Abstract
Purpose
Actigraphy is a non-invasive and valid method to detect sleep/wake status. However, the technique lacks reliability in patients with sleep-disordered breathing and its results may depend on the algorithm employed.
Methods
We compared three currently used algorithms (the Cole-Kripke, Sadeh, and University of California San Diego [UCSD]) and determined which is the most reliable in patients with obstructive sleep apnea (OSA) assessing total sleep time. After identification of the most reliable algorithm, we compared total sleep time with the severity of obstructive sleep apnea.
Results
The mean total sleep time was not significantly different from that yielded by polysomnography when the UCSD algorithm was employed (p = 0.798) and UCSD algorithm was associated with the smallest bias. The correlation levels (with polysomnographic data) were mild-to-modest when the results yielded by all algorithms were evaluated, but were highest when the UCSD algorithm was employed (UCSD, r = 0.498, p < 0.001; Cole-Kripke, r = 0.389, p < 0.01; Sadeh, r = 0.272, p = 0.057). Actigraphic measures of mean total sleep time underestimated sleep in patients with severe obstructive sleep apnea (apnea–hypopnea index [AHI] ≥30), and the correlation was low (r = 0.317, p = 0.116), but overestimated sleep, with high correlations, in patients with mild (5 ≤ AHI < 15) and moderate OSA (15 ≤ AHI < 30; r = 0.859, p < 0.001; r = 0.842, p < 0.001, respectively).
Conclusions
Among the three actigraphic algorithms tested in this study, sleep duration estimated by the UCSD algorithm was the most correlated with polysomnography data in an OSA population. However, none of them was reliable enough for estimating sleep time in patients with sleep-disordered breathing, especially in patients with severe OSA.
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References
Young T, Evans L, Finn L, Palta M (1997) Estimation of the clinically diagnosed proportion of sleep apnea syndrome in middle-aged men and women. Sleep 20(9):705–706
Collop NA, Anderson WM, Boehlecke B, Claman D, Goldberg R, Gottlieb DJ, Hudgel D, Sateia M, Schwab R (2007) Clinical guidelines for the use of unattended portable monitors in the diagnosis of obstructive sleep apnea in adult patients. Portable Monitoring Task Force of the American Academy of Sleep Medicine. J Clin Sleep Med 3(7):737–747
Association ASD (1994) Practice parameters for use of portable recording in the assessment of obstructive sleep apnea. Sleep 17:372–377
Carskadon MA, Dement WC, Mitler MM, Guilleminault C, Zarcone VP, Spiegel R (1976) Self-reports versus sleep laboratory findings in 122 drug-free subjects with complaints of chronic insomnia. Am J Psychiatry 133(12):1382–1388
Reyner LA, Horne JA, Reyner A (1995) Gender- and age-related differences in sleep determined by home-recorded sleep logs and actimetry from 400 adults. Sleep 18(2):127–134
Lockley SW, Skene DJ, Arendt J (1999) Comparison between subjective and actigraphic measurement of sleep and sleep rhythms. J Sleep Res 8(3):175–183
Cole RJ, Kripke DF, Gruen W, Mullaney DJ, Gillin JC (1992) Automatic sleep/wake identification from wrist activity. Sleep 15(5):461–469
Sadeh A, Sharkey KM, Carskadon MA (1994) Activity-based sleep–wake identification: an empirical test of methodological issues. Sleep 17(3):201–207
Webster JB, Kripke DF, Messin S, Mullaney DJ, Wyborney G (1982) An activity-based sleep monitor system for ambulatory use. Sleep 5(4):389–399
