Evaluation of circadian rhythms in depression by using actigraphy: a systematic review and meta-analysis

doi:10.3969/j.issn.1674-8115.2024.05.009

Abstract

Abstract:

Objective ·To systematically review the effectiveness of actigraphy on the evaluation of circadian rhythm characteristics in patients with depression. Methods ·A systematic literature search was conducted in PubMed, Embase, Web of Science, Cochrane Library, PsycINFO, CNKI, WanFang Data, and Chinese biomedical literature database (CBM), from the inception of each database to May 5th, 2023. Case control studies that used actigraphy to evaluate circadian rhythms in patients with depression and compared them with healthy controls were collected. Literature was screened according to the inclusion and exclusion criteria, and the quality of the included literature was evaluated by using the Newcastle-Ottawa Scale. The meta-analysis was performed by using RevMan 5.4 software. Results ·A total of 9 articles were included, including 390 patients with depression and 288 healthy controls. The meta-analysis showed that the MESOR (midline statistic of rhythm) (SMD=-0.29, 95% CI -0.51 ? -0.07, P=0.009) of the circadian cosine function in patients with depression was lower than that in healthy controls; sleep onset (MD=33.06, 95% CI 14.90 ? 51.23, P=0.000) and sleep offset (MD=53.80, 95% CI 22.38 ? 85.23, P=0.000) were later in patients with depression than those in healthy controls; no statistical difference was found in the activity level of the most active 10 hours (SMD=-0.26, 95% CI -0.52 ? 0.01, P=0.060) between patients with depression and healthy controls, although there was a trend for lower activity in patients with depression; no statistical difference was found in the acrophase (MD=25.33, 95% CI -12.41 ? 63.06, P=0.190) of the circadian cosine function between patients with depression and healthy controls; no clear statistical significance of the difference was found in the amplitude (SMD=-0.14, 95% CI -0.42 ? 0.14, P=0.340) and the activity level of the least active 5 hours (SMD=0.31, 95% CI -0.10 ? 0.71, P=0.140) between patients with depression and healthy controls. Conclusion ·Actigraphy can reflect circadian rhythm disruption in patients with depression to some extent, but the limited number of included studies and inconsistencies in the study populations and methodologies have affected the quality and results of the analyses. More high-quality clinical trials are needed to provide evidence.

Key words: depression, actigraphy, circadian rhythm, meta-analysis, systematic review

CLC Number:

R749

SUN Chenyin, WU Baichuan, ZHANG Huifeng, FANG Yiru, PENG Daihui. Evaluation of circadian rhythms in depression by using actigraphy: a systematic review and meta-analysis[J]. Journal of Shanghai Jiao Tong University (Medical Science), 2024, 44(5): 606-616.

Figures/Tables 11

TrendMD

References 51

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Study	Research area	Depression				Control			Actigraphy		Outcome
Study	Research area	Sample size/n	Age/year	Sex (male/female)/n	Diagnostic criteria	Sample size/n	Age/year	Sex (male/female)/n	Instrument model	Wearing time/d
ROBILLARD, 2015^[17]	Australia	135	20.0±4.4	47/88	DSM	41	25.3±5.8	19/22	Actiwatch-64/L/2, Philips Respironics	4‒22	①③⑥⑦
MERIKANTO, 2017^[18]	Finland	8	16.0±1.1	8/0	K-SADS-PL	9	16.0±0.7	9/0	Actiwatch-Plus®, Cambridge Neurotechnology Ltd, Cambridge, UK	23	①④⑤
SLYEPCHENKO, 2019^[19]	Canada	38	39 (22.75)	13/25	MINI	40	30 (20)	20/20	Actiwatch 2 monitor	15	①②③④⑤
MINAEVA, 2020^[20]	The Netherlands	58	52.34±10.59	22/36	CIDI	63	51.94±12.05	34/29	GENEActiv actigraphy	14	①②③
PYE, 2021^[21]	Australia	27	62.7±8.1	8/19	MINI	47	63.1±8.1	19/28	Respironics Actiwatch Spectrum	14	①②③④⑤⑥⑦
TONON, 2022^[22]	Brazil	39	16.1±0.7	19/20	K-SADS-PL	26	15.4±0.8	16/10	ActTrust Condor	10	②③④⑤⑥⑦
ROBILLARD, 2013^[23]	Australia	46	20.1±4.7	17/29	DSM-IV	20	24.8±2.5	8/12	Actiwatch64, Philips Respironics, OR	7	⑥⑦
ROBILLARD, 2018^[24]	Australia	35	21.1±2.9	14/21	DSM-IV	15	24.3±3.4	7/8	Actiwatch64/L/2, Philips Respironics, USA or GENEActiv, Activinsights, UK	12	⑥⑦
MCGLASHAN, 2019^[25]	Australia	8	24.25±2.12	0/8	DSM-IV-TR	31	21.19±2.65	0/31	Actiwatch Spectrum, PLUS, PRO, 2 or L, Philips Respironics, OR, USA	7	⑥⑦

