However, lacking standard quantitative criteria, it is difficult to use actigraphy to aid the diagnosis of sleep disorders, including insomnia. Vallières and Morin 14 showed that actigraphy is a reliable method for monitoring treatment response among insomnia patients, i.e., for comparing pre-and post-treatment sleep quality. One of the unresolved limits of actigraphy is the lack of quantitative criteria for the assessment of sleep quality. 11, 12 The latest one, published in 2007, 12 emphasized that the explosion in the number of studies using actigraphy, together with increased clinical experience in actigraphy use, has led to the inclusion of actigraphy as a possible adjunctive tool for the measurement of sleep duration and sleep patterns for certain sleep disorders in the second edition of the International Classification of Sleep Disorders (ICSD-2), 13 including: paradoxical insomnia, idiopathic hypersomnia, and circadian rhythm disorders. Since then several other updates have been published. In 1995 the American Academy of Sleep Medicine (at that time American Sleep Disorders Association) founded a working group, 7 known today as Standards of Practice Committee (SPC), to review, among other sleep medicine issues, the current knowledge of actigraphy use and to update guidelines. 6, 7 Even if no technological solution has as achieved the status of standard as yet, we know that different commercially available actigraphs have very similar performance. Actigraphy allows us to study patients in their own home environment for multiple nights and has a relatively low cost compared to PSG. Validation studies against PSG have confirmed that when sleep stage identification is not required actigraphy can provide objective and naturalistic measurements of sleep pattern. 5, For these reasons an alternative means of sleep assessment is desirable. Therefore, PSG is not indicated for routine evaluation of chronic insomnia unless the signs or symptoms of another sleep disorders are present. 4Īlthough polysomnography (PSG) is the accepted gold standard for sleep assessment, there is considerable variability in the sleep of insomniacs, and first night effect may produce results that are not representative of an individual's usual sleep pattern. Thus, an objective assessment of sleep in insomnia is crucially important. 3 Consequently sleep alterations characterizing insomnia are on a continuum, making the diagnostic process very difficult. A person can sleep well objectively but subjectively feel a poor sleeper (negative misperception) and vice versa (positive misperception). Data obtained by history-taking and sleep diaries are often challenging and even confounding as many people with insomnia seriously underestimate how much they really do sleep. 1, 2 THE FIRST STEP TOWARD EFFECTIVE treatment of insomnia is an initial clinical and instrumental assessment to establish a correct differential diagnosis. EPIDEMIOLOGICAL DATA INDICATE THAT INSOMNIA IS THE MOST COMMON SLEEP COMPLAINT IN THE INDUSTRIAL WORLD.
0 Comments
Leave a Reply. |
AuthorWrite something about yourself. No need to be fancy, just an overview. ArchivesCategories |