The Role of Actigraphy in Covid-19
The Coronavirus Pandemic (Covid-19) has undoubtedly had a profound effect upon the lives of the global population and will leave a legacy of diminished health and well-being for many years to come. It is critical to understand the impacts of Covid-19 upon human behaviour to help with a longer-term road map for recovery and rehabilitation.
Poor sleep is a known side effect in Covid-19 patients however the impact of the pandemic is more widespread when we also consider the sleep quality of front-line carers and that of the greater population during social isolation. Sleep is linked to the body’s defence system and promotes inflammatory homeostasis1 hence poor sleep can lead to increased susceptibility to opportunistic diseases. Circadian rhythms have been affected by imposed self-isolation and/or prolonged ‘lock-down’. Leone et al2 showed that both duration and timing of sleep are profoundly affected by these factors potentially leading to desynchronization which would negatively affect human performance and health. Reduced physical activity is well known to lead to potential health problems whereby appropriate physical activity can lead to reduced stress and anxiety. Wang et al3 noted that self-reported physical activity levels significantly decreased during the pandemic whereby physical activity is positively correlated to well-being.
There are hence 3 main areas of concern for researchers when examining the effects of the pandemic upon well-being:
Covid Patients – Disrupted sleep quality and reduced physical activity levels: Vitale et al4 noted that poorer sleep (immobility time, sleep efficiency, fragmentation) were positively correlated to severity of Covid-19 symptoms. Wrist actigraphy was used to obtain objective sleep data for subjects in the ICU with varying levels of severity. This study concluded that Wrist actigraphy assessment provided important clinical information about the sleep and activity levels of Covid-19 patients during the post-acute rehabilitation management.
Front-line Medical Staff – Ferini-Strambi et al5 carried out the first actigraphic study investigating the prevalence of sleep disorders among healthcare workers during the pandemic. This study suggests that ‘Poor sleep quality among the medical staff is prevalent, and our experience supports that this has increased during the COVID-19 pandemic’. There is hence a danger that reduced sleep may lead to impaired immune response and potential for increased stress, anxiety and depression.
General Population – As discussed above, the pandemic has led to a behavioural change related to self-isolation and/or prolonged ‘lock-down’ periods of social isolation and disrupted daily routine. There is a potential for longer term negative health impacts among the general population related to poorer sleep hygiene, disrupted circadian rhythms and reduced physical activity. It is essential to set out a road map to recovery and restoration of ‘normal’ behaviour to avoid a new future health catastrophe.
Actigraphy is a long-established means of monitoring subject behaviour unobtrusively to glean valuable objective insights into sleep, light exposure, circadian rhythms and daytime physical activity levels. Such objective data can help scientific research to inform Governments with strategies to move beyond the pandemic and mitigate the possible delayed impact of the negative health and well being effects of Covid-19.
1. Mônico-Neto M, Dos Santos RV, Moreira Antunes HK. The world war against the COVID-19 outbreak: Don’t forget to sleep!. Journal of Clinical Sleep Medicine. 2020 Jul 15;16(7):1215-.
2. Leone MJ, Sigman M, Golombek D. Effects of social isolation on human sleep and chronotype during the COVID-19 pandemic. CURRENT-BIOLOGY-D-20-01055. 2020.
3. Wang H, He L, Gao Y, Gao X, Lei X. Effects of physical activity and sleep quality on well‐being: A wrist actigraphy study during the pandemic. Applied Psychology: Health and Well‐ 2021 Feb 21.
4. Vitale JA, Perazzo P, Silingardi M, Biffi M, Banfi G, Negrini F. Is disruption of sleep quality a consequence of severe Covid-19 infection? A case-series examination. Chronobiology international. 2020 Jul 2;37(7):1110-4.
5. Ferini-Strambi L, Zucconi M, Casoni F, Salsone M. COVID-19 and sleep in medical staff: reflections, clinical evidences, and perspectives. Current Treatment Options in Neurology. 2020 Oct;22(10):1-6.
Other Sleep and Covid-19 Resources:
Sleep and Covid-19 – Article in Healthier Sleep Magazine
Sleep Neurologists Call it ‘COVID-Somnia’ – Article in NeurologyToday.
Sleep Guidelines During the Covid-19 Pandemic – Sleep Foundation
Sleep research in 2020: COVID-19-related sleep disorders – The Lancet Neurology