Study	Research area	Depression				Control			Actigraphy		Outcome
Study	Research area	Sample size/n	Age/year	Sex (male/female)/n	Diagnostic criteria	Sample size/n	Age/year	Sex (male/female)/n	Instrument model	Wearing time/d
ROBILLARD, 2015^[17]	Australia	135	20.0±4.4	47/88	DSM	41	25.3±5.8	19/22	Actiwatch-64/L/2, Philips Respironics	4‒22	①③⑥⑦
MERIKANTO, 2017^[18]	Finland	8	16.0±1.1	8/0	K-SADS-PL	9	16.0±0.7	9/0	Actiwatch-Plus®, Cambridge Neurotechnology Ltd, Cambridge, UK	23	①④⑤
SLYEPCHENKO, 2019^[19]	Canada	38	39 (22.75)	13/25	MINI	40	30 (20)	20/20	Actiwatch 2 monitor	15	①②③④⑤
MINAEVA, 2020^[20]	The Netherlands	58	52.34±10.59	22/36	CIDI	63	51.94±12.05	34/29	GENEActiv actigraphy	14	①②③
PYE, 2021^[21]	Australia	27	62.7±8.1	8/19	MINI	47	63.1±8.1	19/28	Respironics Actiwatch Spectrum	14	①②③④⑤⑥⑦
TONON, 2022^[22]	Brazil	39	16.1±0.7	19/20	K-SADS-PL	26	15.4±0.8	16/10	ActTrust Condor	10	②③④⑤⑥⑦
ROBILLARD, 2013^[23]	Australia	46	20.1±4.7	17/29	DSM-IV	20	24.8±2.5	8/12	Actiwatch64, Philips Respironics, OR	7	⑥⑦
ROBILLARD, 2018^[24]	Australia	35	21.1±2.9	14/21	DSM-IV	15	24.3±3.4	7/8	Actiwatch64/L/2, Philips Respironics, USA or GENEActiv, Activinsights, UK	12	⑥⑦
MCGLASHAN, 2019^[25]	Australia	8	24.25±2.12	0/8	DSM-IV-TR	31	21.19±2.65	0/31	Actiwatch Spectrum, PLUS, PRO, 2 or L, Philips Respironics, OR, USA	7	⑥⑦

Study	Selection				Comparability		Outcome			Quality score
Study	①	②	③	④	①	②	①	②	③	Quality score
ROBILLARD, 2015^[17]	1	1	1	1	1	1	1	1	1	9
MERIKANTO, 2017^[18]	1	1	1	1	1	1	1	1	0	8
SLYEPCHENKO, 2019^[19]	0	1	1	1	1	1	1	1	0	7
MINAEVA, 2020^[20]	0	1	1	1	1	1	1	1	1	8
PYE, 2021^[21]	0	1	0	1	1	0	1	1	1	6
TONON, 2022^[22]	0	1	1	1	0	1	1	1	0	6
ROBILLARD, 2013^[23]	1	1	0	0	0	1	1	1	1	6
ROBILLARD, 2018^[24]	0	1	1	1	0	1	1	1	1	7
MCGLASHAN, 2019^[25]	0	0	1	1	0	1	1	1	1	6

Study	Selection				Comparability		Outcome			Quality score
Study	①	②	③	④	①	②	①	②	③	Quality score
ROBILLARD, 2015^[17]	1	1	1	1	1	1	1	1	1	9
MERIKANTO, 2017^[18]	1	1	1	1	1	1	1	1	0	8
SLYEPCHENKO, 2019^[19]	0	1	1	1	1	1	1	1	0	7
MINAEVA, 2020^[20]	0	1	1	1	1	1	1	1	1	8
PYE, 2021^[21]	0	1	0	1	1	0	1	1	1	6
TONON, 2022^[22]	0	1	1	1	0	1	1	1	0	6
ROBILLARD, 2013^[23]	1	1	0	0	0	1	1	1	1	6
ROBILLARD, 2018^[24]	0	1	1	1	0	1	1	1	1	7
MCGLASHAN, 2019^[25]	0	0	1	1	0	1	1	1	1	6

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