ical

dis

orde

r th

atca

uses

sle

ep a

bnor

mal

ity /

low

sam

ple

size

; not

ran

dom

-iz

ed

Nig

httim

e M

I in

Grp

2 >

Grp

1bu

t no

sign

ific

ant d

iffe

renc

esbe

twee

n G

rps1

& 2

in V

AS

scor

es

VA

S re

sults

not

dir

ectly

com

-pa

red

to A

CT

Fren

ch (

140)

4C-b

Unb

linde

d, n

onra

ndom

ized

,ob

serv

atio

nal s

tudy

/ H

igh

fide

lity

wea

pons

sys

tem

str

aine

rs (

flig

ht s

imul

ator

s) /

Ent

ire

24 h

s; 1

2D A

CT

NS

(32)

/ N

S / N

orm

al

Non

e / N

S / w

rist

/ N

S / N

S /

Wal

ter

Ree

d A

lgor

ithm

(Gen

eral

Act

ivity

Pro

gram

)

Mel

aton

in: S

aliv

ary;

End

ocri

ne: S

aliv

ary

cort

isol

;M

ood:

PO

MS;

bod

y pa

in s

ur-

vey;

cog

nitiv

e pe

rfor

man

cete

st b

atte

ry, a

ctiv

ity lo

g, 2

-m

ins

elec

trop

hysi

olog

icm

easu

re, 3

0-S

voic

e re

cord

,or

al te

mp,

fat

igue

sco

re

Ope

ratio

nally

qua

lifie

d cr

ewm

embe

rs p

artic

ipat

ing

in s

im-

ulat

ed, l

ong

dur

bom

ber

mis

-si

ons

/ NS

/ NS

Cre

ws

had

less

sle

ep d

urin

gm

issi

on 1

, com

pare

d to

mis

-si

ons

2 &

3. R

ecov

ered

nor

-m

al s

leep

dur

w/in

48

hs a

fter

mis

sion

3. L

east

res

tful

sle

epaf

ter

mis

sion

1.

Frie

dman

(13

6)

2B

RC

T, S

B, p

aral

lel d

esig

n,A

CT

com

pare

d w

/ oth

er te

ch-

niqu

es in

a s

ubsa

mpl

e / N

S /

Ent

ire

24-h

s; 4

D A

CT

BL

, 4D

AC

TT

x, 4

D A

CT

f/u

39 (

35)

/ Grp

1 61

.9±

7.1,

Grp

265

.1±

8.6,

Grp

3 65

.1±

5.8

/In

som

nia,

Age

≥55

PSG

; MSL

T; S

SS; l

og; u

rine

sam

ples

to e

nsur

e no

sle

epm

ed u

se /

(AM

I) /

ndom

wri

st/ 3

0 se

c / N

S / A

CT

ION

1.3

2

Log

: TST

, TIB

, SE

, SL

,W

ASO

; PSG

: TIB

, TST

, SE

,SL

, WA

SO; A

CT

: TST

, SE

,SL

, WA

SO

NS

/ Acu

te u

nsta

ble

med

ical

or p

sych

iatr

ic il

lnes

s, c

hron

icill

ness

ass

ocia

ted

w/ i

nsom

-ni

a, s

peci

fic

slee

p di

sord

ersu

ch a

s sl

eep

apne

a, s

edat

ing

or s

timul

atin

g m

eds,

no

slee

pm

eds

for ≥3

wks

/ N

S

Few

bet

wee

n-G

rp d

iffe

renc

esin

Tx

effi

cacy

. A

CT

corr

elat

ed m

ore

high

lyth

an lo

g w

/ PSG

Frie

dman

(12

6)

4C-b

Unb

linde

d, n

onra

ndom

ized

,ob

serv

atio

nal s

tudy

, coh

ort

stud

y / H

ome

/ Ent

ire

24-h

s;6D

AC

T

101

(48)

/ 70

±6.

9 (5

6-88

) /

Alz

heim

er’s

dis

ease

(A

D)

byN

INC

DS-

AR

DR

DA

crite

ria

Non

e / A

ctig

raph

, Am

bula

tory

Mon

itori

ng I

nc /

wri

st /

30se

c / N

S /A

CT

ION

1.3

AC

T: T

ST, S

E, S

On,

WA

SO,

circ

adia

n ac

tivity

, (am

plitu

de,

acro

phas

e, m

esor

);B

ehav

iora

l: M

MSE

, Tim

eB

ased

Beh

avio

ral D

istu

rban

ceQ

uest

ionn

aire

, Alz

heim

er’s

Dis

ease

Ass

essm

ent S

cale

Part

icip

ants

in lo

ngitu

dina

lst

udy

of A

D /

NS

/ Non

-re

spon

se b

ias

- AC

Tda

ta in

only

48

“rec

ords

” fr

om s

am-

ple

of 1

01 s

ubje

cts

Sign

ific

ant c

orre

latio

nsbe

twee

n hi

gher

Tim

e B

ased

Beh

avio

ral D

istu

rban

ceQ

uest

ionn

aire

ove

rall

scor

e,SE

& W

ASO

. No

sign

ific

ant

corr

elat

ion

betw

een

circ

adia

nac

tivity

mea

sure

s an

d T

ime

Bas

ed B

ehav

iora

l Dis

turb

ance

Que

stio

nnai

re

Mea

sure

s of

poo

r sl

eep

byA

CT

corr

elat

ed w

/ mor

e ov

er-

all d

isru

ptiv

e be

havi

or in

AD

;bu

t not

w/ n

octu

rnal

dis

rup-

tive

beha

vior

Gar

fink

el (

135)

4C-b

RC

T, D

B,

cros

s-ov

er d

esig

n,pl

aceb

o-co

ntro

lled

/ Hom

e /

Noc

turn

al o

nly

for

NS

h; 3

Nt

AC

TB

L, 3

Nt A

CT

Tx,

1 w

kw

asho

ut, 3

Nt A

CT

Tx

NS

(12)

/ 76

±8

(68-

93)

/In

som

nia;

Ind

epen

dent

ly li

v-in

g ol

der

peop

le w

/ med

ical

cond

ition

s an

d w

/ oth

er m

eds.

Mel

/ So

mni

tor

(Neu

rim

Phar

mac

eutic

als,

Tel

Avi

v,Is

rael

) / w

rist

/ N

S / N

S /

“aut

omat

ic s

cori

ng a

lgor

ithm

”by

Col

e, K

ripk

e et

al

AC

T: S

L, S

E, T

ST, W

ASO

N

S / N

S / L

ow s

ampl

e si

ze

SE w

as s

igni

fica

ntly

gre

ater

afte

r w

/ mel

than

pla

cebo

and

WA

SO w

as s

hort

er w

/ mel

than

pla

cebo

Uri

ne 6

- su

lpha

toxy

-mel

mea

sure

d at

BL

only

Ger

tner

(17

1)

4C-b

Ran

dom

ized

, pro

spec

tive

/ou

t of

lab,

hos

pita

l bed

/ 72

h,

2 su

cces

sive

ses

sion

s

36 (

34)

/ M, 2

0, F

, 14,

( n

ew-

born

s) /

norm

al &

pre

mat

ure

infa

nts

Non

e / A

MI

min

atur

e ac

ti-gr

aphs

/ an

kle

/ NS

/NS

/Sa

deh

AC

T; %

qui

et s

leep

, act

ivity

leve

l, T

STN

S/N

S E

arly

bio

logi

cal m

atur

ityre

late

d to

chi

ld’s

dev

elop

men

-ta

l sta

tus.

Dec

reas

ed T

ST,

incr

ease

d ac

tivity

at n

ight

all

pred

ictiv

e of

hig

her

deve

lop-

men

tal s

core

s

Use

d in

pre

term

new

born

s

Glo

d (1

68)

4C-b

Unb

linde

d, n

onra

ndom

ized

,ob

serv

atio

nal s

tudy

, cas

e-co

n-tr

ol s

tudy

/ H

ome

/ Ent

ire

24-

hs; 3

D A

CT

NS

(44)

/ G

rp1

8.3±

1.9,

Grp

29.

4±2.

3, G

rp3

10.0

±1.

6 /

Grp

1 no

rmal

, Grp

2 ph

ysic

al&

or

sexu

al a

buse

, Grp

3m

ajor

dep

ress

ion

or d

ys-

thym

ia

Non

e / M

otio

n lo

gger

(A

MI)

/w

aist

w/ w

rist

in a

sub

sam

ple

/ 5 m

ins

/ Acc

eler

atio

ns >

.01g

/ Mac

tivity

, Act

ivity

Ana

lyze

AC

T: T

ST, S

E, S

On,

TIB

,W

ASO

, num

nig

httim

e aw

ak-

enin

gs; B

ehav

iora

l: C

hild

beha

vior

che

cklis

t; M

ood:

K-

SAD

S-E

(Sc

hedu

le f

orA

ffec

tive

Dis

orde

rs a

ndSc

hizo

phre

nia

for

Scho

ol-a

geC

hild

ren-

Epi

dem

iolo

gic

ver-

sion

)

NS

/ Grp

1 no

sig

nifi

cant

psy

-ch

opat

holo

gy /

NS

Con

trol

s vs

. dep

ress

ed c

hil-

dren

had

no

sign

ific

ant d

iffe

r-en

ces

in s

leep

par

amet

ers

byA

CT.

Phy

sica

l abu

seap

pear

ed to

be

the

fact

oras

soci

ated

w/ s

leep

dis

tur-

banc

e ra

ther

than

Pos

tT

raum

atic

Str

ess

Dis

orde

r.

Wai

st p

lace

men

t of

the

acti-

grap

hs

Cit

atio

n - A

utho

r/

Evi

denc

e L

evel

St

udy

Cri

teri

a D

esig

n /

Loc

atio

n / P

roto

col

Sam

ple

Size

(C

ompl

eted

Stud

y) /

Mea

n A

ge (

Ran

ge)

/M

edic

al C

ondi

tion

s

Com

pari

son

Mea

sure

s /

Act

igra

ph a

ppar

atus

/P

lace

men

t / E

poch

Len

gth

/Se

nsit

ivit

y / S

cori

ng

Out

com

e M

easu

res

Incl

usio

n / E

xclu

sion

/ B

ias

Stud

y C

oncl

usio

n fr

ompa

per

Com

men

ts f

rom

Rev

iew

er


Glo

d (1

94)

4C-b

Unb

lend

ed, r

ando

miz

ed, n

on-

rand

omiz

ed, o

bser

vatio

nal

stud

y, c

ase-

cont

rol s

tudy

/ho

me

or h

ospi

tal i

npat

ient

s /

entir

e 24

h, 3

D A

CT

(wee

kday

s)

NS

/ (22

) G

rp 1

M –

13,

F –

6; G

rp 2

, M –

9, F

-6 /

grp

1,9.

