Actigraphy Correctly Predicts Sleep Behavior in Infants Who Are Younger than Six Months, When Compared with Polysomnography

Abstract

Actigraphy has been widely used in adults and children. In infants, validation of actigraphy has typically used a comparison with behaviorally determined sleep state classification rather than polysomnography (PSG). This study validated actigraphy against PSG for determining sleep and waking states in infants who were younger than 6 mo. Twenty-two healthy infants, 13 term and 9 preterm, were studied at three different matched postconceptional ages. Actigraph data were compared with PSG recordings in 1-min epochs. Agreement rate (AR), predictive value for sleep, predictive value for wake, sensitivity. and specificity were calculated and compared between activity thresholds and across ages with two-way ANOVA for repeated measures. Thirty-two validation studies were analyzed. Overall AR with PSG of 93.7 Ϯ 1.3 and 91.6 Ϯ 1.8 were obtained at 2-4 wk and 5-6 mo, respectively, at the low activity threshold setting, whereas the auto activity threshold gave the best agreement with PSG at 2-4 mo (AR 89.3 Ϯ 1.3%). Sensitivity values of 96.2 Ϯ 1.1% at 2-4 wk, 91.2 Ϯ 1.5% at 2-4 mo, and 94.0 Ϯ 1.9% were obtained at these same settings. There was no difference across ages in AR or sensitivity. PVW and specificity values were low in this study. We conclude that actigraphy is a valid method for monitoring sleep in infants who are younger than 6 mo. Newborn infants spend~70% of their time asleep, and maturation of sleep is one of the major developments that occur during the first year of life. Sleep-related problems are extremely common in the preschool years, affecting~30% of this age group (1). Indeed, sleep problems are the most common subject on which parents seek advice from health professionals in these preschool years. These problems can range from disrupted sleep patterns with frequent night awakenings to sleep deprivation. The long-term consequences of poor sleep patterns are known to be slow growth, behavioral problems, poor school performance, family disruption, and even child abuse (2). Most home-based studies on infant sleep patterns have relied in parental reports. However, studies that have used both subjective and objective measures have identified that parental reporting may underestimate night-time awakening (3). Actigraphy provides a useful tool that has advantages over other methods of sleep/wake assessment in that it provides a noninvasive, continuous assessment that can be used for prolonged periods of time in a variety of situations. The actigraph continuously records the occurrence of limb movements and then sums the number of movements for a given epoch length. Through the use of a specially developed algorithm, the motility levels can be computer scored into states of sleep or wake (4,5). The actigraph was first developed for use in adults; however, it has recently been used in children to distinguish between sleep and wakefulness and provides a reliable measure of sleep-wake organization and sleep quality (4). To date, only two studies have been conducted in infants to validate actigraphy against other...

Algorithms for sleep–wake identification using actigraphy: a comparative study and new results

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Validating Actigraphy as a Measure of Sleep for Preschool Children

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Sleep Pattern of Japanese Infants and Their Mother’s Parenting Stress

“…Under this nocturnal environment, the infant's sleep measures were assessed objectively. Because the sleep measures retrieved from actigraph were highly correlated with polysomnography and observation method [18,19], it was confirmed that waking time and waking duration during night was decreased and the longest sleep duration was increased. Thus, the sleep measures of infants assessed by actigraph showed significant developmental change in this study.…”

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