Comparison of actigraphy immobility rules with polysomnographic sleep onset latency in children and adolescents

Abstract

Purpose While actigraphy has gained popularity in pediatric sleep research, questions remain about the validity of actigraphy as an estimate of sleep-wake patterns. In particular, there is little consistency in the field in terms of scoring rules used to determine sleep onset latency. The purpose of this study was to evaluate different criteria of immobility as a measure of sleep onset latency in children and adolescents. Methods Ninety-five youth (ages 3-17 years, 46% male) wore both the Ambulatory-Monitoring Inc. Motionlogger Sleep Watch (AMI) and the Philips Respironics Mini-Mitter Actiwatch-2 (PRMM) during overnight polysomnography in a pediatric sleep lab. We examined different sleep onset latency scoring rules (3, 5, 10, 15, and 20 minutes of immobility) using different algorithms (Sadeh and Cole-Kripke) and sensitivity settings (Low, Medium, High) for the devices. Comparisons were also made across age groups (preschoolers, school-aged, adolescents) and sleep disordered breathing status (no obstructive sleep apnea [OSA], mild OSA, clinically significant OSA). Results For the AMI device, shorter scoring rules performed best for children and longer scoring rules were better for adolescents, with shorter scoring rules best across sleep disordered breathing groups. For the PRMM device, medium to longer scoring rules performed best across age and sleep disordered breathing groups. Conclusions Researchers are encouraged to determine the scoring rule that best fits their population of interest. Future studies are needed with larger samples of children and adolescents to further validate actigraphic immobility as a proxy for sleep onset latency.

Environmental and behavioural factors associated with school children's sleep in Aotearoa/New Zealand

“…Rest intervals were then analysed using the Actiware algorithm, which categorises each epoch as either asleep or awake and has been validated against the gold standard of polysomnography in this age group, set at: epoch length – 1 min; wake threshold – medium; sleep onset and offset detection – 10 min immobile. For Actiwatch AW‐2 actigraphs, settings of medium sensitivity and either 10 or 15 min immobility to detect sleep onset/offset have been demonstrated to provide accurate estimations of sleep onset latency in school‐aged children …”

Actigraphy scoring for sleep outcome measures in chronic obstructive pulmonary disease

“…Actigraph scoring settings can be adjusted, but also include default settings that vary from actigraph to actigraph. Default actigraphy scoring settings are commonly used in research of adults with sleep disturbances, but recent studies have provided evidence challenging the use of default settings in other populations such as Parkinson’s disease[6] and children[7]. In addition to sleep disturbances, people with chronic illnesses may have disease-related characteristics that affect actigraphy scoring.…”

Sleep disturbance as detected by actigraphy in pre-pubertal juvenile monkeys receiving therapeutic doses of fluoxetine

“…Actimeters were the only indicator of sleep; no information on EEG, EOG or leg movement was available to better translate the fluoxetine effects in juvenile primates to children. Some commercial actimeters, but not the Actritrac actimeter, have been validated with EEG measures of sleep (polysomnography) in children (Meltzer et al, 2015; Meltzer et al, 2015; Meltzer et al, 2012). Also, we are not able to assess the subjective quality of sleep disturbance and sleepiness which are the basis for symptom reports in humans.…”