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The Role of Actigraphy in the Assessment of Central Disorders of Hypersomnolence: A Systematic Review and Meta-Analysis
Published online by Cambridge University Press: 26 May 2025
Abstract
Background:
Actigraphy provides an objective measure of sleepiness and is recommended by the American Academy of Sleep Medicine for use 7–14 days prior to multiple sleep latency testing. It plays a valuable role in the differential diagnosis of hypersomnolence.
Objective:
Our aim was to provide a comprehensive summary of actigraphy features in central disorders of hypersomnolence (CDH).
Methods:
Data were sourced from six bibliographic databases. Fixed- or random-effects models were applied to compare patients with narcolepsy type 1 (NT1) to controls.
Results:
Of the 1,737 publications identified in our search, 8 studies met the inclusion criteria. The total sample consisted of 473 participants, encompassing patients with NT1, idiopathic hypersomnia (IH), hypersomnolence with normal CSF hypocretin-1 levels, Kleine–Levin syndrome (KLS), traumatic brain injury (TBI), major depressive disorder (MDD), myotonic dystrophy (MD), primary insomnia and healthy controls. Actigraphy devices varied across studies. Compared to control subjects, NT1 patients had lower total sleep time (TST), sleep efficiency and daytime motor activity, with increased wake after sleep onset, awakenings, nocturnal motor activity and longest nap duration. In KLS, TST was higher during hypersomnia episodes than during asymptomatic phases. TBI and MDD patients had a higher TST than the control group, while MD patients had a lower TST than patients with IH.
Conclusions:
Actigraphy is a valuable tool for objectively assessing sleep and can assist in detecting CDH. However, the absence of standardized guidelines limits their broader implementation in clinical practice.
Résumé
Le rôle de l’actigraphie dans l’évaluation des troubles de l’hypersomnie d’origine centrale : une revue systématique et une méta-analyse.
L’actigraphie fournit une mesure objective de la somnolence et est recommandée par l’American Academy of Sleep Medicine pour une utilisation de 7 à 14 jours avant les tests de latence du sommeil multiple. Elle joue un rôle précieux dans le diagnostic différentiel de l’hypersomnie. Objectif : Notre but était de fournir un résumé complet des caractéristiques de l’actigraphie dans les troubles de l’hypersomnie d’origine centrale.
Nos données provenaient de six bases de données bibliographiques. Des modèles à effets fixes ou aléatoires ont été appliqués pour comparer les patients atteints de narcolepsie de type 1 (NT1) aux témoins.
Sur les 1 737 publications identifiées lors de notre recherche, huit études répondaient à nos critères d’inclusion. L’échantillon total était ainsi composé de 473 participants, ce qui incluait des témoins en santé et des patients atteints de NT1, d’hypersomnie idiopathique (HI), d’hyper-somnolence avec des niveaux normaux d’hypocrétine-1 dans le liquide cérébrospinal (LCS), du syndrome de Kleine-Levin (SKL), de lésions cérébrales traumatiques (LCT), de troubles dépressifs majeurs (TDM), de dystrophie myotonique et d’insomnie primaire. Les appareils d’actigraphie variaient d’une étude à l’autre. Par rapport aux témoins, les patients atteints de NT1 donnaient à voir un temps de sommeil total (TST), une efficacité du sommeil et une activité motrice diurne plus faibles, avec une augmentation des réveils après le début du sommeil, des réveils en cours de sommeil, de l’activité motrice nocturne et de la durée de leurs siestes.Dans le cas du SKL, le TST était plus élevé pendant les épisodes d’hypersomnie que pendant les phases asymptomatiques. Les patients atteints de LCT et de TDM avaient un TST plus élevé que les témoins, tandis que les patients atteints de dystrophie myotoniqueavaient un TST plus faible que les patients atteints d’HI.
L’actigraphie est un outil précieux pour évaluer objectivement le sommeil et peut aider à détecter l’hypersomnie d’origine centrale. Cependant, l’absence de directives standardisées limite une mise en œuvre plus étendue dans la pratique clinique.
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Maia et al. supplementary material
Maia et al. supplementary material
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