How Accurately Does Wrist Actigraphy Identify the States of Sleep and Wakefulness?

Pollak, Charles P.; Tryon, Warren W.; Nagaraja, Haikady N.; Dzwonczyk, Roger

doi:10.1093/sleep/24.8.957

Cited by 195 publications

(145 citation statements)

References 15 publications

Supporting

Mentioning

140

Contrasting

Unclassified

Order By: Relevance

“…While most actigraphy validation studies discuss an overestimation of WASO in infants and children, 15,16,27 the direction of error in other pediatric 14 and adult studies is not as consistent. [28][29][30] It may be that as children age, the level of movement during sleep not associated with an awakening decreases. Alternatively, older children may be more likely to lie still when awake than younger children, either of which will result in the switch in the direction of bias.…”

Section: Discussionmentioning

confidence: 99%

Comparison of Commercial Wrist-Based and Smartphone Accelerometers, Actigraphy, and PSG in a Clinical Cohort of Children and Adolescents

Toon

Davey

Hollis

et al. 2016

Journal of Clinical Sleep Medicine

119

View full text Add to dashboard Cite

Study Objectives: To compare two commercial sleep devices, an accelerometer worn as a wristband (UP by Jawbone) and a smartphone application (MotionX 24/7), against polysomnography (PSG) and actigraphy (Actiwatch2) in a clinical pediatric sample. Methods: Children and adolescents (n = 78, 65% male, mean age 8.4 ± 4.0 y) with suspected sleep disordered breathing (SDB), simultaneously wore an actiwatch, a commercial wrist-based device and had a smartphone with a sleep application activated placed near their right shoulder, during their diagnostic PSG. Outcome variables were sleep onset latency (SOL), total sleep time (TST), wake after sleep onset (WASO), and sleep efficiency (SE). Paired comparisons were made between PSG, actigraphy, UP, and MotionX 24/7. Epoch-by-epoch comparisons determined sensitivity, specificity, and accuracy between PSG, actigraphy, and UP. Bland-Altman plots determined level of agreement. Differences in bias between SDB severity and developmental age were assessed. Results: No differences in mean TST, WASO, or SE between PSG and actigraphy or PSG and UP were found. Actigraphy overestimated SOL (21 min). MotionX 24/7 underestimated SOL (12 min) and WASO (63 min), and overestimated TST (106 min) and SE (17%). UP showed good sensitivity (0.92) and accuracy (0.86) but poor specificity (0.66) when compared to PSG. Bland-Altman plots showed similar levels of bias in both actigraphy and UP. Bias did not differ by SDB severity, however was affected by age. Conclusions: When compared to PSG, UP was analogous to Actiwatch2 and may have some clinical utility in children with sleep disordered breathing. MotionX 24/7 did not accurately reflect sleep or wake and should be used with caution. I NTRO DUCTI O NShort sleep duration or sleep disruption during childhood, either due to a physiological sleep disorder or psychosocial basis, have adverse effects on brain development, cognitive performance, behavioral functioning, and psychological well-being.1-7 Appropriate treatment of sleep problems in children and adolescents depends on accurate assessment. The current gold standard for assessing sleep and diagnosing sleep disorders in children is polysomnography (PSG). 8,9 This technique, which uses sophisticated technology to assess brain, cardiovascular and respiratory activity during sleep usually in a laboratory environment, is expensive and labor-intensive and typically only provides one or two nights of information, which may not be reflective of sleep in the home. 10Actigraphy, which use accelerometer technology to provide estimates of sleep and wake based on the level of activity, is used to provide objective assessments of sleep-wake patterns over long periods of time 11,12 and assist in diagnosis and treatment monitoring of sleep disorders such as delayed sleep phase syndrome and behavioral insomnia.13 Validation studies in infants, children and adolescents have shown that actigraphy is sensitive in assessing actual sleep, however over-or

show abstract

Section: Discussionmentioning

confidence: 99%

Comparison of Commercial Wrist-Based and Smartphone Accelerometers, Actigraphy, and PSG in a Clinical Cohort of Children and Adolescents

Toon

Davey

Hollis

et al. 2016

Journal of Clinical Sleep Medicine

119

View full text Add to dashboard Cite

show abstract

“…24 But sleep efficiency and latency may be overestimated by actigraphy as compared with PSG. 14,26,27 The sensitivity of actigraphy, which is its ability to identify sleep when PSG does so, is 86.6-94%, but its specificity, the ability to identify wakefulness when PSG does so, is only 32-36%. 26,27 Actigraphy may overestimate sleep in patients with limb hypomobility because of various reasons, including Parkinson's disease, joint diseases, or involvement of the nervous system.…”

Section: Discussionmentioning

confidence: 99%

“…14,26,27 The sensitivity of actigraphy, which is its ability to identify sleep when PSG does so, is 86.6-94%, but its specificity, the ability to identify wakefulness when PSG does so, is only 32-36%. 26,27 Actigraphy may overestimate sleep in patients with limb hypomobility because of various reasons, including Parkinson's disease, joint diseases, or involvement of the nervous system. 14 Low specificity and exaggerated sensitivity of actigraphic data are expected in patients with plegia or paresis of the arms.…”

