Actigraphy
DESCRIPTION
Actigraphy refers to the assessment of activity patterns by devices typically placed on the wrist or ankle that record body movement, which is interpreted by computer algorithms as periods of sleep and wake. Sleep/wake cycles may be altered in sleep disorders including insomnia, circadian rhythm sleep disorders, sleep-related breathing disorders, restless legs syndrome, and periodic limb movement disorder. In addition, actigraphy could potentially be used to assess sleep/wake disturbances associated with numerous other diseases or disorders such as attention-deficit/hyperactivity disorder, chronic fatigue syndrome, asthma, Parkinson’s syndrome, post-surgical delirium, stroke, advanced cancer, and intensive care monitoring.
Actigraphic devices are typically placed on the non-dominant wrist with a wristband and are worn continuously for at least 24 hours. Activity is usually recorded for a period of 3 days to 2 weeks, but can be collected continuously over extended time periods with regular downloading of data onto a computer. The activity monitors may also be placed on the ankle for the assessment of restless legs syndrome, or on the trunk to record movement in infants. The algorithms for detection of movement are variable among devices and may include “time above threshold,” the “zero crossing method,” or “digital integration” method, resulting in different sensitivities. Sensitivity settings (e.g., low, medium, high, automatic) can also be adjusted during data analysis. The digital integration method reflects both acceleration and amplitude of movement; this form of data analysis may be most commonly used today. Data on patient bed times (lights out) and rise times (lights on) are usually entered into the computer record from daily patient sleep logs or by patient-activated event markers. Proprietary software is then used to calculate periods of sleep based on the absence of detectable movement, along with movement-related periods of wake. In addition to providing graphic depiction of the activity pattern, device-specific software may analyze and report a variety of sleep parameters including sleep onset, sleep offset, sleep latency, total sleep duration, and wake after sleep onset. Actigraphy has been used for over 2 decades as an outcome measure in sleep disorders research. Numerous actigraphy devices have received U.S. Food and Drug Administration (FDA) approval through the 510(k) process.
POLICY
Actigraphy as a technique to record and analyze body movement, including but not limited to, its use to evaluate sleep disorders, is considered investigational.
See also: General Policy on Sleep Apnea and Sleep Disorder Diagnosis and Treatment
IMPORTANT REMINDERS
ADDITIONAL INFORMATION
Well-designed studies are not available in the published literature that validates the application of actigraphy to either diagnose or direct the management of individuals with sleep disorders.
SOURCES
BlueCross BlueShield Association. Medical Policy Reference Manual. (2:2012). Actigraphy (2.01.73). Retrieved December 4, 2012 from BlueWeb. (17 articles and/or guidelines reviewed)
Garciia-Dilaz, E., Quintana-Gallego, E., Ruiz, A., Carmona-Bernal, C., Sanchez-Armengol, A., Botebol-Benhamou, G., et al. (2007). Respiratory polygraphy with actigraphy in the diagnosis of sleep apnea-hypopnea syndrome. Chest, 131 (3), 725 - 732. (Level 2 Evidence)
Hayes. Medical Technology Directory. (2008, April). Actigraphy for diagnosis of obstructive sleep apnea syndrome in adults. Retrieved July 1, 2009 from www.Hayesinc.com/subscribers. (66 articles and/or guidelines reviewed)
Hayes. Medical Technology Directory. (2010, November; last update search November 2012). Actigraphy for diagnosis of circadian rhythm sleep disorders. Retrieved December 4, 2012 from www.Hayesinc.com/subscribers. (67 articles and/or guidelines reviewed)
Morgenthaler, T., Alessi, C., Friedman, L., Owens, J., Kapur, V., Boehlecke, B., et al. (2007). Practice parameters for the use of actigraphy in the assessment of sleep and sleep disorders. Sleep, 30 (40, 519-529. (Level 5 Evidence)
National Guideline Clearinghouse. National Center for Primary Care. (2007 April). Practice parameters for the use of actigraphy in the assessment of sleep and sleep disorders: an update for 2007. Retrieved July 1, 2009 from http://www.guideline.gov/summary/summary.aspx?doc_id=10779&nbr=005607&string=actigraphy.
National Guideline Clearinghouse. National Center for Primary Care. (2005 April). Practice parameters for the indications for polysomnography and related procedures: an update for 2005. Retrieved July 1, 2009 from http://www.guideline.gov/summary/summary.aspx?doc_id=8156&nbr=004545&string=practice+AND+parameters+AND+polysomnography.
U. S. Food and Drug Administration. (1986, June). Center for Devices and Radiological Health. Premarket notification database. Retrieved July 1, 2009 from. http://www.accessdata.fda.gov/scripts/cdrh/cfdocs/cfPMN/pmn.cfm?ID=59752.
U.S. Food and Drug Administration. (2007, October). Center for Devices and Radiological Health. 510(k) Premarket Notification Database. K071230. Retrieved July 1, 2009 from http://www.accessdata.fda.gov/cdrh_docs/pdf7/K071230.pdf.
ORIGINAL EFFECTIVE DATE: 1/14/2006
MOST RECENT REVIEW DATE: 1/10/2013
ID_BA
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