4 (S

D =

2.3

); G

rp 2

8.3

(S

D =

1.9

) /n

one,

Grp

1 =

phys

ical

ly a

nd o

r se

xual

lyab

used

; Grp

2, h

ealth

y co

n-tr

ols

Non

e / N

S / b

elt-

wor

n / N

S /

NS

/ NS

AC

T: d

iurn

al a

ctiv

ity, d

iurn

alsk

ew, %

low

-lev

el a

ctiv

ity,

mes

or, a

mpl

itude

, % r

elat

ive

ampl

itude

, acr

opha

se; M

ood,

sche

dule

for

Aff

ectiv

eD

isor

ders

and

Sch

izop

hren

iafo

r Sc

hool

-Age

Chi

ldre

n-E

pide

mio

logi

c V

ersi

on; C

hild

Beh

avio

r ch

eckl

ist

Incl

usio

n: m

edic

atio

n-fr

eean

d m

edic

ally

hea

lthy

(tw

o in

Grp

1 h

ad il

lnes

s) /

NS

/Pa

tient

sel

ectio

n (G

rp 1

mos

t-ly

in p

atie

nts,

Grp

2 o

utpa

-tie

nts)

Abu

sed

child

ren

wer

e 10

%m

ore

activ

e th

an n

orm

als

(p<

.05)

, and

had

few

per

iods

of lo

w-l

evel

day

time

activ

ity

(p<

.01)

. L

ater

age

of

abus

ew

as a

ssoc

iate

d w

ith c

irca

dian

dysr

egul

atio

n.

Hai

mov

(19

5)

4C-b

Con

trol

led

clin

ical

tria

l, D

B,

rand

omiz

ed, c

ross

-ove

rde

sign

/ ho

me

(33

sub

ject

s),

NH

(18

sub

ject

s) /

entir

e 24

h, 7

D A

CT;

7 D

AC

TT

x 1,

Tx

2, a

nd T

x 3:

7 D

AC

Tdu

r-in

g la

st w

eek

of T

x 4

(2 m

o);

7 D

AC

Tf/

u (G

rp 2

onl

y) T

x=

mel

aton

in (

2 m

g f

ast o

rsu

stai

ned

rele

ase

or 1

mg

sus-

tain

ed r

elea

se)

or p

lace

bo/

NS

(51)

/ G

rp 1

; M, 4

, F, 4

;G

rp 2

, M, 6

, F, 1

2; G

rp 3

, M,

19, F

, 6 /

Grp

1; 7

3.1

(SD

=3.

9); G

rp 2

; 81.

1 (S

D =

8.9)

Grp

3; 7

1.4

(SD

= 5

.2)

/ot

her:

Grp

1 in

depe

nden

tlyliv

ing

inso

mni

acs;

Grp

2,

inst

itutio

naliz

ed in

som

niac

s;G

rp 3

, ind

epen

dent

ly li

ving

elde

rly

w/o

sle

ep d

isor

ders

,go

od c

linic

al c

ondi

tion,

not

depr

esse

d, n

ot d

emen

ted

Que

stio

nnai

re, s

leep

log,

diar

y, m

elat

onin

/ N

S / w

rist

/N

S /N

S /S

adeh

, et a

l.

Slee

p di

ary,

log

, mel

aton

in,

AC

T; T

ST, S

E, S

L, m

ean

activ

ity le

vel d

urin

g sl

eep

Incl

usio

n: P

artic

ipan

ts in

prio

r st

udy

of m

el a

nd s

leep

,G

rp 1

and

Grp

2 h

ad lo

wer

peak

mel

sec

retio

n / N

S / N

S

Impr

oved

SE

and

act

ivity

leve

l dur

ing

slee

p w

ith a

2 m

gsu

stai

ned

rele

ase

mel

, and

impr

oved

SL

with

2 m

g fa

st-

rele

ase

mel

. Fu

rthe

r im

prov

e-m

ent a

fter

2 m

o 1

mg

sus-

tain

ed r

elea

se m

el.

Hat

onen

(11

7)

5D-b

SB, n

onra

ndom

ized

, com

par-

ativ

e T

x, p

lace

bo-c

ontr

olle

d /

Hom

e / E

ntir

e 24

-hs;

7D

AC

TB

L, 7

D A

CT

Tx

w/ p

lace

bo,

7D A

CT

Tx

w/ 2

.5m

g m

el,

7D A

CT

Tx

w/ 5

mg

mel

NS

(5)

/ 14.

6 (1

2-19

) /

Inso

mni

a, n

euro

nal c

eroi

dlip

ofus

cino

sis

(NC

L)

log

/ (A

MI)

/ w

rist

/ 1

min

/N

S / A

ctio

n 3.

15

log;

AC

T: n

orm

al v

s. f

rag-

men

ted

mot

or a

ctiv

ity r

hyth

m(p

erio

d an

alys

is b

y m

axen

trop

y sp

ectr

al, a

uto-

corr

ela-

tion

and

harm

onic

ana

lyse

s)

All

had

NC

L: /

NS

/ low

sam

-pl

e si

ze

2 su

bjec

ts h

ad a

bnor

mal

lyfr

agm

ente

d ac

tivity

rhy

thm

sdu

ring

BL

& p

lace

bo o

r m

eldi

dn’t

aff

ect r

est/a

ctiv

ityrh

ythm

s. I

n 3

subj

ects

fam

i-lie

s re

port

ed s

light

lyim

prov

ed S

Q w

/ mel

.

Ver

y lit

tle a

ctua

l dat

a re

port

-ed

.

Hin

dmar

ch (

141)

4C-b

RC

T, u

nblin

ded,

cro

ss-o

ver

desi

gn, e

ach

subj

ect a

cted

as

thei

r ow

n co

ntro

l / L

abor

ator

y-

Med

ical

Res

earc

h C

ente

r /

Ent

ire

24-h

s; 5

sep

arat

e te

stD

s of

AC

Tw

/ at l

east

6D

was

hout

per

iod

betw

een

test

Ds

NS

(30)

/ 27

.3±

0.7

(19-

36)

/H

ealth

y ha

bitu

al te

a &

cof

fee

drin

kers

LSE

Q /

AM

I AM

A-3

2M

otio

nlog

gers

(A

MI)

/ nd

omw

rist

/ 30

sec

/ N

S / S

tanl

ey19

97

AC

T: T

ST; C

ritic

al F

licke

rFu

sion

Tes

t; C

hoic

e R

eact

ion

time;

Lin

e A

nalo

gue

Rat

ing

Scal

e

Hea

lthy

nons

mok

ers

/ NS

/Su

bjec

ts w

ere

not b

linde

d to

the

drin

ks

Caf

fein

e ha

d do

se d

epen

dent

nega

tive

effe

ct o

n ge

tting

tosl

eep

and

qual

ity o

f sl

eep

byL

SEQ

and

dos

e-de

pend

ent

nega

tive

effe

ct o

n T

STby

AC

T

Hin

dmar

ch (

142)

4C-b

RC

T, D

B, c

ross

over

des

ign

/L

abor

ator

y -

Med

ical

Res

earc

h C

tr. /

Ent

ire

24-h

s;6D

AC

TT

x, W

asho

ut o

f 4D

or m

ore

betw

een

test

Ds

NS

(24)

/ 32

.6 (

19-5

8) /

Hea

lthy

norm

al v

olun

teer

s N

one

/ Am

bula

tory

Mon

itori

ng, I

nc /

ndom

wri

st/ N

S / N

S / A

CT

ION

3

AC

T: %

sle

ep, %

W; C

ritic

alFl

icke

r Fu

sion

Thr

esho

ld;

Cho

ice

Rea

ctio

n T

ime;

Lin

eA

nalo

gue

Rat

ing

Scal

es f

orSe

datio

n

NS

/ No

med

s ot

her

than

OC

P’s,

no

alco

hol,

nico

tine

orca

ffei

ne /

NS

Prom

etha

zine

(an

ant

ihis

ta-

min

e w

/ sed

atin

g si

de e

ffec

ts)

incr

ease

% s

leep

dur

ing

the

dayt

ime

and

acro

ss th

e st

udy

peri

od c

ompa

red

w/ f

exof

ena-

dine

, lor

atoa

dine

and

pla

cebo

.

Hum

phre

ys (

196)

5D-a

Obs

erva

tiona

l stu

dy /

wom

en’s

she

lter

/ int

ervi

ewan

d 2D

AC

T&

log

54 (

50)

NS

(NS)

/ ba

ttere

dw

omen

Sl

eep

log-

diar

y/m

ini-

mot

ion

logg

er /

wri

st /

30 s

ec /

NS

/A

ctio

n 3

Slee

p di

ary-

log

– be

havi

oral

;Pi

ttsbu

rgh

Slee

p Q

ualit

yIn

dex

fatig

ue, V

AS;

AC

T

NS/

NS/

NS

Bat

tere

d w

omen

exp

erie

nce

slee

p di

stur

banc

e an

d da

ytim

efa

tigue

AC

Tsl

eep

assu

med

to b

e tr

uesl

eep

Ito

(197

)

4C-b

Con

trol

led

clin

ical

tria

l,un

blen

ded,

non

rand

omiz

ed,

para

llel d

esig

n /

NS

/ ent

ire

24 h

, 7 D

AC

TB

L, 7

D A

CT

Tx

1 (b

righ

t lig

ht)

7 D

AC

TT

x 2

(bri

ght l

ight

or

brig

htlig

ht a

nd v

itam

in B

12

NS

(30)

M, 1

2, F

, 16

/ 78.

3(N

S) /

norm

al, A

lzhe

imer

’sde

men

tia

Non

e / A

MI

/ NS

/ NS

/ NS

/N

S/

AC

T: D

and

NT

perc

ent

slee

p, D

and

Nt a

wak

enin

gs,

Oth

ers,

MM

SE, C

linic

alD

emen

tia R

atin

g

NS/

NS/

NS

No

chan

ge w

ith b

righ

t lig

htal

one.

Bri

ght l

ight

plu

s vi

ta-

min

B12

dec

reas

ed d

aytim

epe

rcen

t sle

ep a

nd n

um o

fna

ps.

No

Nt d

iffe

renc

es

Cit

atio

n - A

utho

r/

Evi

denc

e L

evel

St

udy

Cri

teri

a D

esig

n /

Loc

atio

n / P

roto

col

Sam

ple

Size

(C

ompl

eted

Stud

y) /

Mea

n A

ge (

Ran

ge)

/M

edic

al C

ondi

tion

s

Com

pari

son

Mea

sure

s /

Act

igra

ph a

ppar

atus

/P

lace

men

t / E

poch

Len

gth

/Se

nsit

ivit

y / S

cori

ng

Out

com

e M

easu

res

Incl

usio

n / E

xclu

sion

/ B

ias

Stud

y C

oncl

usio

n fr

ompa

per

Com

men

ts f

rom

Rev

iew

er


Jean

-Lou

is (

143)

4C-b

Unb

linde

d, n

onra

ndom

ized

,ob

serv

atio

nal s

tudy

, cro

ss-

sect

iona

l stu

dy /

Hom

e /

Ent

ire

24-h

urs;

3D

AC

T

NS

(273

) / M

51±

7, F

52±

7(A

ll 40

-64)

/ C

omm

unity

dwel

ling

resi

dent

s of

San

Die

go id

entif

ied

by r

ando

mte

leph

one

surv

ey.

Non

e / A

ctill

ume

(AM

I) /

wri

st /

1 m

in /

NS

/ Act

ion3

(Col

e et

al 1

992

w/ W

ebst

er’s

re-s

cori

ng r

ules

)

AC

T: T

IB, T

ST, S

OL

, SE

,sl

eep

(am

plitu

de, m

esor

, and

phas

e), a

ctiv

ity (

ampl

itude

,m

esor

, and

pha

se),

illu

min

a-tio

n (a

mpl

itude

, m

esor

, and

phas

e); S

BJ

moo

d

NS

/ NS

/ Com

orbi

dity

NS

Sign

ific

ant g

ende

r di

ffer

-en

ces,

men

had

sho

rter

TST

,lo

wer

SE

, sho

rter

TIB

, low

erSl

eep

ampl

itude

, hig

her

illu-

min

atio

n am

plitu

de a

nd h

igh-

er il

lum

inat

ion

mes

or; s

igni

fi-

cant

whi

te v

s. m

inor

ity d

iffe

r-en

ces,

whi

te s

ampl

e ha

dlo

nger

TST

, lon

ger

SE, s

hort

-er

SO

L, g

reat

er s

leep

am

pli-

tude

, and

hig

her

slee

p m

esor

.To

tal s

ampl

e av

erag

e T

STw

as 6

.22

hs.

