Sleep assessments in healthy school-aged children using actigraphy: concordance with polysomnography

Abstract

SUMMAR Y Actigraphic (ACT) recordings are used widely in schoolchildren as a less intrusive and more extended approach to evaluation of sleep problems. However, critical assessment of the validity and reliability of ACT against overnight polysomnography (NPSG) are unavailable. Thus, we explored the degree of concordance between NPSG and ACT in school-aged children to delineate potential ACT boundaries when interpreting pediatric sleep. Non-dominant wrist ACT was recorded simultaneously with NPSG in 149 healthy school-aged children (aged 4.1-8.8 years, 41.7% boys, 80.4% Caucasian) recruited from the community. Analyses were limited to the Actiware (MiniMitter-64) calculated parameters originating from 1-min epoch sampling and medium sensitivity threshold value of 40; i.e. sleep period time (SPT), total sleep time (TST) and wake after sleep onset (WASO). SPT was not significantly different between ACT and NPSG. However, ACT underestimated TST significantly by 32.2 ± 33.4 min and overestimated WASO by 26.3 ± 34.4 min. The decreased precision of ACT was also evident from moderate to small concordance correlation coefficients (0.47 for TST and 0.09 for WASO). ACT in school-aged children provides reliable assessment of sleep quantity, but is relatively inaccurate during determination of sleep quality. Thus, caution is advocated in drawing definitive conclusions from ACT during evaluation of the sleepdisturbed child.k e y w o r d s actigraphy,

Validating Actigraphy as a Measure of Sleep for Preschool Children

“…However, ACT80 and AlgoSmooth decreased the ability of actigraphy to detect wakefulness compared to ACT40. The low specificity (about 60% of PSG wakefulness is scored as wakefulness by actigraphy) observed in our data is similar to that found in previous studies that compared different brands of actigraphy with PSG in infants 14,20 and children, 17,21 highlighting the difficulty of correctly identifying wake with actigraphy. Nevertheless, when the actigraphs scored wake, AlgoSmooth showed higher agreement with PSG (NPV = 76.6%) than the other two algorithms (42.8% and 52.7%), suggesting that AlgoSmooth is better suited for this purpose.…”

“…Sitnick et al 19 showed that an algorithm commonly used with adults is too sensitive with a population of young children, resulting in high false negative rates (i.e., actigraphy detects wakefulness when the child is probably sleeping). In fact, although several studies with infants and children have reported that various actigraphy devices are highly correlated (> 80%) with PSG or videosomnography, 14,[16][17][18][19][20][21][22][23] most of these studies have shown very low ability to correctly identify wakefulness 14,17,19,22 and hence, sleep fragmentation. 24 Nevertheless, the American Academy of Sleep Medicine (AASM) states that the use of actigraphy in normal children and special pediatric populations is indicated for the assessment of sleep patterns and response to treatment.…”

Melatonin for non-respiratory sleep disorders in typically developing children

“…Published evidence supports actigraphy as the most convenient and widely used objective method followed by polysomnography (Spruyt 2011). Sleep diaries present the most subjective evidence for monitoring sleep quality (Bates 2002).…”

The Effects of Lithium Carbonate Supplemented with Nitrazepam on Sleep Disturbance during Cannabis Abstinence

“…It may be that the use of daily sleep diaries or repeat AIS measures throughout treatment could have provided more useful subjective information for correlating to actiwatch measures than the sleep items on the Cannabis Withdrawal Scale. 42 …”