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

Introduction: Individuals with substance use disorders (SUDs) are at increased risk for sleep disturbances, creating a bidirectional relationship that may heighten relapse risk. While polysomnography is the gold standard for measuring sleep, many studies have used actigraphy, a noninvasive, wrist-worn device that estimates rest-activity patterns and sleep-wake characteristics. Despite its utility, the use of actigraphy in populations with SUDs remains limited, and findings vary across substances and methodologies. This protocol outlines a systematic review and meta-analysis aiming to synthesize evidence on actigraphy-derived sleep outcomes across various substances. Method and analysis: We will include peer-reviewed observational or interventional studies involving individuals aged 18 or older with a diagnosis of substance use (e.g., alcohol, benzodiazepines, cannabis, cocaine, opioids, methamphetamine, or nicotine) who use actigraphy to assess sleep compared to matched controls. Studies will be excluded during screening if they do not use actigraphy, do not include populations with SUDs, or focus on participants younger than 18. There will be no restrictions on location, setting, or language. Databases to be searched include PubMed, Scopus, Web of Science, ProQuest, ClinicalTrials.gov, CINAHL, PsycINFO, and Embase. Titles and abstracts will be screened in the first phase, followed by full-text screening using eligibility criteria. At least two independent reviewers will assess risk of bias using the Risk Of Bias In Non-randomized Studies of Exposures (ROBINS-E) tool. A synthesis will summarize key findings, including study characteristics, population differences, and methodological variations. Discussion: This review will offer a clear and comprehensive assessment of the current literature on actigraphy to examine sleep in SUD and to inform future research to study sleep and its implications in SUD populations. Protocol registration number: International Prospective Register for Systematic Reviews (PROSPERO) number CRD420251072028.