Aut

hors

ref

er to

thei

r un

pub-

lishe

d w

ork

com

pari

ng w

rist

AC

Tto

PSG

in w

omen

age

d51

-77

w/ 8

9% m

in-b

y-m

inag

reem

ent,

r =

.90.

Jean

-Lou

is (

122)

4C-b

Unb

linde

d, n

onra

ndom

ized

,ob

serv

atio

nal s

tudy

/ H

ome

/E

ntir

e 24

-hs;

5D

AC

T

NS

(32)

/ 44

.76±

20.6

4 /

Hea

lthy

norm

al v

olun

teer

s SS

S, lo

g / G

aehw

iler

Ele

ctro

nics

(H

ombr

echt

ikon

,Sw

itzer

land

) / d

om w

rist

/ 60

sec

/ ≥.1

g /

AD

AS

AC

T: T

ST, S

E in

dex,

WA

SO,

SOL

, fre

quen

cy o

f tr

ansi

tions

betw

een

slee

p an

d w

akef

ul-

ness

, day

time

activ

ity le

vel,

auto

- r

(am

plitu

de o

f ac

tivity

)

NS

/ NS

/ Sm

all s

ampl

e si

ze

Wom

en h

ad a

bet

ter

slee

ppr

ofile

than

men

by

AC

TR

elat

ivel

y sm

all s

ampl

e

Jean

-Lou

is (

46)

4C-a

Unb

linde

d, n

onra

ndom

ized

,ob

serv

atio

nal s

tudy

, cro

ss-

sect

iona

l stu

dy /

Hom

e /

Ent

ire

24-h

s; 3

D A

CT

273

(273

) / (

40-6

4) /

L

og /

Act

illum

e (A

MI)

/ 1

min

/ N

S / N

S / A

utom

atic

scor

ing

rhyt

hm; A

CT

ION

3

AC

T: T

ST, S

OL

, SE

inde

x,m

esor

, am

plitu

de (

of th

eco

sine

) an

d ph

ase

(tim

ing

ofth

e pe

ak o

f th

e fi

tted

cosi

ne)

Lev

el o

f ill

umin

atio

n

Com

mun

ity d

wel

ling

resi

-de

nts

of S

an D

iego

iden

tifie

dby

ran

dom

tele

phon

e su

rvey

/N

S / N

S

CR

of

illum

inat

ion

was

sig

-ni

fica

ntly

ass

ocia

ted

w/ a

ctiv

-ity

and

sle

ep r

hyth

m m

eas-

ures

. Hig

her

ampl

itude

of

log

illum

inat

ion

corr

elat

ed w

ithsl

eep

phas

e (r

= .1

6), l

ower

SE in

dex

(r=

-.15

), a

nd le

ssre

port

ed d

aytim

e na

ppin

g (r

=-

.16)

. Hig

her

ampl

itude

of

activ

ity c

orre

late

d w

ith s

leep

ampl

itude

(r=

.30)

, Sdu

r(r

=.2

1) a

nd le

ss d

aytim

e na

p-pi

ng (

r =

-.1

6).

Hig

her

ampl

itude

of

activ

ity(b

y A

CT

) w

as a

ssoc

iate

d w

/le

ss r

epor

ted

dayt

ime

nap-

ping

. (r

=-.

16,

p<.0

5).

Jean

-Lou

is (

198)

2B

Unb

linde

d, n

onra

ndom

ized

,ob

serv

atio

nal s

tudy

/ la

bora

-to

ry /

noct

urna

l onl

y fo

r N

Sh,

2 N

t PSG

, 1 N

t AC

T(o

nse

cond

NT

of P

SG)

NS

(24)

M 1

7, F

, 7 /

45

(SD

= 9

) / 1

8 w

ith in

som

nia,

6w

ith h

yper

som

nia,

cur

rent

maj

or d

epre

ssiv

e ep

isod

e

PSG

/ G

aehw

iler

/ wri

t / 6

0se

c / >

0.1g

/ A

DA

S PS

G: S

OL

, WA

SO, S

E, T

ST;

AC

T: T

ST, S

E, M

ood:

Bec

kD

epre

ssio

n In

vent

ory,

HA

MD

Incl

usio

n; r

ecru

ited

from

ongo

ing

PSG

stu

dies

/ N

S/N

S

AC

Tsc

orin

g cr

iteri

a ba

sed

onhe

alth

y yo

ung

adul

ts d

id n

otpe

rfor

m a

s w

ell i

n th

isde

pres

sed

sam

ple

as c

rite

ria

optim

ized

for

this

sam

ple.

½ o

f sa

mpl

e us

ed to

cal

ibra

tene

w A

CT

scor

ing

algo

rith

man

d ot

her

½ o

f sa

mpl

e us

ed to

valid

ate

the

new

alg

orith

m

Jean

-Lou

is (

199)

4C-b

DB

, ran

dom

ized

, cro

ss-o

ver

desi

gn /

hom

e / e

ntir

e 24

h,

5D A

CT

Tx

1 (6

mg

mel

or

plac

ebo)

; 5D

AC

TT

x 2

(pla

cebo

or

6 m

g m

el)

NS

(10)

/ M

, 4, F

, 6 /

68.8

(SD

= 1

5.8)

/ se

lf-r

epor

ted

s/w

dis

turb

ance

, Alz

heim

er’s

dise

ase

SSS,

sle

ep lo

g, d

iary

, VA

S /

NS

/ wri

st /

NS

/ NS

/ AD

AS

Slee

p di

ary,

log,

AC

T; T

ST,

SE in

dex,

WA

SO, T

WT,

SW

Tan

d re

st-a

ctiv

ity a

mpl

itude

;O

ther

s: A

lzhe

imer

’s D

isea

seA

sses

smen

t Sca

le, D

igit

span

,D

igit

sym

bol s

ubst

itutio

n, f

in-

ger

tapp

ing,

MM

SE

Incl

usio

n: A

ging

and

Alz

heim

er’s

Reg

istr

y, s

elf-

repo

rted

s /

w d

istu

rban

ce,/

Exc

lusi

on, s

leep

apn

ea, P

LM

,m

edic

al, n

euro

logi

cal o

r ps

y-ch

iatr

ic il

lnes

s ot

her

than

Alz

heim

er’s

dis

ease

/ lo

wsa

mpl

e si

ze

Mel

enh

ance

d re

st-a

ctiv

ityrh

ythm

, red

uced

SO

L,

redu

ced

SWT,

and

impr

oved

reca

ll of

pre

viou

sly

lear

ned

mat

eria

ls

Kar

io (

200)

5D-b

Unb

lend

ed, n

onra

ndom

ized

,ob

serv

atio

nal /

NS

/ 1 D

sim

ulta

neou

s A

CT

and

ambu

-la

tory

BP

mon

itori

ng

NS

/ (23

1) M

, 126

, F, 1

05 /

46 (

30-6

6, S

D=

8.9

) / n

orm

al

Non

e / A

MI

/ wai

st w

hile

awak

e, w

rist

dur

ing

slee

p /

NS

/ NS

/ NS

AC

T: p

hysi

cal a

ctiv

ity d

urin

gS

and

W, M

ood;

Bri

efSy

mpt

om I

nven

tory

) d

epre

s-si

on a

nd a

nxie

ty)

Sym

ptom

ratin

g ch

eckl

ist-

90-R

evis

ed;

Oth

ers:

24

h am

bula

tory

BP

mon

itori

ng

Incl

usio

n: e

nrol

led

in la

rger

wor

k si

te b

lood

pre

ssur

est

udy/

Exc

lusi

on n

o hy

pert

en-

sion

, dep

ress

ion

or a

nxie

tym

eds;

not

shi

ft w

orke

r / N

S

Dep

ress

ion

was

ass

ocia

ted

with

dis

rupt

ed d

iurn

al B

Pva

riat

ion

inde

pend

ent o

fph

ysic

al a

ctiv

ity b

y A

CT

inm

en, b

ut n

ot w

omen

Nt p

hysi

cal a

ctiv

ity (

by A

CT

)w

as u

sed

to e

stim

ate

SQ, b

utno

AC

Tsl

eep

find

ings

rep

ort-

ed

Lee

(20

1)

4C-b

Cro

ss-s

ectio

nal s

tudy

/ H

ome

/ Ent

ire

24 h

; 2 D

AC

T10

4 (1

00)

/ 38.

3±7.

8 / H

IVQ

uest

ionn

aire

/ M

ML

/ wri

st /

NS

/ NS

/ Act

ion3

L

og; A

CT;

Moo

d N

S / D

emen

tia n

euro

path

yus

e of

illic

it su

bsta

nces

, hos

-pi

taliz

atio

n / N

S

Pts

aver

aged

6.5

h/N

t; 45

%na

pped

. CD

4 ce

ll co

unts

unre

late

d to

sle

ep, h

igh

fatig

ue g

rp h

ad m

ore

dis-

turb

ed s

leep

and

mor

e de

pres

-si

on s

ympt

oms.

Rhy

thm

stre

ngth

inve

rsel

y re

late

d to

dayt

ime

dysf

unct

ion,

dir

ectly

rela

ted

to n

appi

ng, T

ST.

Cit

atio

n - A

utho

r/

Evi

denc

e L

evel

St

udy

Cri

teri

a D

esig

n /

Loc

atio

n / P

roto

col

Sam

ple

Size

(C

ompl

eted

Stud

y) /

Mea

n A

ge (

Ran

ge)

/M

edic

al C

ondi

tion

s

Com

pari

son

Mea

sure

s /

Act

igra

ph a

ppar

atus

/P

lace

men

t / E

poch

Len

gth

/Se

nsit

ivit

y / S

cori

ng

Out

com

e M

easu

res

Incl

usio

n / E

xclu

sion

/ B

ias

Stud

y C

oncl

usio

n fr

ompa

per

Com

men

ts f

rom

Rev

iew

er


Lem

ke (

153)

4C-b

Unb

linde

d, n

onra

ndom

ized

,ob

serv

atio

nal s

tudy

/ E

ntir

e24

-hs;

3D

AC

T

NS

(52)

/ 43

.0±

12.5

/Ps

ychi

atri

c un

it in

-pts

w/

DSM

IV

crite

ria

for

maj

orde

pres

sive

dis

orde

r

Que

stio

nnai

re, l

og P

SQI

/A

ktom

eter

(Z

AK

, Ger

man

y);

ndom

han

d; 2

min

s;Se

nsiti

vity

: >.1

g; S

cori

ng:

ZA

K s

oftw

are

Log

: TST

, SW

T, S

Q V

AS;

AC

T: m

ean

activ

ity; M

ood:

HA

MD

(G

erm

an v

ersi

ons)

NS

/ Psy

chot

ic f

eatu

res

and

or n

euro

lept

ics,

med

s ch

ange

ddu

ring

stu

dy p

erio

d, m

otor

syst

em d

isor

ders

(e.

g.Pa

rkin

son’

s di

seas

e) /

Low

sam

ple

size

of

good

sle

eper

sfo

r co

mpa

riso

n to

poo

r sl

eep-

ers

by P

SQI,

dif

fere

ntia

lre

port

ing

bias

(m

ore

seve

rely

depr

esse

d pt

s m

ay e

xagg

erat

esl

eep

prob

lem

s on

log)

PSQ

I “p

oor”

sle

eper

s ha

dhi

gher

mea

n ni

ghtti

me

mot

orac

tivity

than

“go

od”

slee

pers

;D

epre

ssed

pts

w/ l

ess

depr

es-

sive

sym

ptom

s ha

d lo

wer

mea

n ni

ghtti

me

mot

or a

ctiv

ity&

hig

her

log-

repo

rted

SQ

Man

uscr

ipt T

able

2 in

corr

ect-

ly la

bels

poo

r &

goo

d sl

eep-

ers

(cor

rect

in th

e te

xt);

AC

Tda

ta o

nly

anal

yzed

as

mea

nac

tivity

leve

ls, n

ot S

/W

Mau

s (1

37)

4C-b

Con

trol

led

clin

ical

tria

l,un

blin

ded,

non

rand

omiz

ed /

Lab

orat

ory

/ 22

hs; G

rp1

(nor

mal

s) 2

D A

CT

(1D

AC

Tno

rmal

con

trol

, 1D

AC

Tno

slee

p al

low

ed),

Grp

2 (S

leep

Apn

ea)

1D A

CT

allo

wed

tosl

eep

but w

/o r

espi

rato

ryas

sist

ance

(na

sal C

PAP)

NS

(NS)

/ G

rp1

31 (

22-4

5),

Grp

2 56

(38

-74)

/ N

orm

al in

Grp

1 (h

ealth

y co

ntro

ls-s

tu-

dent

s &

hea

lth c

are

wor

kers

),se

vere

OSA

S in

Grp

2

Non

e /A

ctig

raph

(A

MI)

/ N

S/ 1

min

/ N

S / S

adeh

,Te

chni

cian

Sle

ep L

abor

ator

y,Is

rael

End

ocri

ne: u

rine

nor

epi a

ndep

i; A

CT

: Act

ivity

inde

x, S

EI

Nig

httim

e pu

lse

oxim

etry

-de

sats

NS

/ h/

o ey

e su

rger

y, c

hron

icey

e di

seas

e, a

sym

met

ric

intr

aocu

lar

pres

sure

s, m

eds

know

n to

aff

ect a

queo

ushu

mor

flo

w /

Patie

nt s

elec

-tio

n: G

rp2

olde

r th

an G

rp1

Slee

p ap

nea

Grp

had

hig

her

nigh

ttim

e ac

tivity

inde

x by

AC

Tan

d lo

wer

SE

I co

mpa

red

to c

ontr

ols

allo

wed

to s

leep

McA

rthu

r (1

69)

4C-b

RC

T, D

B, T

x or

der,

cros

s-ov

er d

esig

n, c

ompa

rativ

e T

x,pl

aceb

o-co

ntro

lled

/ Hom

e /

Ent

ire

24-h

s; 1

0 w

ks o

f AC

T(7

D A

CT

BL

, 28D

AC

TT

x,7D

AC

Tw

asho

ut, 2

8D A

CT

Tx)

NS

(9)

/ 10.

1±1.

5 / R

ett

Synd

rom

e (s

tage

III

or

IV)

lo

g by

car

egiv

ers,

SO

L,

num

of a

wak

enin

gs &

fin

al m

orn-

ing

awak

enin

g /

(Am

bula

tory

Mon

itori

ng, I

nc)

/ NS

/ NS

/N

S / A

ctio

n3

log;

AC

T: T

ST, S

E, n

um o

faw

aken

ings

, SO

LN

S / N

S / L

ow s

ampl

e si

ze

SOL

sign

ific

antly

red

uced

by

mel

dur

ing

the

1st 3

wks

of

tria

l

Hig

h va

riab

ility

in s

ubje

ctre

spon

sive

ness

to m

el

McC

arte

n (

202)

4C-b

Con

trol

led

clin

ical

tria

l,un

blin

ded,

non

rand

omiz

ed,

cros

s-ov

er d

esig

n / l

ab /

10 D

& N

AC

T

NS

( 7)

/ M

7, 7

3 (

62-8

1) /

disr

upte

d sl

eep,

Alz

heim

ers

Dis

ease

obse

rvat

ion

by n

urse

s / A

MI

/do

m w

rist

/ N

S / N

S / N

S

AC

T: S

O, #

aw

aken

ings

, TST

duri

ng d

ay ,

mea

n ac

tivity

A

lcoh

ol o

r dr

ug a

buse

, ser

i-ou

s m

edic

al il

lnes

s, s

ever

ede

pres

sion

/ lo

w s

ampl

e si

ze

Nur

ses

obse

rvat

ions

agr

eed

with

act

igra

phy.

Tri

azol

amha

d no

sig

nifi

cant

eff

ect o

nT

STat

nig

ht S

O, #

aro

usal

s,or

TST

duri

ng d

ay.

No

sig

drug

eff

ects

on

mem

ory

Men

dlow

icz

(144

)

5D-a

Unb

linde

d, n

onra

ndom

ized

,ob

serv

atio

nal s

tudy

/ H

ome

/E

ntir

e 24

-hs;

5D

AC

T

NS

(32)

/ 50

.00±

23.9

7 (1

8-79

) / N

orm

al c

omm

unity

dwel

ling

volu

ntee

rs

SSS,

log

/ Gae

hwile

rE

lect

roni

cs /

wri

st /

NS

/ NS

/A

DA

S

AC

T: d

aytim

e ac

tivity

leve

l,T

ST, S

OL

, tra

nsiti

on f

rom

slee

p to

wak

eful

ness

, WA

SO,

TIB

; Moo

d: d

epre

ssed

moo

dfr

om A

lzhe

imer

’s D

isea

seA

sses

smen

t Sca

le;

Alz

heim

er’s

Dis

ease

Ass

essm

ent S

cale

, SSS

,M

MSE

, VA

S

No

psyc

hiat

ric

or m

edic

alpr

oble

ms

/ NS

/ sm

all s

ampl

e A

ge w

as a

ssoc

iate

d w

/ TIB

,T

ST&

WA

SO; s

igni

fica

ntpr

edic

tors

of

depr

esse

d m

ood

wer

e da

ytim

e ac

tivity

leve

l,SO

L, W

ASO

, TST

, & T

IB

Men

nella

(17

0)

4C-b

RC

T, S

B,

cros

s-ov

er d

esig

n /

Priv

ate

carp

eted

roo

m w

/cri

b/ 3

.5 h

s; 2

test

Ds

in e

ach

infa

nt, s

epar

ated

by

1 w

k;in

fant

s bo

ttle-

fed

100

ml o

fbr

east

milk

w/ 4

0ml (

32m

g)et

hano

l

15 m

othe

r/in

fant

pai

rs (

13m

othe

r/in

fant

pai

rs)

/ Grp

127

.4yr

s±1.

1 (2

2-34

), G

rp2

2.7m

os±0

.3 (

1.5-

5.6m

os)

/N

S

Non

e / A

MA

-32

(AM

I) /

infa

nt’s

Lt l

eg /

1 m

in /

NS

/Sa

deh

et a

l

AC

T: s

leep

%, t

otal

min

squ

iet s

leep

, tot

al m

ins

activ

esl

eep,

long

est S

P, S

L, n

um o

fsl

eepi

ng b

outs

, m

ean

activ

ityco

unt d

urin

g w

akef

ulne

ss

Non

smok

ing,

lact

atin

gw

omen

and

thei

r in

fant

s / N

S/ N

S

Shor

t-te

rm e

xpos

ure

to s

mal

lam

ount

s of

alc

ohol

in b

reas

tm

ilk a

lters

sle

ep in

infa

nts

Aut

hors

ref

er to

ano

ther

stu

dyw

here

add

ing

vani

lla f

lavo

rdi

d no

t alte

r th

e in

fant

’s s

leep

Mia

skow

ski (

149)

4C-b

Unb

linde

d, n

onra

ndom

ized

,ob

serv

atio

nal s

tudy

/ H

ome

/E

ntir

e 24

-hs;

2D

AC

T

NS

(22)

/ 56

.6±1

3.0

/ Can

cer

pts

w/ p

ainf

ul b

ony

met

as-

tase

s

Log

; Lik

ert s

cale

s of

SQ

and

feel

ing

rest

ed /

MM

L/ w

rist

/N

S / N

S / A

ctio

n3

AC

T: T

ST, S

E &

num

of

awak

enin

gs; M

ood:

CE

S-D

;O

ther

s: L

ee F

atig

ue S

cale

,pa

in n

umer

ic r

atin

g sc

ale

Rec

eivi

ng r

adia

tion

ther

apy

for

pain

ful b

ony

met

asta

ses,

age ≥

18, s

poke

Eng

lish,

Kar

nofs

ky s

core

≥50

, pai

nin

tens

ity ≥

2.5

on a

0-1

0sc

ale,

x-r

ay b

one

met

s &

on

opio

ids

/ NS

/ NS

No

sign

ific

ant c

orre

latio

nsbe

twee

n th

e O

BJ

mea

sure

s of

slee

p an

d se

lf-r

atin

gs o

f fe

el-

ing

rest

ed q

ualit

y of

sle

ep.

Tim

e sp

ent n

appi

ng w

as p

osi-

tivel

y re

late

d to

incr

ease

dam

ount

s of

sle

ep th

e ni

ght

befo

re.

No

evid

ence

of

firs

t nig

htef

fect

b/t

2 co

nsec

utiv

e ni

ghts

of w

rist

AC

T

Cit

atio

n - A

utho

r/

Evi

denc

e L

evel

St

udy

Cri

teri

a D

esig

n /

Loc

atio

n / P

roto

col

Sam

ple

Size

(C

ompl

eted

Stud

y) /

Mea

n A

ge (

Ran

ge)

/M

edic

al C

ondi

tion

s

Com

pari

son

Mea

sure

s /

Act

igra

ph a

ppar

atus

/P

lace

men

t / E

poch

Len

gth

/Se

nsit

ivit

y / S

cori

ng

Out

com

e M

easu

res

Incl

usio

n / E

xclu

sion

/ B

ias

Stud

y C

oncl

usio

n fr

ompa

per

Com

men

ts f

rom

Rev

iew

er


Mill

er (

203)

5D-a

Unb

lend

ed, n

onra

ndom

ized

,ca

se s

erie

s / h

ome

/ ent

ire

24h,

AC

TB

L, A

CT

plac

ebo,

AC

TT

x (

with

met

hylp

heni

date

or

pem

o-lin

e), n

um d

ays

AC

TN

S

NS

(15)

Grp

1m

ethy

lphe

nida

te, M

-6; F

-2;

Grp

2 P

emol

ine,

M-5

, F-3

/G

rp 1

; 7.5

(SD

= 2

.1)

Grp

29.

1 (S

D =

2.3

)/ n

orm

al,

AD

HD

, Grp

1 r

ecei

ved

met

hylp

heni

date

, Grp

2re

ceiv

ed p

emol

ine

Non

e / N

S /N

S /N

S /N

S/ N

S A

CT

: mot

or a

ctiv

ity “

whi

leaw

ake”

and

“w

hile

asl

eep”

,O

ther

s: C

onno

rs p

aren

ts’r

at-

ing

scal

e (h

yper

activ

ity);

Glo

bal r

atin

g sc

ale

(of

impr

ovem

ent)

NS/

NS/

low

sam

ple

size

W

ake

activ

ity, s

leep

act

ivity

and

hype

ract

ivity

dec

reas

edw

ith m

ethy

lphe

nida

te.