Section: Discussionmentioning

confidence: 99%

The feasibility of sleep assessment by actigraph in patients with tetraplegia

2007

View full text Add to dashboard Cite

Background: Sleep disturbances are frequent in patients with high spinal cord lesions, and are difficult to diagnose by means of polysomnography (PSG). Design: Retrospective cohort study. Objective: Examine the feasibility of sleep assessment by actigraph in patients with tetraplegia. Setting: A rehabilitation center in Israel. Subjects: Twenty-one patients with tetraplegia and 20 healthy persons. Interventions: Sleep assessment by actigraphs attached to the head and the wrist. Main outcome measures: The actigraphic movement index (MI), total sleep time (TST), sleep efficiency (SE), wake after sleep onset (WASO), sleep latency (SL), and number of awakenings (NOA). Results: In the control group actigraphy showed that during sleep the hand moves more than the head but that the movements were highly correlated. In patients with tetraplegia below C 5 -C 7 the hand also moved more than the head, but in patients with tetraplegia below C 4 , the head moved more (Po0.05). No significant differences were found between patients with C 5 -C 7 tetraplegia and healthy controls in the sleep indices obtained by hand movements, or between patients with C 4 tetraplegia and healthy controls in the indices obtained by head movements. Control subjects and patients showed similar subjective assessment of sleep quality. Conclusions: These preliminary findings support the validity of wrist actigraphy for sleep assessment in patients with C 5 -C 7 tetraplegia, and suggest that head-mounted actigraphy is a feasible alternative for sleep assessment in patients with tetraplegia below C 4 . To establish these findings, further investigations are required, with a larger number of patients and comparison with PSG.

show abstract

“…However, measuring this sleep quality over long periods is very inconvenient, especially for the elderly, and measures are necessary to avoid the devices not being worn. For example, artifacts in Act records can be due to noncompliance (i.e., not wearing the device), breathing movements, postural blocking of arm movement and externally imposed movement, e.g., from riding in a moving vehicle (Pollak et al, 2001;Tryon, 2004). To remove such artifacts, many researchers routinely ask the participants to keep a log of the times they sleep and remove the device (Youngstedt et al, 2001;Cole et al, 2002).…”

Section: Introductionmentioning

confidence: 99%

Automatic Sleep/Wake Scoring from Body Motion in Bed: Validation of a Newly Developed Sensor Placed under a Mattress

Kogure

Shirakawa

Shimokawa

et al. 2011

J Physiol Anthropol

View full text Add to dashboard Cite

The purpose of this study was to formulate a "sleep/wake" scoring algorithm for processing activity measurements obtained using a newly developed nonwear actigraphy (NWA) device, and to test its validity. The NWA device has a highly sensitive pressure sensor and is placed under a mattress. It can continuously record the activity of a person lying on the mattress and identify an "in-bed/out-ofbed" state from the vibrations of the mattress. We formulated the sleep/wake scoring algorithm by using data obtained simultaneously by wrist actigraphy (Act) and the NWA device in 33 healthy participants. Agreement rate, sensitivity, and specificity with Act were 95.7%, 97.6%, and 75.8% (33 healthy people); the corresponding values were 85.9%, 89.1%, and 79.8% for 12 nursing home residents and 93.7%, 97.2%, and 60.8% for 60 nights for 6 healthy persons who slept 10 nights on their futons. Agreement rate, sensitivity, and specificity with polysomnography were in almost perfect agreement with Act (12 nights; 6 healthy persons who slept 2 nights). All our validation results indicate that the NWA device, placed under a mattress or a futon, can produce almost identical sleep/wake scores to Act. It is expected that the NWA device, a nonwear device for scoring sleep/wake and inbed/out-of-bed, enables convenient long-term sleep-related evaluation in various fields, including hospital settings, homecare settings, and care facility settings such as nursing homes.

show abstract

How Accurately Does Wrist Actigraphy Identify the States of Sleep and Wakefulness?

Abstract: Low PV's and overestimation of sleep currently disqualify actigraphy as an accurate sleep-wake indicator. Actigraphy may, however, by useful for measuring circadian period and sleep-wake consolidation and has face validity as a measure of rest/activity.

Cited by 195 publications

References 15 publications

Comparison of Commercial Wrist-Based and Smartphone Accelerometers, Actigraphy, and PSG in a Clinical Cohort of Children and Adolescents

Comparison of Commercial Wrist-Based and Smartphone Accelerometers, Actigraphy, and PSG in a Clinical Cohort of Children and Adolescents

The feasibility of sleep assessment by actigraph in patients with tetraplegia

Automatic Sleep/Wake Scoring from Body Motion in Bed: Validation of a Newly Developed Sensor Placed under a Mattress

Contact Info

Product

Resources

About