-
Journal of Clinical Sleep Medicine :... Jan 2019Delirium is a postoperative complication accompanied by disturbances in attention, cognition, arousal, and psychomotor activity. Wrist actigraphy has been advocated to...
STUDY OBJECTIVES
Delirium is a postoperative complication accompanied by disturbances in attention, cognition, arousal, and psychomotor activity. Wrist actigraphy has been advocated to study inactivity and inferred sleep patterns during delirium. We hypothesized that altered patterns of motor activity or immobility, reflective of disordered sleep and wakefulness patterns, would serve as predictive markers of hypoactive postoperative delirium.
METHODS
Eighty-four elderly surgical patients were classified into three groups based on the timing of hypoactive delirium following surgery: intact with no delirium throughout postoperative days (POD) 0-5 (n = 51), delirium during POD 0-1 (n = 24), and delirium during POD 2-5 (n = 13). Delirium was detected on daily Confusion Assessment Method evaluations and chart review. Actigraphy measures were calculated from accelerometry signals acquired on the first postoperative day (POD 0, 16:00-23:00) and night (POD 0, 23:00-POD 1, 06:00).
RESULTS
Actigraphy metrics showed substantial interpatient variability. Among the three patient groups, only those without delirium showed greater movement during the day compared to night and also fewer minutes of night immobility ( = .03 and = .02, Wilcoxon rank-sum tests). These patients were poorly discriminated from those with delirium during either POD 0-1 or POD 2-5, using differences in day and night activity (C-statistic, 95% confidence interval [CI]: 0.66 [0.53-0.79] and C-statistic, 95% CI: 0.71 [0.55-0.87], respectively). Inclusion of low-frequency signals improved performance of immobility measures without affecting those based on activity. Cognitively intact patients during POD 0-5 were distinguished from those with delirium during POD 0-1, based on differences in the number of day and night immobile minutes (C-statistic 0.65, 95% CI: [0.53-0.78]). Actigraphy metrics with the strongest association to delirium incidence were not reliably correlated with an increased risk during POD 0-5, when accounting for patient age, sex, intensive care unit admission, and Charlson Comorbidity Index (adjusted odds ratio of 1.7, 95% CI: [1.0-3.0], = .09, likelihood ratio test).
CONCLUSIONS
Early postoperative wrist actigraphy metrics that serve as markers of sleep and wakefulness offer limited capacity as sole predictors or markers of hypoactive delirium.
CLINICAL TRIAL REGISTRATION
Registry: ClinicalTrials.gov; Title: Electroencephalography Guidance of Anesthesia to Alleviate Geriatric Syndromes (ENGAGES) Study; Identifier: NCT02241655; URL: https://clinicaltrials.gov/ct2/show/NCT02241655.
Topics: Actigraphy; Aged; Delirium; Female; Geriatric Assessment; Humans; Male; Postoperative Complications; Predictive Value of Tests; Reproducibility of Results
PubMed: 30621829
DOI: 10.5664/jcsm.7576 -
Journal of Psychosomatic Research Aug 2019Discrepancies between self-reported and actigraphy sleep measures are common, producing ambiguity about which are better predictors of experimental pain outcomes. The...
OBJECTIVE
Discrepancies between self-reported and actigraphy sleep measures are common, producing ambiguity about which are better predictors of experimental pain outcomes. The current study tested if pain intensity during and situational pain catastrophizing following experimental pain were differentially predicted by self-reported or actigraphy sleep measures in patients with chronic temporomandibular disorder (TMJD) or healthy controls (HCs).
METHODS
Forty patients with TMJD and 20 HCs completed self-report sleep measures (Pittsburgh Sleep Quality Index, PSQI; Insomnia Severity Index, ISI; PROMIS Sleep-Related Impairment [SRI] and Sleep Disruption [SD]), underwent an experimental pain induction consisting of four consecutive cold-water hand immersions, and provided pain intensity and situational pain catastrophizing ratings. Participants also wore an actigraphy watch and completed sleep diaries for seven days, which were averaged for actigraphic indices of total sleep time, sleep efficiency, wake after sleep onset, and self-reported sleep quality and restfulness.
RESULTS
Individuals with TMJD reported higher pain intensity during experimental pain (M = 65.81 vs. 47.77, p = .007) and self-reported worse sleep compared to HCs (all p's < 0.02, Cohen's D = 0.73-1.25). No group differences emerged for actigraphy measures (all p's > 0.05, Cohen's D = 0.05-0.53). Sleep variables did not interact with group to predict responses to experimental pain (all p's > 0.05). Across groups, PROMIS-SRI predicted pain intensity (β = 0.36, p = .008) and catastrophizing (β = 0.36, p = .009) after controlling for multiple comparisons, smoking, medications, and age.
CONCLUSION
Self-reported sleep (but not actigraphy) measures differentiate patients with TMJD from HCs. Sleep-related interference may place people at particular risk for higher pain intensity and catastrophizing following experimental pain.