Aw

ake

activ

ity in

crea

sed

and

asle

epac

tivity

and

hyp

erac

tivity

inde

x de

crea

sed

with

pem

o-lin

e (s

tatis

tical

test

ing

NS)

Min

imal

spe

cifi

c in

form

atio

non

the

stud

y’s

met

hodo

logy

and

the

lack

of

stat

istic

al te

st-

ing

repo

rted

mak

es th

e fi

nd-

ings

dif

ficu

lt to

inte

rpre

t.

Mis

him

a (9

9)

4C-b

RC

T, u

nblin

ded,

cro

ssov

erde

sign

/ N

H /

Ent

ire

24-h

s;co

ntin

uous

AC

Tfo

r 1

wk

pre-

Tx,

2 w

ks T

x, 1

wk

post

-Tx,

≥4

wks

was

hout

cro

ss-o

ver;

Tx=

5-80

00 lu

x 9-

11am

;C

ontr

ol=

300

lux

9-11

am

22 (

NS)

/ G

rp1

81, G

rp2

78 /

Grp

1 V

ascu

lar

dem

entia

,G

rp2

Alz

heim

er’s

dem

entia

Non

e / (

AM

I) /

ndom

wri

st /

1 m

in /

NS

/ act

ivity

cou

nts

used

, sle

ep n

ot s

core

d

AC

T: T

otal

, day

time

& n

ight

-tim

e ac

tivity

, % n

ight

/tota

lac

tivity

DSM

IV

Dx

of v

ascu

lar

dem

entia

or A

lzhe

imer

’s /

mix

ed d

emen

tia e

xclu

ded

/U

nabl

e to

blin

d T

x, s

mal

l N

Vas

cula

r D

emen

tia: d

aily

brig

ht li

ght r

educ

es n

ight

time

activ

ity; A

lzhe

imer

’sD

emen

tia: b

righ

t lig

ht d

oes

not a

ffec

t act

ivity

rhy

thm

Show

s A

CT

dete

cted

Tx

effe

ct in

wel

l-de

sign

ed, c

on-

trol

led

tria

l. S

ugge

st A

CT

usef

ul to

det

ect o

utco

me

inC

R T

x st

udy

Moo

rcro

ft (

145)

5D-b

Unb

linde

d, n

onra

ndom

ized

,ob

serv

atio

nal s

tudy

/ H

ome

/N

octu

rnal

onl

y fr

om 8

:00p

mun

til 1

0 m

ins

afte

r aw

aken

-in

g; 3

Nt A

CT

NS

(15)

/ (1

9-62

) / P

eopl

eab

le to

sel

f-aw

aken

at a

sel

f-pr

edet

erm

ined

tim

e w

/o e

xter

-na

l mea

ns

log

to g

et in

tend

ed W

time

for

the

next

mor

ning

/Act

igra

ph(A

MI)

/ N

S / N

S / N

S / N

S

log;

AC

T: S

leep

& W

peri

ods,

time

of f

inal

aw

aken

ing

Abl

e to

sel

f-aw

aken

/ N

S /

Low

sam

ple

size

D

ata

sugg

este

d th

at th

ese

peop

le c

ould

aw

aken

at a

sel

f-de

term

ined

tim

e.

Mor

mon

t (15

0)

4C-b

Unb

linde

d, n

onra

ndom

ized

,ob

serv

atio

nal s

tudy

, coh

ort

stud

y, lo

ngitu

dina

l stu

dy /

Hom

e / E

ntir

e 24

-hs;

3D

AC

T

200

(192

) / 5

8 (2

0-75

) /

Am

bula

tory

met

asta

tic c

ol-

orec

tal c

ance

r pt

s re

ferr

ed f

orch

rono

mod

ulat

ed c

hem

othe

r-ap

y

Non

e / A

CT

(AM

I) /

NS

/ 1m

in /

NS

/ NS

End

ocri

ne m

easu

res:

cir

cadi

-an

cha

nges

in c

ortis

ol &

WB

C; A

CT

: aut

o-r

at 2

4h &

adi

chot

omy

inde

x co

mpa

ring

amou

nts

of a

ctiv

ity w

hen

inbe

d &

out

of

bed,

mea

n ac

tiv-

ity; M

ood:

HA

DS

(sca

le o

fan

xiet

y an

d de

pres

sion

);Q

LQ

-C30

(Q

OL

)

NS

/ Poo

r ge

nera

l hea

lth(W

HO

per

form

ance

sta

tus

72)

/ NS

Pts

w/ m

arke

d re

st/a

ctiv

ityrh

ythm

s ha

d a

5-fo

ld h

ighe

rsu

rviv

al r

ate

at 2

yrs

, had

a 5

-fo

ld h

ighe

r su

rviv

al r

ate

at 2

yrs,

had

bet

ter

QO

L&

rep

ort-

ed le

ss f

atig

ue. R

est/a

ctiv

ityrh

ythm

rem

aine

d a

sign

ific

ant

pred

icto

r of

sur

viva

l in

mul

ti-va

riat

e an

alys

is.

Ous

land

er (

166)

5D-b

Cas

e se

ries

, des

crip

tive

/ NH

/N

octu

rnal

onl

y fo

r 9

hs; A

CT

1 N

t BL

, 2 m

os la

ter,

AC

T1

Nt 2

nd B

L

73 (

73)

/ 86.

9±7.

2 /

Inco

ntin

ence

N

S / N

S / N

S / 2

min

s / N

S /

NS

A

CT

: Sle

ep in

terv

als

NS

/ NS

/ No

info

rmat

ion

onho

w (

slee

p) A

CT

reco

rded

In

cont

inen

ce w

as n

ot r

elat

edto

sle

ep d

isru

ptio

n B

uilt

own

actig

raph

Pank

hurs

t (1

46)

4C-b

Unb

linde

d, n

onra

ndom

ized

,ob

serv

atio

nal s

tudy

, coh

ort

stud

y, c

ross

-sec

tiona

l stu

dy /

Hom

e / N

octu

rnal

for

NS

hs;

8Nt A

CT

Stud

y1 9

6 (9

2) /

(23-

67)

/co

uple

s sl

ept t

oget

her,

Stud

y2 (

95)

/ NS

/ sub

ject

sw

ho s

lept

alo

ne. A

ll su

bjec

tsw

ere

com

mun

ity d

wel

ling

peop

le li

ving

nea

r 4

UK

air

-po

rts

Log

/ G

aehw

iler

Ele

ctro

nics

Hom

brec

htik

on, S

witz

erla

nd /

NS

/ 30

sec

/ >

.1g

/A

CC

OR

D (

auth

or’s

ow

n pr

o-gr

am)

log;

AC

T:”

actib

lip”

inci

-de

nces

N

S / H

ypno

tics,

pai

n th

atse

riou

sly

disr

upte

d sl

eep

/C

omor

bidi

ty w

as n

otad

dres

sed

Men

had

mor

e m

ovem

ents

.Fo

r sl

eep

part

ners

, 1/3

of

mov

emen

ts w

ere

com

mon

tobo

th p

artn

ers;

sub

ject

s sl

eep-

ing

w/ p

artn

er h

ad m

ore

mov

emen

ts; m

ovem

ents

decr

ease

d w

hen

part

ner

abse

nt

AC

Tda

ta n

ot s

core

d as

S/W

but a

s “a

ctib

lips”

(m

ovem

ent)

Pat-

Hor

encz

yk (

160)

4C-b

Unb

linde

d, n

onra

ndom

ized

,ob

serv

atio

nal s

tudy

/ N

H /

Ent

ire

24-h

s; 1

D A

CT

77 (

67)

/ Grp

1 85

, Grp

2 87

,A

ll 85±7

.3 (

60-1

00)

/ NH

res

-id

ents

w/ d

emen

tia; S

DG

-M

MSE

<20

, MM

DG

-MM

SE≥2

0

Non

e / A

ctill

ume

/ NS

/ NS

/≥.

003g

/ N

S A

CT

: min

s as

leep

eac

h hr

,fu

lly a

slee

p ea

ch h

r, fu

llyaw

ake

each

hr

NS

/ Non

e (m

ost p

ts h

ad m

ul-

tiple

med

ical

dia

gnos

es a

ndw

ere

taki

ng m

ultip

le m

eds)

/N

S

SDG

sle

pt m

ore

at e

ach

hr,

and

mor

e th

an d

urin

g m

eal

times

. Pea

k of

sle

ep o

ccur

red

2 hs

ear

lier

in S

DG

Grp

,M

MD

G h

ad m

ore

wak

eful

-ne

ss a

t nig

ht a

nd S

DG

had

mor

e sl

eepi

ness

dur

ing

D

Paul

(20

4)

4C-b

Unb

lend

ed, n

onra

ndom

ized

,ob

serv

atio

nal s

tudy

/hom

e /

entir

e 24

h, A

CT

5 D

pri

or to

re-s

uppl

y m

issi

on a

nd u

ntil

mis

sion

com

plet

ed

NS

(N

S) N

S (N

S) /

norm

al

Non

e / P

reci

sion

con

trol

Des

ign

/ wri

st /

1 m

inut

e / N

S/ W

in A

ct 1

.2

AC

T: n

um a

nd d

ur o

f sl

eep

epis

odes

; Oth

ers,

psy

chom

o-to

r ta

sks;

ser

ial c

hoic

e re

ac-

tion

time,

logi

cal r

easo

ning

task

ser

ial s

ubtr

actio

n ta

skan

d m

ultit

ask

Incl

usio

n: C

anad

ian

Air

Com

man

d pi

lots

and

co-

pilo

ts/ N

S/ N

S

Am

ount

of

daily

sle

epde

crea

sed

duri

ng th

e 3

Dpr

ior

to m

issi

on.

Dur

ing

mis

-si

on, w

orst

sle

ep o

n ni

ght 2

.D

urin

g m

issi

on, d

ecre

ased

self

-rat

ed a

lert

ness

and

incr

ease

d fa

tigue

Cit

atio

n - A

utho

r/

Evi

denc

e L

evel

St

udy

Cri

teri

a D

esig

n /

Loc

atio

n / P

roto

col

Sam

ple

Size

(C

ompl

eted

Stud

y) /

Mea

n A

ge (

Ran

ge)

/M

edic

al C

ondi

tion

s

Com

pari

son

Mea

sure

s /

Act

igra

ph a

ppar

atus

/P

lace

men

t / E

poch

Len

gth

/Se

nsit

ivit

y / S

cori

ng

Out

com

e M

easu

res

Incl

usio

n / E

xclu

sion

/ B

ias

Stud

y C

oncl

usio

n fr

ompa

per

Com

men

ts f

rom

Rev

iew

er


Polla

k (1

38)

4C-b

Cas

e-co

ntro

l stu

dy /

Hom

e /

Ent

ire

24-h

s; 1

2 N

t&D

AC

T15

(15

) / G

rp1

75.9

, Grp

272

.0 /

NS

Non

e / V

italo

g PM

S-8

/ wri

st/ 1

min

/ N

S / N

S lo

g; A

CT

: act

ivity

N

S / N

S / S

mal

l sam

ple

size

R

x us

es (

i.e. t

hose

taki

ngm

eds

at B

T)

beco

me

activ

e1.

