Sample Actigraphy Report
Emma Jones is a 4-year-old girl with WAGR syndrome, a genetic condition characterized by intellectual disability, visual impairments, and tumors of the kidneys and gonads and commonly associated with anxiety, attention-deficit/hyperactivity disorder (ADHD), and ASD. Emma has a history of difficulties initiating sleep, prolonged nocturnal awakenings, and/or early sleep termination. An actigraphy study was ordered to evaluate Emma’s sleep patterns, including sleep onset time, sleep onset latency, night-waking frequency and duration, sleep offset time, and sleep efficiency. Emma was asked to wear an Ambulatory-Monitoring Sleepwatch actigraph for 17 days (although she only wore the device 14/17 days), and her parents kept a concurrent sleep diary. This report contains an overall summary. Attached is the actigram, giving a picture of the full actigraphy study.
Summary of Overall Sleep Patterns
Per her parents, Emma’s average bedtime (time when she attempted to fall asleep) was 7:52 pm. Actigraphy found a sleep onset time of 8:35 pm. Emma’s parents reported an average wake time of 6:46 am, with actigraphy showing her average wake time to be 6:30 am. Notably on four mornings, Emma had early sleep termination (waking between 3:51 am and 5:09 am).
Emma’s average sleep onset latency was somewhat prolonged at 42.4 min, with a sleep onset latency above 30 min on 10 of the 14 nights. There was notable variability in her sleep onset latency, with six nights between 30 and 50 min, and four nights greater than 50 min.
Overall Emma had an average sleep opportunity of 10.9 hours, with her sleeping an average of only 8.4 h. Emma’s sleep efficiency (actigraphy time sleeping divided by reported time in bed) was low at 77% (normal above 80%). Again, significant variability was found with her sleep efficiency, with three nights below 70% and five nights 85% or higher.
Parents reported an average of 0.3 night wakings, estimating these wakings were approximately 1 h each. However, by actigraphy Emma averaged 1.9 wakings per night (>10 min), with a range of 0–3 wakings per night. Notably, on 4 of the 14 nights Emma had a prolonged waking greater than 150 min (or 2.5 h). These prolonged night awakenings are highly abnormal.
Summary and Recommendations
Emma is a 4-year-old girl with WAGR syndrome and a history of difficulties initiating and maintaining sleep. Prior to this study, Emma began taking small doses of melatonin both at dinnertime and bedtime, which her parents reported has been helpful with sleep initiation. Parents also reported that in general Emma seems to be sleeping better than before. However, this actigraphy study shows that Emma continues to experience prolonged nighttime awakenings approximately twice a week, in addition to early sleep termination approximately twice a week. Subsequently, Emma will have about two to three nights per week where she sleeps 9.5–10.5 h
At this point it is not clear whether Emma or her family would benefit from additional pharmacological treatment for her sleep issues. Behaviorally the parents have worked on sleep training, and now Emma is able to fall asleep at bedtime independently and return to sleep independently following nighttime awakenings. Parents were not aware of all of Emma’s nighttime awakenings as she no longer cries every time she wakes but instead plays quietly, sometimes even singing or laughing.
I discussed with Emma’s parents the importance of monitoring Emma’s sleep and daytime functioning, and if one or both should significantly change, then a repeat actigraphy study may be indicated to help determine the need for additional treatment.