Actigraphic monitoring of sleep and circadian rest-activity rhythm in individuals with major depressive disorder or depressive symptoms: A meta-analysis

Background: Disrupted sleep and rest-activity pattern are common clinical features in depressed individuals. This meta-analysis compared sleep and circadian rest-activity rhythms in people with major depressive disorder (MDD) or depressive symptoms and healthy controls. Methods: Eligible studies were identified in five databases up to December 2023. The search yielded 53 studies with a total of 11,115 participants, including 4000 depressed participants and 7115 healthy controls. Results: Pooled meta-analyses demonstrated that depressed individuals have significantly longer sleep latency (SMD = 0.23, 95 % CI: 0.12 to 0.33) and wake time after sleep onset (SMD = 0.37, 95 % CI: 0.22 to 0.52), lower sleep efficiency (SMD = −0.41, 95 % CI: −0.56 to −0.25), more nocturnal awakenings (SMD = 0.58, 95 % CI: 0.29 to 0.88), lower MESOR (SMD = −0.54, 95 % CI: −0.81 to −0.28), amplitude (SMD = −0.33, 95 % CI: −0.57 to −0.09), and interdaily stability (SMD = −0.17, 95 % CI: −0.28 to −0.05), less daytime (SMD = −0.79, 95 % CI: −1.08 to −0.49) and total activities (SMD = −0.89, 95 % CI: −1.28 to −0.50) when compared with healthy controls. Limitations: Most of the included studies reported separate sleep and activity parameters instead of 24-hour rest-activity rhythms. The variabilities among actigraphy devices and the types of participants recruited also impede precise comparisons. Conclusions: The findings emerging from this study offered a better understanding of sleep and rest-activity rhythm in individuals with MDD or depressive symptoms. Future studies could advocate for deriving objective, distinctive 24-hour rest-activity profiles contributing to the risk of depression. PROSPERO registration number: CRD42021259780.