Combining cardiac monitoring with actigraphy aids nocturnal arousal detection during ambulatory sleep assessment in insomnia

Abstract

Study Objectives The objective assessment of insomnia has remained difficult. Multisensory devices collecting heart rate (HR) and motion are regarded as the future of ambulatory sleep monitoring. Unfortunately, reports on altered average HR or heart rate variability (HRV) during sleep in insomnia are equivocal. Here, we evaluated whether the objective quantification of insomnia improves by assessing state-related changes in cardiac measures. Methods We recorded electrocardiography, posture, and actigraphy in 33 people without sleep complaints and 158 patients with mild to severe insomnia over four days in their home environment. At the microscale, we investigated whether HR changed with proximity to gross (body) and small (wrist) movements at nighttime. At the macroscale, we calculated day-night differences in HR and HRV measures. For both timescales, we tested whether outcome measures were related to insomnia diagnosis and severity. Results At the microscale, an increase in HR was often detectable already 60 seconds prior to as well as following a nocturnal chest, but not wrist, movement. This increase was slightly steeper in insomnia and was associated with insomnia severity, but future EEG recordings are necessary to elucidate whether these changes occur prior to or simultaneously with PSG-indicators of wakefulness. At the macroscale, we found an attenuated cardiac response to sleep in insomnia: patients consistently showed smaller day-night differences in HR and HRV. Conclusions Incorporating state-related changes in cardiac features in the ambulatory monitoring of sleep might provide a more sensitive biomarker of insomnia than the use of cardiac activity averages or actigraphy alone.

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“…Lack of consistent daily routines has been reported to predict increased bedtime resistance for children with ADHD [ 40 ], and interventions for better sleep hygiene and parenting consistency decreased bedtime resistance [ 41 ]. These findings may be consistent with our current report that children’s bedtime resistance, night waking, parasomnias and sleep anxiety are significantly correlated with parental insomnia probability, as insomnia disorder is associated with greater sleep timing variability and less consistent sleep routines [ 42 ]. As such, greater parental insomnia symptoms may result in less-consistent household bedtime routines which in turn would contribute to children’s bedtime resistance, sleep anxiety and night-time wakenings.…”

Machine learning approaches for predicting sleep arousal response based on heart rate variability, oxygen saturation, and body profiles

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Actigraphy in studies on insomnia: Worth the effort?

“…It is not unlikely that a much larger number of null results have been left unreported (Rosenthal, 1979 ). In recent years, vast efforts have been undertaken to improve the quality of actigraphy sleep estimates for insomnia research (Angelova et al, 2020 ; Rösler et al, 2022 ; te Lindert et al, 2020 ). In a retrospective study of more than 400 participants, Natale et al ( 2014 ) concluded that actigraphy satisfactorily differentiates patients with insomnia from controls, when the correct quantitative actigraphic criteria for the used device are applied.…”