5 hs

ear

lier

in th

e m

orni

ng

Polla

k (1

58)

4C-b

Cas

e se

ries

/ H

ome

/ Ent

ire

24-h

s; 9

D&

Nt A

CT

88 (

44 p

airs

) / G

rp1

77.9

(64

-92

) G

rp2

61.9

(29

-86)

/ N

S N

S / M

ML

/ Ndo

m w

rist

/0.

5 m

in /

NS

/ NS

log;

AC

T: a

ctiv

ity le

vel

65+

; hav

e ca

re g

iver

; dis

rup-

tive

noct

urna

l beh

avio

r(D

NB

) / N

S / N

S

Beh

avio

r of

eld

ers

& c

are-

give

rs w

ere

less

sim

ilar

inda

ytim

e th

an a

t Nt;

at N

t it

was

eld

ers

that

initi

ated

inte

r-ac

tion,

thus

dis

turb

ing

slee

pof

car

egiv

er

Pres

ents

a p

artia

l mat

hem

ati-

cal m

odel

of

spon

tane

ous

mot

or b

ehav

ior.

Use

d vi

deo

at N

t to

wat

ch in

tera

ctio

nsbe

twee

n el

der

& c

areg

iver

Red

eker

(15

6)

4C-b

Obs

erva

tiona

l stu

dy; l

ongi

tu-

dina

l stu

dy /

Hom

e; o

ut-o

f-la

b ho

spita

l bed

/ E

ntir

e 24

-hs

; 7D

pos

tope

rativ

e in

hos

pi-

tal,

7D E

arly

rec

over

y at

hom

e, 7

D r

esum

e ac

tiviti

es,

7D c

ompl

ete

resu

mpt

ion

ofac

tiviti

es

22 (

13)

/ Grp

1 63

.7±9

.9 (

43-

83),

Grp

2 62±1

0.76

(43

-78)

/C

oron

ary

arte

ry b

ypas

s gr

aft

surg

ery

NS

/ MM

L/ n

dom

wri

st /

1m

in /

NS

/ AC

TIO

N

AC

T: T

ST, n

um w

akes

, mea

nW

time,

mea

n sl

eep

inte

rval

,%

sle

ep; S

ickn

ess

Impa

ctPr

ofile

NS

/ NS

/ Low

sam

ple

in f

ol-

low

-up

Sign

ific

ant d

aytim

e sl

eep

&fr

agm

ente

d ni

ghtti

me

slee

pdu

ring

hos

pita

lizat

ion;

Ove

r 6

mos

per

iod

post

-sur

gery

,sl

eep

cons

olid

ated

& d

aytim

esl

eep

low

er; P

erce

ived

sle

epim

prov

emen

ts c

onsi

sten

t w/

AC

Tm

easu

res

Nic

e lo

ngitu

dina

l fol

low

-up

(6 m

os)

Red

eker

(20

5)

4C-b

Cas

e se

ries

, tim

e se

ries

/ O

ut-

of-l

ab h

ospi

tal b

ed /

Ent

ire

24-h

s; C

ontin

uous

for

ent

ire

hosp

ital D

25 (

17)

/ Grp

1 63

.67±

9.86

(42.

83)

/ Cor

onar

y by

pass

surg

ery

Non

e / M

ML

/ ndo

m /

1-m

in/ N

S / A

ctio

n A

CT

: Act

ivity

cou

nts;

Sick

ness

Im

pact

Pro

file

N

S / N

S / S

mal

l sam

ple

Rel

atio

nshi

p be

twee

n rh

yth-

mic

& li

near

pat

tern

s of

act

iv-

ity w

/ rec

over

y; i.

e. P

ositi

vere

latio

nshi

p be

twee

n le

ngth

of

stay

& d

ysfu

nctio

n w

/ sho

rter

activ

ity p

erio

ds a

ssoc

iate

d w

/le

ss d

ysfu

nctio

n. P

ositi

ve c

ir-

cadi

an a

ctiv

ity p

erio

ds w

ere

rela

ted

to b

ette

r fu

nctio

ning

& s

hort

er s

tay

Loo

ked

at r

hyth

ms

as a

n ou

t-co

me

Red

eker

(15

7)

4C-b

Obs

erva

tiona

l stu

dy, d

escr

ip-

tive,

cor

rela

tiona

l / O

ut-o

f-la

bho

spita

l bed

/ E

ntir

e 24

-hs;

Con

tinuo

us f

or c

ours

e of

hos

-pi

tal s

tay

(ran

ge =

1-1

0D)

40 (

33)

/ M 5

6.1±

11.9

, F59

.5±1

0.9

/ Car

diac

dis

ease

:ac

ute

myo

card

ial i

nfar

ctio

n,un

stab

le a

ngin

a

Non

e / M

ML

/ ndo

m /

1-m

in /

NS

/ Act

ion

3 A

CT

: Nig

ht in

terv

al, T

ST,

SE, n

um w

akes

, dur

of

slee

pin

terv

al, d

ur o

f w

akes

; Ver

an&

Syn

der-

Hal

pern

Sle

epSc

ale-

pts.

Per

cept

ion

of th

eir

slee

p; S

leep

loss

sub

scal

e of

pt. S

leep

scr

eene

r

Exc

lusi

on: K

now

n sl

eep

dis-

orde

rs, p

sych

otro

pic

med

s,bl

indn

ess,

dea

fnes

s / N

S

pre-

hosp

ital e

ndog

enou

s va

ri-

able

s, a

ge, g

ende

r, &

New

Yor

k H

eart

Ass

ocia

tion

func

-tio

nal c

lass

ific

atio

n an

d pr

e-ho

sp s

leep

loss

all

rela

ted

toSE

& d

ur o

f w

akes

onc

e ho

s-pi

taliz

ed. P

re-h

osp

seve

rity

of

card

iac

dise

ase

grea

test

cor

re-

late

Red

eker

(15

5)

4C-b

Cas

e se

ries

/ O

ut-o

f-la

b ho

s-pi

tal b

ed /

Ent

ire

24-h

s;C

ontin

uous

for

hos

pita

l sta

y

22 (

NS)

/ G

rp1

57.1

2±6.

6(4

7-65

), G

rp2

72.3

6±4.

1 (6

6-77

) / C

oron

ary

arte

ry b

ypas

s

Non

e / M

ML

/ ndo

m /

1 m

in/ N

S / A

CT

ION

3

AC

T: a

ctiv

ity c

ount

s, c

osin

orpa

ram

eter

s; S

ickn

ess

Impa

ctPr

ofile

Exc

lusi

on: H

/o o

f ps

ychi

atri

cdi

sord

er, n

euro

mus

cula

r di

s-or

der,

chro

nic

rena

l fai

lure

,bl

indn

ess,

dea

fnes

s / S

mal

lSa

mpl

e

Act

ivity

leve

ls &

str

engt

h of

CR

s in

crea

sed

over

Ds

2-5

post

-ope

rativ

e. I

n ol

der

adul

tsit

took

long

er (

at a

slo

wer

rate

)

Exa

min

ed th

e ef

fect

of

age

Rey

ner

(147

)

4C-b

Unb

linde

d, n

onra

ndom

ized

,ob

serv

atio

nal s

tudy

/ H

ome

/N

octu

rnal

onl

y fo

r N

S hs

;15

Nt A

CT

NS

(400

) / G

rp1

(20-

34),

Grp

2 (3

5-49

), G

rp3

(50-

70)

/ Sle

ep n

orm

al C

omm

unity

dwel

ling

peop

le li

ving

nea

r 4

UK

air

port

s

log

/ “Sw

iss-

type

” G

aehw

iler

elec

tron

ics

/ wri

st /

30 s

ec /

NS

/ Hor

ne e

t al,

“SO

n al

go-

rith

m”

log;

AC

T: t

ime

of S

On,

SQ

do

or-t

o-do

or s

urve

y / s

leep

-pr

omot

ing

med

s or

exc

essi

veal

coho

l / N

S

Tim

e of

SO

n w

as e

ffec

ted

byge

nder

& a

ge; a

nd d

iffe

red

from

log

and

AC

T; A

vera

gem

ovem

ent d

eclin

ed w

/ age

,an

d m

en h

ad m

ore

mov

emen

tth

an w

omen

Sade

h (1

72)

4C-b

Obs

erva

tiona

l., lo

ngtit

udin

al /

hom

e / n

octu

rnal

, 5N

13

5/13

5 / M

, 69,

F, 6

6, N

S(7

.2-1

2.7)

/ no

rmal

, NS

Non

e / M

ini-

mot

ionl

ogge

r(A

MI)

/ no

n-do

m w

rist

/ 1-

min

/ N

S / S

adeh

act

igra

phic

scor

ing

algo

rith

m

AC

T; S

O, m

orni

ng u

p tim

e,to

tal s

leep

per

iod,

% s

leep

, #aw

akes

, lon

gest

sle

ep p

erio

d,qu

iet s

leep

%, n

euro

psyc

hte

sts

NS

/ NS

K

ids

frag

men

ted

slee

p ha

dlo

wer

per

form

ance

and

mor

ebe

havi

or p

robl

ems

Cit

atio

n - A

utho

r/

Evi

denc

e L

evel

St

udy

Cri

teri

a D

esig

n /

Loc

atio

n / P

roto

col

Sam

ple

Size

(C

ompl

eted

Stud

y) /

Mea

n A

ge (

Ran

ge)

/M

edic

al C

ondi

tion

s

Com

pari

son

Mea

sure

s /

Act

igra

ph a

ppar

atus

/P

lace

men

t / E

poch

Len

gth

/Se

nsit

ivit

y / S

cori

ng

Out

com

e M

easu

res

Incl

usio

n / E

xclu

sion

/ B

ias

Stud

y C

oncl

usio

n fr

ompa

per

Com

men

ts f

rom

Rev

iew

er


Sade

h (2

06)

4C-b

Cas

e-co

ntro

l stu

dy /

Hom

e /

Ent

ire

24 h

s 3-

4D

NS

(NS)

/ G

rp1

12.1

(8.

2-15

.4),

Grp

2 12

.4 (

8.9-

14.7

) /

asth

ma

Non

e / A

MA

-32

(AM

I) /

ndom

/ 1

min

/ N

S / A

SApr

o-gr

am

AC

T: S

OL

, TST

, s1e

ep p

er-

cent

, lon

gest

SP,

% q

uiet

slee

p; a

ctiv

ity le

vel;

Pulm

onar

y fu

nctio

n, a

sthm

ase

veri

ty, s

leep

Q b

y ch

ild &

pare

nt

NS

/ NS

/ NS

Ast

hma

kids

wer

e m

ore

activ

e du

ring

sle

ep &

had

less

% q

uiet

sle

ep; b

oys

w/ a

sth-

ma

fell

asl

eep

fast

er th

angi

rls;

con

trol

gir

ls f

ell a

slee

pfa

ster

than

boy

s; %

slee

p &

mea

n ac

tivity

cor

rela

ted

w/

even

ing

& m

orni

ngPu

lmon

ary

peak

exp

irat

ory

flow

mea

sure

s &

poo

r sl

eep

asso

ciat

ed w

/ mor

e se

vere

asth

ma

Was

fir

st h

ome-

base

d ev

alua

-tio

n of

ast

hma

& s

leep

inch

ildre

n

Sade

h (2

07)

4C-b

Obs

erva

tiona

l stu

dy /

out o

fla

b ho

spita

l bed

/ E

ntir

e 24

hrs;

3D

39 (

NS)

/ G

rp1

9.51

±1.

