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

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. 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. 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. 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. 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. CRD42021259780. •The review included 53 new studies up to December 2023.•Depressed individuals reported significantly poorer sleep than healthy controls.•Depressed individuals had disrupted circadian rest-activity rhythms.•Actigraphy has wide reaching and cost-effective public mental health implication.•Future studies can identify objective, distinctive 24-h rest-activity profiles in depression.