The design of monopile foundations for offshore wind turbine structures is dominated by requirements resulting from serviceability and fatigue limit state. To fulfil these criteria, the load deflection-behaviour and therefore long-term accumulations of permanent deflections and rotations of the monopile foundation due to cyclic occurring wind and wave loads have to be predicted. In this paper a brief overview on current design code practice as well as other proposed methods for the prediction of accumulated deflections or rotations is given. Further, the results of a systematic model test study dealing with the response of monopiles to lateral cyclic loading in medium dense sand at different cyclic load ratios, load eccentricities and pile embedment lengths are described and evaluated. The observations of the model test study are supplemented by results of a second test series involving the visualisation of displacement fields around laterally loaded piles by means of particle image velocimetry. Based on the findings and the results of previous experimental investigations, recommendations regarding the prediction of displacement accumulations for large diameter monopiles in sand are given. © 2020