0418 Use of Actigraphy for the Optimization of the Diagnosis and Treatment of Hypersomnia

Introduction Actigraphy and sleep logs are used prior to Mean Sleep Latency Test (MSLT) testing to effectively interpret MSLT. Inaccuracies in sleep logs may inadvertently mask insufficient sleep, thereby resulting in a false positive MSLT. We evaluate the use of actigraphy in comparison to patient-reported sleep logs in the diagnosis and treatment of hypersomnia. Methods Retrospective analysis of n=56 patients (average age 39±16.8 years, 19.5% male) who underwent evaluation for hypersomnia with actigraphy, sleep diary, polysomnogram (PSG), and MSLT in 2021 at the Cleveland Clinic was completed. Data was collected from the electronic medical record, actigraphy and polysomnography softwares. Positive MSLT (MSL) was defined as ≤8min. Average total sleep time (TST) from actigraphy and sleep logs were divided into three different time points; inadequate TSTs were defined at ≤8hours and ≤7hours, and invalid TST at ≤6hours. Paired t-test was used to compare TST from actigraphy and sleep diary. Receiver operating characteristic (ROC) analysis was performed to investigate the discrimination of MSLT(≤8min) by total sleep time from actigraphy and sleep logs using area under curve (AUC). Results Mean TST did not have a statistically significant difference between actigraphy and sleep logs (7.8±1.3 hours vs. 8.0±1.5 hours, p=0.53). However, on sub-analysis, out of 20 people who reported >8hours average TST on sleep logs, 11 were objectively found to have ≤8hours of average TST on actigraphy (55%). Of the 34 who reported >7hours TST on sleep logs, 8 had ≤7hours on actigraphy (24%). Of the 41 who reported >6hours TST on sleep logs, 1 had ≤6hours on actigraphy (2%). On MSLT, the average MSL was 12.7±5.1min, with 20% of patients with times ≤8min. Actigraphy performs better than sleep logs in discriminating MSL ≤8min (AUC 0.67 vs. 0.61). Conclusion Actigraphy is more objective than sleep logs and thus less prone to human recall errors. This study demonstrates the utility of actigraphy in the validation of the MSLT and in the accurate diagnosis of disorders of hypersomnia. In the future, our continued collection of an actigraphy and sleep log database will allow for more detailed analyses including consideration of the influence of medications on these findings. Support (If Any)