Topics: Actigraphy; Adult; Case-Control Studies; Female; Humans; Male; Pain; Self Report; Sleep Wake Disorders; Temporomandibular Joint Disorders
PubMed: 31376882
DOI: 10.1016/j.jpsychores.2019.05.008 -
Scientific Reports Aug 2021Our recent study on full-term toddlers demonstrated that daytime nap properties affect the distribution ratio between nap and nighttime sleep duration in total sleep...
Our recent study on full-term toddlers demonstrated that daytime nap properties affect the distribution ratio between nap and nighttime sleep duration in total sleep time but does not affect the overall total amount of daily sleep time. However, there is still no clear scientific consensus as to whether the ratio between naps and nighttime sleep or just daily total sleep duration itself is more important for healthy child development. In the current study, to gain an answer to this question, we examined the relationship between the sleep properties and the cognitive development of toddlers born prematurely using actigraphy and the Kyoto scale of psychological development (KSPD) test. 101 premature toddlers of approximately 1.5 years of age were recruited for the study. Actigraphy units were attached to their waist with an adjustable elastic belt for 7 consecutive days and a child sleep diary was completed by their parents. In the study, we found no significant correlation between either nap or nighttime sleep duration and cognitive development of the preterm toddlers. In contrast, we found that stable daily wake time was significantly associated with better cognitive development, suggesting that sleep regulation may contribute to the brain maturation of preterm toddlers.
Topics: Actigraphy; Child Development; Cognition; Female; Humans; Infant; Infant, Premature; Male; Polysomnography; Sleep; Time Factors; Wakefulness
PubMed: 34354199
DOI: 10.1038/s41598-021-95495-5 -
Journal of Sleep Research Feb 2012Actigraphy is increasingly used in the assessment and treatment of various clinical conditions, being a convenient and cost-effective method of capturing bodily... (Comparative Study)
Comparative Study
Actigraphy is increasingly used in the assessment and treatment of various clinical conditions, being a convenient and cost-effective method of capturing bodily movements over long periods of time. This study examined the use of actigraphy in the measurement of sleep of patients with depression and insomnia. Fifty-four patients diagnosed with a current major depressive episode and chronic insomnia underwent a baseline overnight study with concurrent actigraphic and polysomnography (PSG) monitoring, as well as subjective sleep diaries. Agreement between PSG, actigraphy and sleep diary measurements was evaluated using two-tailed t-tests, Pearson's correlations and the Bland-Altman concordance technique. The only significant difference found between actigraphy and PSG was in latency to persistent sleep, in which actigraphy underestimated sleep latency relative to PSG (P < 0.05). There were moderate positive correlations between actigraphy and PSG for all variables. In contrast, significant differences were observed between sleep diaries and PSG for all sleep variables. Bland-Altman concordance diagrams also demonstrated that, while bias was limited between PSG and the other two measurement types, there were somewhat broad 95% limits of agreement for all sleep variables with both sleep diaries and actigraphy. In summary, actigraphic measurements of sleep more closely approximated those of PSG than did sleep diaries in this sample of depressed insomniacs.
Topics: Actigraphy; Adult; Comorbidity; Depressive Disorder, Major; Female; Humans; Male; Middle Aged; Polysomnography; Self Report; Sensitivity and Specificity; Sleep; Sleep Initiation and Maintenance Disorders; Young Adult
PubMed: 21447050
DOI: 10.1111/j.1365-2869.2011.00917.x -
Supportive Care in Cancer : Official... May 2021Disturbed sleep is common among breast cancer survivors. Identifying patients at risk for disturbed sleep and its sequelae will aid in improving screening and...
BACKGROUND
Disturbed sleep is common among breast cancer survivors. Identifying patients at risk for disturbed sleep and its sequelae will aid in improving screening and intervention strategies to improve sleep and cancer-related quality of life (QOL).
METHODS
Women with stages I-III breast cancer undergoing neoadjuvant or adjuvant chemotherapy (N = 415) reported subjectively assessed sleep quality (PSQI) and actigraphy-assessed wake after sleep onset (AAS-WASO), total sleep time (AAS-TST), and sleep efficiency (AAS-SE), sociodemographic, and clinical characteristics and completed questionnaires assessing physical and mental health QOL at study entry and 3, 6, 12, and 15 months later.
RESULTS
Being from a racially/ethnically underserved population was associated with poorer sleep in all indices (p's < .04). Lower income was associated with poorer subjective sleep and greater AAS-WASO (p's < .02). BMI was associated with lower AAS-SE (p < .001). Baseline subjective sleep complaints were positively associated with depression, fatigue, and health-related QOL and cancer-related symptoms across follow-up (p's < 0.05). Baseline AAS-WASO was positively associated with anxiety and negatively associated with physical health-related QOL at the 3-month follow-up (p's < .001). Baseline AAS-WASO and AAS-SE were associated with mental health-related QOL at the 6-month follow-up (p's < .05).
CONCLUSIONS
In keeping with previous health disparity research, racially/ethnically underserved populations, lower household income, and higher BMI were associated with increased risk for disturbed sleep. Sleep disturbance may have long-term effects on multiple aspects of QOL for women undergoing treatment for breast cancer. Results may inform strategies to identify patients at greatest risk for disturbed sleep and its sequelae.
Topics: Actigraphy; Breast Neoplasms; Cancer Survivors; Female; