Validation of actigraphy for determining sleep and wake in children with sleep disordered breathing

112

Study Objectives:The algorithms used to derive sleep variables from actigraphy were developed with adults. Because children change position during sleep more often than adults, algorithms may detect wakefulness when the child is actually sleeping (false negative). This study compares the validity of three algorithms for detecting sleep with actigraphy by comparing them to PSG in preschoolers. The putative infl uence of device location (wrist or ankle) is also examined. Methods: Twelve children aged 2 to 5 years simultaneously wore an actigraph on an ankle and a wrist (Actiwatch-L, MiniMitter/Respironics) during a night of PSG recording at home. Three algorithms were tested: one recommended for adults and two designed to decrease false negative detection of sleep in children. Results: Actigraphy generally showed good sensitivity (> 95%; PSG sleep detection) but low specifi city (± 50%; PSG wake detection). Intraclass correlations between PSG and actigraphy variables were strong (> 0.80) for sleep latency, sleep duration, and sleep effi ciency, but weak for number of awakenings (< 0.40). The two algorithms designed for children enhanced the validity of actigraphy in preschoolers and increased the proportion of actigraphyscored wake epochs scored that were also PSG-identifi ed as wake. Sleep variables derived from the ankle and wrist were not statistically different. Conclusion: Despite the weak detection of wakefulness, Actiwatch-L appears to be a useful instrument for assessing sleep in preschoolers when used with an adapted algorithm. S C I E N T I F I C I N V E S T I G A T I O N SS leep is considered to be of paramount importance for brain development during the fi rst two years of life.1 In fact, children spend over half of their fi rst two years of life sleeping, with daily sleep duration decreasing from 14.5 to about 13 hours between 6 months and 2 years of age. 2,3 In the preschool years, daily sleep needs remain high, decreasing from 13 hours at 2 years to about 11 hours at 5 years.2-4 During infancy and childhood, frequent night awakenings or diffi culty falling asleep are among the most frequent developmental complaints. Studies estimate that from 10% to 75% of parents report that their children have sleep problems.5 Importantly, sleep problems tend to persist during childhood 6 and are associated with several adverse consequences for behavioral, cognitive, and emotional health. For example, it has been shown that sleep problems are associated with behavioral and emotional self-regulation problems.7 In fact, results suggest that when the sleep of preschoolers is insuffi cient or fragmented by wakefulness, they show more diffi culty inhibiting emotional responses and more frequent impulsive and aggressive behavior.8 Poor sleep quality also seems associated with obesity in preschool children. 9Studies further suggest that sleep problems, whether occurring in infancy 10 or at school age, 4,11 are associated with lower cognitive performance. In light of the prevalence and the serious consequences of pediatr...

Section: Discussionsupporting

confidence: 74%

mentioning

confidence: 99%

Validating Actigraphy as a Measure of Sleep for Preschool Children

Bélanger

Bernier²,

Paquet³

et al. 2013

112

“…The opposite was found when PSG was compared to Fitbit in the sensitive mode. 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.…”

Section: Discussionmentioning

confidence: 95%

“…13 Validation studies in infants, children and adolescents have shown that actigraphy is sensitive in assessing actual sleep, however over-or underestimates wake after sleep onset, providing a poor estimate of sleep disruption when compared to PSG. [14][15][16][17] While actigraphy is less expensive, labor-intensive, and more reflective of natural sleep patterns than PSG, it still requires specialized software and expertise to analyze and interpret. 16 A number of commercial devices that claim to assess sleep duration and quality are now available.…”

Section: Introductionmentioning

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

Self Cite

121

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

“…Actigraphy is a validated wristwatch-like device that distinguishes sleep from wakefulness based on accelerometer measured movement. 18,19 Caregivers simultaneously completed a daily sleep diary which was used to identify bedtime and wake time, as well as to identify when the device was removed. Data were analyzed and interpreted centrally by a single technologist and a single pediatric sleep medicine specialist, respectively.…”

Section: Actigraphymentioning

confidence: 99%

Sleep/Wake Patterns and Parental Perceptions of Sleep in Children Born Preterm

Biggs

Meltzer

Tapia

et al. 2016

Study Objectives:To compare sleep/wake patterns in children born preterm in Australia vs Canada and determine cultural differences in the relationship between parental perception of sleep and actual sleep behaviors. Methods: Australian and Canadian children born preterm were recruited from the Caffeine for Apnea of Prematurity trial (n = 188, 5-12 y) and underwent 14 days actigraphy monitoring. Parents completed the National Sleep Foundation 2004 Sleep in America questionnaire. Cross-cultural differences in sleep characteristics assessed by actigraphy and parent-reported questionnaire were examined. Correlational analyses determined the associations between parental perceptions of child sleep need and sleep behavior. Results: Actigraphy showed preterm children obtained, on average, 8 h sleep/night, one hour less than population recommendations for their age. There was no difference in total sleep time (TST) between Australian and Canadian cohorts; however, bed and wake times were earlier in Australian children. Bedtimes and TST varied by 60 minutes from night to night in both cohorts. Parent-reported child TST on the National Sleep Foundation questionnaire was 90 minutes longer than recorded by actigraphy. Both bedtime and TST on weekdays and weekends were related to parental perception of child sleep need in the Australian cohort. Only TST on weekdays was related to parental perception of child sleep need in the Canadian cohort. Conclusions: This study suggests that short sleep duration and irregular sleep schedules are common in children born preterm. Cultural differences in the association between parental perception of child sleep need and actual sleep behaviors provide important targets for future sleep health education.