9 (7

-14

) / S

ever

e ps

ychi

atri

c pr

ob-

lem

s

Non

e / A

MA

-32

/ non

-dom

/1

min

/ N

S / A

SAA

CT

: SO

, TSP

, % s

leep

, tru

esl

eep

time,

long

est s

leep

per

-ce

nt, %

qui

et s

leep

; WIS

C -

R, D

epre

ssio

n sc

ale,

psy

cho-

logi

cal t

ests

, Abu

se h

isto

ry

NS

/ NS

/ NS

Low

er S

Q d

urin

g ho

spita

liza-

tion

stro

ngly

ass

ocia

ted

w/

self

rep

ort o

n de

pres

sion

,ho

pele

ssne

ss &

low

sel

fes

teem

in c

hild

ren

w/ s

ever

ebe

havi

or d

isor

ders

Saka

kiba

ra (

207)

4C-b

Unb

linde

d; R

ando

miz

ed;

cros

s-ov

er d

esig

n / H

ome

/E

ntir

e 24

-hs;

5N

t AC

T, P

SGla

st 2

Nt

10 (

10)

/ 59.

7 (5

0-69

) /

Nor

mal

N

S / M

ML

/ ndo

m /

NS

/ NS

/ Col

e et

al

log;

PSG

; AC

T: m

ean

activ

i-ty

, mov

emen

t ind

ex, d

aytim

eac

tivity

leve

l

Exc

lusi

on: O

n m

eds,

men

tally

ill, p

hysi

cally

ill /

Sm

all s

am-

ple

60 m

ins

of b

righ

t lig

ht in

the

mor

ning

red

uced

noc

turn

alac

tivity

Sche

rder

(11

4)

4C-b

Ran

dom

ized

/ N

S / E

ntir

e 24

-hs

; 4D

AC

TB

L1,

4D

AC

Taf

ter

6wk

Tx;

4D

AC

Taf

ter

6wks

no

Tx

16 (

15)

/ Grp

1 81

.7 (

70-9

1) /

Alz

heim

er’s

Dis

ease

N

S / N

o in

fo

AC

T: i

s (i

nter

daily

sta

bilit

y);

IVin

terd

aily

var

iabi

lity;

RA

rela

tive

ampl

itude

Exc

lusi

on: A

lcoh

olis

m, P

sych

illne

ss, c

ereb

ral t

raum

a,C

ereb

rova

scul

ar d

is, E

pile

psy,

etc.

/ N

ot e

noug

h in

fo

TE

NS

incr

ease

d IS

Schl

esin

ger

(208

)

4C-b

Unb

lend

ed, n

onra

ndom

ized

,ob

serv

atio

nal s

tudy

/hom

e /

noct

urna

l onl

y fo

r N

S h

/ 3 N

tA

fter

whi

plas

h in

jury

and

3N

t f/

u (3

-5 m

onth

s la

ter

NS

(34)

Grp

1, M

, 4, F

, 14;

Grp

2, M

, 5, F

, 11

/ Grp

1,

36.5

, (2

0-48

, SD

= 8

.5)

Grp

2, 3

3.2,

(20

-50,

SD

= 8

.0)

,no

rmal

, Grp

1; a

cute

whi

plas

hin

jury

in tr

affi

c ac

cide

nt, G

rp2,

nor

mal

con

trol

s

Non

e / A

MI

/ wri

st /

NS

/ NS

/ Act

igra

ph S

tatis

tical

ana

lysi

s Sl

eep

diar

y, lo

g; A

CT,

SL

,to

tal c

umul

ativ

e S

dur,

SEan

d nu

m a

rous

als

Exc

lusi

on G

rp 2

: no

med

s, n

osl

eep

prob

lem

s, n

o h/

ow

hipl

ash

inju

ry

No

sign

ific

ant d

iffe

renc

es in

AC

Tm

easu

red

slee

p be

twee

nw

hipl

ash

pts

and

cont

rols

. In

slee

p lo

gs, w

hipl

ash

pts

had

prol

onge

d SL

, and

impa

ired

SQ.

In w

hipl

ash

pts,

gre

ater

sign

s/sy

mpt

oms

of w

hipl

ash

corr

elat

ed w

ith g

reat

er n

umar

ousa

ls a

nd lo

wer

SE

.

Schn

elle

(20

9)

5D-b

Con

trol

led

clin

ical

tria

l,un

blin

ded,

non

rand

omiz

ed,

cros

s-ov

er d

esig

n / N

H /

Noc

turn

al f

or 1

0 hs

; 5N

t AC

T

267

(184

) / N

o in

fo /

NS

NS

/ NS

AC

T: P

eak

activ

ity; m

ean

activ

ity

Noi

se &

ligh

t red

uced

cor

re-

late

d w

/ cha

nge

in %

sle

epbu

t no

chan

ge in

D s

leep

(by

obse

rvat

ion)

or

actu

al s

leep

vari

able

s

Mea

sure

d no

ise

leve

ls, u

sed

AC

Ton

ly a

t Nt,

used

obs

er-

vatio

n of

sle

ep d

urin

g D

Schw

ietz

er (

210)

5D-b

RC

T; D

B; c

ompa

rativ

e T

x /

Lab

orat

ory

/ 3D

AC

TN

S (1

2) /

31.3

±8.

1 / N

orm

al;

Hyp

erse

nsiti

vity

to e

nvir

on-

men

tal a

llerg

en

MSL

T/ (

AM

I) /

NS

/ 1 m

in /

NS

/ NS

Log

: VA

S; M

SLT,

sim

ulat

edas

sem

bly

line

task

N

o A

CT

resu

lts r

epor

ted.

afte

r 3

Ds

amou

nt o

f sl

eepi

-ne

ss r

epor

ted

and

on M

SLT,

sam

e in

all

Grp

s

Not

giv

en a

ny in

fo o

n ac

ti-gr

aph

resu

lts

Sham

ir (

211)

4C-b

RC

T; D

B; c

ross

-ove

r de

sign

;co

mpa

rativ

e T

x / N

S / 3

Nt

AC

Tdu

ring

eac

h T

x ph

ase

2mg

mel

vs.

pla

cebo

27 (

19)

/ 42±

5 (2

4-67

) /

Inso

mni

a; S

chiz

ophr

enia

N

S / S

omni

tor

/ NS

/ NS

/ NS

/ NS

AC

T: S

E, S

OL

, TST

, WA

SO,

Frag

men

tatio

n in

dex,

num

wak

es

Exc

lusi

on: L

iver

or

rena

l dis

-ea

se o

r ot

her

psyc

h di

sord

ers,

seve

re p

hysi

cal i

llnes

s / M

uch

info

rmat

ion

mis

sing

on

AC

T

SE im

prov

ed w

/ mel

com

-pa

red

to p

lace

bo in

thos

e w

host

arte

d ou

t w/ p

oor

slee

p

Ana

lyze

d th

ose

w/ p

oor

slee

pto

sta

rt o

ut w

/ sep

arat

ely

Shilo

(21

2)

4C-b

Obs

erva

tiona

l stu

dy /

Out

-of-

lab

hosp

ital b

ed /

Ent

ire

24-

hs; 7

2 hs

AC

T

NS

(14)

/ G

rp1

61±

11 (

39-7

6)G

rp2

59±

11 (

49-7

4) /

All

onIC

U

NS

/ Som

nito

r / N

S / N

S / N

S/ N

S M

elat

onin

; AC

T: T

STV

ery

little

sle

ep in

a 7

2-h

peri

od 6

-SM

Tab

norm

al in

all

w/ n

o no

ctur

nal r

ise

Shilo

(21

3)

4C-b

Com

para

tive

Tx

(mel

/pla

ce-

bo)

/ Out

-of-

lab

hosp

ital b

ed /

Ent

ire

24-h

s; 3

D A

CT

NS

(8)

/ 62±

14 (

30-7

2) /

On

pulm

onar

y IC

U-C

OPD

N

S / S

omni

tor

/ ndo

m w

rist

/1m

in /

NS

/ NS

AC

T: T

ST, n

um a

wak

enin

gs

NS

/ NS

/ Sm

all s

ampl

e bu

tun

ders

tate

d po

pula

tion

Mel

aton

in im

prov

ed s

leep

-bo

th d

urat

ion

& q

ualit

y

Cit

atio

n - A

utho

r/

Evi

denc

e L

evel

St

udy

Cri

teri

a D

esig

n /

Loc

atio

n / P

roto

col

Sam

ple

Size

(C

ompl

eted

Stud

y) /

Mea

n A

ge (

Ran

ge)

/M

edic

al C

ondi

tion

s

Com

pari

son

Mea

sure

s /

Act

igra

ph a

ppar

atus

/P

lace

men

t / E

poch

Len

gth

/Se

nsit

ivit

y / S

cori

ng

Out

com

e M

easu

res

Incl

usio

n / E

xclu

sion

/ B

ias

Stud

y C

oncl

usio

n fr

ompa

per

Com

men

ts f

rom

Rev

iew

er


Shin

koda

(21

4)

4C-b

Obs

erva

tiona

l stu

dy /

Hom

e /

Ent

ire

24-h

s; ~

4 m

os A

CT

NS

(4)

/ (26

-31)

/ N

orm

al;

preg

nant

or

post

-del

iver

y N

S / A

MA

-32C

L(A

MI)

/nd

om w

rist

/ 1

min

/ N

S / N

S lo

g / A

CT

: TST

, SE

, SO

L,

Nap

s, W

ASO

N

S / N

S / L

ow s

ampl

e bu

tun

usua

l pop

ulat

ion

Aft

er d

eliv

ery,

sle

ep b

ecam

eir

regu

lar

& W

ASO

wen

t up

Shir

ota

(215

)

4C-b

Obs

erva

tiona

l stu

dy /

Hom

e /

Ent

ire

24-h

s; 1

0-14

D A

CT

NS

(28)

/ G

rp1

74.1

±4.

9,G

rp2

73.0

±5.

0 / N

orm

al

NS

/ NS

/ nd

om /

NS

/ NS

/N

S

log

/ AC

T: m

ean

act

ivity

,T

ST, S

OL

, TST

-nap

N

S / N

S / N

S H

i vol

ition

al a

ged

pts

had

wel

l str

uctu

red

slee

p an

dm

ost t

ook

1400

h na

p; lo

wvo

litio

nal h

ad p

oor

stru

ctur

edsl

eep

& to

ol ti

me-

depe

nden

tna

p ~

8h a

fter

aw

aken

ing

Stei

n (2

16)

5D-b

Con

trol

led

clin

ical

tria

l; D

B;

cros

s-ov

er d

esig

n / H

ome

/N

octu

rnal

onl

y fo

r 16

hs;

2-

18h

peri

ods

duri

ng e

ach

of 4

wks

of

prot

ocol

NS

(25)

/ 8±

1.8

(6-1

2) /

AD

HD

N

S / N

S / N

S / N

S / N

S / N

S lo

g; A

CT

: act

ivity

leve

l, SO

L,

TST

, num

aw

ake,

dur

atio

n of

wak

es

NS

/ NS

/ NS

Slep

t les

s w

hen

Rx

give

n T

IBth

an in

pla

cebo

The

ssin

g (1

04)

5D-b

Cro

ss-s

ectio

nal s

tudy

/L

abor

ator

y / D

iurn

al o

nly

for

8 hs

; 1D

AC

T(w

hile

asl

eep

in la

b du

ring

D)

30 (

24)

/ 21

(18-

29)

/ Nor

mal

N

S /(

AM

I) /

wri

st /

1 m

in /

NS

/ NS

log;

AC

T: T

ST, W

ASO

N

S / N

S / N

S N

o di

ffer

ence

in s

leep

betw

een

the

diff

eren

t lig

htco

nditi

ons

Test

ed s

hift

wor

kers

dur

ing

the

D a

fter

a n

ight

w/ b

righ

tlig

ht T

x

Usu

i (21

7)

4C-a

AC

Tco

mpa

red

with

oth

erte

chni

ques

/hom

e/en

tire

24 h

,5-

7 D

AC

T&

Log

s

18 (

18)

M, 1

1, F

, 7/ 3

0.1

(NS)

norm

al

Slee

p lo

g, d

iary

/Mot

ionl

ogge

r-A

MI/

non

-dom

wri

st /

1 m

in /0

.01

g/ra

d/s

/N

S

Slee

p di

ary,

log,

AC

T: s

leep

min

utes

, wak

e m

inut

es

NS/

NS/

low

sam

ple

size

Se

nsiti

vity

(sl

eep)

bet

wee

nA

CT

and

log

was

86.