Ancoli-Israel S, Cole R, Alessi C, Chambers M, Moorcroft W, Pollak CP (2003) The role of actigraphy in the study of sleep and circadian rhythms. Sleep 26(3):342–392
Littner M, Hirshkowitz M, Kramer M, Kapen S, Anderson WM, Bailey D, Berry RB, Davila D, Johnson S, Kushida C, Loube DI, Wise M, Woodson BT (2003) Practice parameters for using polysomnography to evaluate insomnia: an update. Sleep 26(6):754–760
Gagnadoux F, Nguyen XL, Rakotonanahary D, Vidal S, Fleury B (2004) Wrist-actigraphic estimation of sleep time under nCPAP treatment in sleep apnoea patients. Eur Respir J 23(6):891–895
Kushida CA, Chang A, Gadkary C, Guilleminault C, Carrillo O, Dement WC (2001) Comparison of actigraphic, polysomnographic, and subjective assessment of sleep parameters in sleep-disordered patients. Sleep Med 2(5):389–396
Wang D, Wong KK, Dungan GC 2nd, Buchanan PR, Yee BJ, Grunstein RR (2008) The validity of wrist actimetry assessment of sleep with and without sleep apnea. J Clin Sleep Med 4(5):450–455
Kellner O, Bastuji H, Adeleine P (1997) Actimetry in sleep medicine. Sleep Breath 2(1):33–39
Johnson NL, Kirchner HL, Rosen CL, Storfer-Isser A, Cartar LN, Ancoli-Israel S (2007) Sleep estimation using wirst actigraphy in adolescents with and without sleep disordered breathing: a comparison of three data modes. Sleep 30(7):899–905
Jean-Louis G, von Gizycki H, Zizi F, Fookson J, Spielman A, Nunes J, Fullilove R, Taub H (1996) Determination of sleep and wakefulness with the actigraph data analysis software (ADAS). Sleep 19(9):739–743
de Souza L, Benedito-Silva AA, Pires ML, Poyares D, Tufik S, Calil HM (2003) Further validation of actigraphy for sleep studies. Sleep 26(1):81–85
Morgenthaler T, Alessi C, Friedman L, Owens J, Kapur V, Boehlecke B, Brown T, Chesson A Jr, Coleman J, Lee-Chiong T, Pancer J, Swick TJ (2007) Practice parameters for the use of actigraphy in the assessment of sleep and sleep disorders: an update for 2007. Sleep 30(4):519–529
Paquet J, Kawinska A, Carrier J (2007) Wake detection capacity of actigraphy during sleep. Sleep 30(10):1362–1369
Lichstein KL, Stone KC, Donaldson J, Nau SD, Soeffing JP, Murray D, Lester KW, Aguillard RN (2006) Actigraphy validation with insomnia. Sleep 29(2):232–239
Vallieres A, Morin CM (2003) Actigraphy in the assessment of insomnia. Sleep 26(7):902–906
Iranzo A, Santamaria J (2005) Severe obstructive sleep apnea/hypopnea mimicking REM sleep behavior disorder. Sleep 28(2):203–206
Schenck CH, Milner DM, Hurwitz TD, Bundlie SR, Mahowald MW (1989) A polysomnographic and clinical report on sleep-related injury in 100 adult patients. Am J Psychiatry 146(9):1166–1173
Blackwell T, Redline S, Ancoli-Israel S, Schneider JL, Surovec S, Johnson NL, Cauley JA, Stone KL (2008) Comparison of sleep parameters from actigraphy and polysomnography in older women: the SOF study. Sleep 31(2):283–291
Cho YW, Shin WC, Yun CH, Hong SB, Kim J, Earley CJ (2009) Epidemiology of insomnia in korean adults: prevalence and associated factors. J Clin Neurol 5(1):20–23
Hauri PJ, Wisbey J (1992) Wrist actigraphy in insomnia. Sleep 15(4):293–301
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Kim, M.J., Lee, GH., Kim, CS. et al. Comparison of three actigraphic algorithms used to evaluate sleep in patients with obstructive sleep apnea. Sleep Breath 17, 297–304 (2013). https://doi.org/10.1007/s11325-012-0689-z
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DOI: https://doi.org/10.1007/s11325-012-0689-z