Actigraphy-based sleep outcomes in substance use disorders: A systematic review and meta-analysis

Sleep disturbances are prevalent in substance use disorders (SUDs). Objective (e.g., polysomnography) and subjective (e.g., Pittsburgh sleep quality index [PSQI]) assessments are commonly used, with polysomnography enabling sleep architecture analysis and diagnosis of sleep disorders, but its use limited by logistical constraints. Actigraphy offers a feasible alternative for longitudinal and naturalistic assessment. We aimed to synthesize actigraphy-based sleep outcomes in individuals with SUDs and compare them with subjective sleep measures. We conducted a meta-analysis (PROSPERO: CRD420251072028), searching 8 databases by March, 2026. Studies included adults with SUDs reporting actigraphy-based parameters and/or subjective sleep outcomes. Nine studies (n = 1366) met inclusion criteria. Actigraphy showed reduced total sleep time in alcohol use disorder (AUD) (mean difference [MD] = -44.67; 95%CI: -56.10 to -33.24) and opioid use disorder (MD = -40.00, 95%CI = -72.08 to -7.92), and increased wake after sleep onset in nicotine use disorder (MD = 6.60; 95%CI: 2.41-10.80). Subjective data indicated poorer sleep quality in AUD (PSQI MD = 4.37; 95%CI: 1.28-7.47). Available evidence suggests consistent objective and subjective sleep disturbances in AUD and general concordance between actigraphy- and polysomnography-derived sleep parameters. Actigraphy appears to be a feasible objective tool for sleep assessment in SUDs, though additional studies across diverse substances are needed.