7% a

ndsp

ecif

icity

(w

ake)

was

97.0

4%

Use

d A

CT

as g

old

stan

dard

tova

lidat

e sl

eep

log

in h

ealth

yad

ults

Usu

i (21

8)

4C-a

AC

Tco

mpa

red

with

oth

erte

chni

ques

/hom

e/ 2

-7D

AC

T&

log

35 (

35)

Grp

1; 2

7.6

, (N

S)G

rp 2

; 74.

3, (

NS)

Grp

3,

42.1

; (N

S) n

orm

al, n

arco

lep-

sy, o

ther

; sle

ep s

tate

mis

con-

cept

ion,

idio

path

ic h

yper

som

-ni

a, D

SPS

Slee

p lo

g, d

iary

/Mot

ionl

ogge

r –

AM

I / n

on-

dom

wri

st /

1 m

in /

0.01

g/ra

d/s

/ Col

e

Slee

p di

ary,

log

, AC

T: s

leep

& w

ake

min

utes

N

S/N

S/N

S Sl

eep

log

does

not

alw

ays

dete

ct s

leep

sta

te. A

gree

men

tdr

oppe

d du

ring

sle

ep-w

ake

tran

sitio

n pe

riod

s. S

ensi

tivity

was

low

er in

pat

ient

s w

ithsl

eep

diso

rder

s th

an n

orm

als.

Use

d ac

tigra

phy

as g

old

stan

-da

rd to

val

idat

e sl

eep

logs

inhe

alth

y vs

. eld

erly

vs.

sle

epdi

sord

ered

pat

ient

s

Usu

i (21

9)

5D-a

Unb

lend

ed, r

ando

miz

ed,

cros

s-ov

er d

esig

n, c

ase

seri

es/ h

ome

/ ent

ire

24 h

3D

AC

TB

L, 4

D A

CT

Tx

1, 3

D A

CT

was

hout

, 4 D

AC

TT

x 2.

Tx

=2

h br

ight

ligh

t 250

0 lu

x at

BT

or tr

iazo

lam

.125

mg

4 (3

) / N

S (

64-8

0) /

norm

al,

NS

Slee

p lo

g, d

iary

, VA

S-sl

eepi

-ne

ss /

Mot

ionl

ogge

r, A

MI

/no

n-do

m w

rist

/ N

S / .

01 g

/C

ole

et a

l

Slee

p di

ary,

log;

AC

T; d

ayT

ST, n

ight

TST

; Oth

ers:

sle

eplo

g va

riab

les:

Son

tim

e, S

Off

time,

day

TST

in m

aps

NS/

NS/

low

sam

ple

size

, no

plac

ebo

Dec

reas

ed D

and

Nt T

ST(b

yA

CT

) w

ith b

righ

t lig

ht.

Incr

ease

d N

TT

ST(b

y A

CT

with

tria

zola

m.

Find

ings

less

-en

ed o

ver

the

4 D

for

bot

hT

x.

Van

Lon

den

(220

)

4C-b

Obs

erva

tiona

l stu

dy /

NS

/E

ntir

e 24

-hs;

5D

AC

TN

S (7

8) /

Grp

1 45

.2±

14.4

(22-

77),

Grp

2 42

.2±

16.3

(19

-73

) / D

epre

ssio

n

NS

/ Gae

hwile

r / n

dom

/ 30

sec

/ NS

/ NS

log

/ AC

T: m

ean

activ

ity d

ur-

ing

W&

sle

ep; i

mm

obili

tydu

ring

sle

ep; f

ragm

enta

tion

NS

/ NS

/ NS

Dur

ing

W: p

ts <

mea

n ac

tivi-

ty th

an c

ontr

ols;

pts

low

erfr

agm

enta

tion

& lo

wer

TST

;D

urin

g sl

eep:

pts

had

hig

her

activ

ity

Van

Som

eren

(11

5)

4C-b

Obs

erva

tiona

l stu

dy /

Hom

e18

=N

t; N

H 1

6=N

t / E

ntir

e24

-hs;

155

hs

AC

T

42 (

34)

/ 72±

1.2

/A

lzhe

imer

’s

NS

/ NS

/ wri

st /

NS

/ NS

/E

EPR

OM

A

CT

: IS

(int

erda

ily s

tabi

lity)

,IV

(int

rada

ily v

aria

bilit

y)

NS

/ NS

/ NS

Rhy

thm

dis

turb

ance

in m

ost

Alz

heim

er’s

Dis

ease

pts

, no

sund

owni

ng, r

hyth

ms

in N

Hle

ss s

tabl

e th

an h

ome

part

icu-

larl

y in

IS

Ver

coul

en (

221)

5D-b

RC

T; D

B; p

aral

lel d

esig

n /

NS

/ Ent

ire

24-h

s; 1

2D A

CT

NS

(96)

/ G

rp1

38.5

±10

.1,

Grp

2 39

.9±

8.6,

Grp

337

.8±

11.9

, Grp

4 39

.8±

7.4

/C

hron

ic f

atig

ue s

yndr

ome;

depr

essi

on

NS

/ Act

omet

er /

ankl

e / N

S /

NS

/ NS

log;

AC

T: m

ean

activ

ity;

Moo

d: B

eck,

SIP

(SIP

-sic

k-ne

ss im

pact

pro

file

)

Exc

lusi

on: O

ther

psy

ch d

isor

-de

rs

No

diff

eren

ce in

any

out

com

em

easu

res

betw

een

the

4 G

rps

Wal

lace

-Guy

(22

2)

4C-b

Unb

lend

ed, n

onra

ndom

ized

,ob

serv

atio

nal s

tudy

/ ho

me

/en

tire

24 h

7D

AC

T

NS

(154

) F

, 154

/ 66

.7 (

51-

81)

/ nor

mal

, pos

tmen

opau

sal

wom

en

Non

e / A

ctill

ume

(AM

I) /

wri

st /

1 m

in /1

0 se

c / N

S /

NS

AC

T: l

ux, i

n-be

d sl

eep,

out

of

bed

slee

p, S

E, S

L, w

ake

with

-in

sle

ep, T

ST, s

leep

tim

ing,

amou

nt o

f da

ytim

e na

ppin

g;M

ood:

dep

ress

ion

brie

fsc

reen

ing

ques

tionn

aire

Incl

usio

n: p

artic

ipan

ts in

wom

ens’

heal

th in

itiat

ive

obse

rvat

iona

l stu

dy /

Exc

lusi

on/ p

hysi

cally

una

ble

to p

artic

ipat

e or

not

like

ly t

osu

rviv

e fe

w m

onth

s / N

S

Gre

ater

24-

h ill

umin

atio

n co

r-re

late

d w

ith s

hort

er S

L,

redu

ced

wak

e w

ithin

sle

ep,

and

grea

ter

depr

esse

d m

ood.

Eve

ning

ligh

t exp

osur

e w

asno

t ass

ocia

ted

with

thes

e va

ri-

able

s.

Cit

atio

n - A

utho

r/

Evi

denc

e L

evel

St

udy

Cri

teri

a D

esig

n /

Loc

atio

n / P

roto

col

Sam

ple

Size

(C

ompl

eted

Stud

y) /

Mea

n A

ge (

Ran

ge)

/M

edic

al C

ondi

tion

s

Com

pari

son

Mea

sure

s /

Act

igra

ph a

ppar

atus

/P

lace

men

t / E

poch

Len

gth

/Se

nsit

ivit

y / S

cori

ng

Out

com

e M

easu

res

Incl

usio

n / E

xclu

sion

/ B

ias

Stud

y C

oncl

usio

n fr

ompa

per

Com

men

ts f

rom

Rev

iew

er


Wol

ter

(223

)

4C-b

RC

T; D

B; p

aral

lel d

esig

n /

Hom

e &

out

-of-

lab

hosp

ital

bed

/ Ent

ire

24-h

s; 7

D A

CT

inho

spita

l, 7D

AC

Tla

st w

kpa

tch

Tx,

7D

AC

Tof

f pa

tch,

7D A

CT

@ 6

mos

f/u

71 (

NS)

/ 47

.5 (

23-6

6) /

Smok

er

NS

/ (A

MI)

/ w

rist

/ 1m

in /

NS

/ (A

MI)

lo

g; A

CT

: mea

n ac

tivity

, SE

,in

act i

ndex

dur

ing

D

Exc

lusi

on:O

SA, E

DS,

PL

MS,

narc

olep

sy, p

aras

omni

a / N

S 1.

NS

diff

in S

E b

etw

een

dif-

fere

nt p

atch

dos

es; 2

. At a

llph

ases

of

Tx

mea

n ac

t les

sth

an B

L

Yes

avag

e (2

24)

4C-b

Unb

lend

ed, n

on-r

ando

miz

ed,

obse

rvat

iona

l, lo

ngitu

dina

l/ho

me

/ ent

ire

24 h

5D

AC

Tev

ery

6 m

o fo

r an

ave

rage

2.2

yrs

NS

(42)

61.

9% M

, 38.

1% F

/70

.8 (

SD =

7.5

) / n

orm

al

Non

e / A

MI

/ non

-dom

wri

st /

30 s

ec /

NS

/ Act

ion

soft

war

eve

rsio

n 1.

32

Slee

p di

ary,

log,

AC

T: S

E,

ampl

itude

of

rest

, act

ivity

CR

;O

ther

s; M

MSE

Prob

ably

Alz

heim

er’s

dis

ease

and

MM

SE =

15.

/ maj

or m

ed-

ical

illn

ess

/ NS

Bet

wee

n su

bjec

ts d

iffe

renc

esex

plai

ned

over

55%

of

vari

-an

ce o

ver

time

in S

E a

nd C

R.

MM

SE s

tate

exp

lain

ed o

nly

5%

of

vari

ance

ove

r tim

e.

Zhd

anov

a (

225)

4C-b

Cas

e-co

ntro

l stu

dy /

Hom

e /

Ent

ire

24-h

s; 7

D A

CT

prio

r to

mel

. Tx,

5D

AC

Ton

mel

0.3m

g

13 (

NS)

/ 6.

5 (2

-10)

/In

som

nia;

Ang

elm

an s

yn-

drom

e

NS

/ min

i-lo

gger

200

0 / p

ock-

et o

n ba

ck o

f ve

st /

1min

/ N

S/ M

ITal

gor.

log;

End

ocri

ne M

easu

res;

AC

T: n

um b

ody

mov

emen

ts,

TSP

NS

/ NS

/ Not

blin

ded,

no

plac

ebo

cont

rol

Slee

p im

prov

ed w

/ mel

Documents

Cpr Actigraphy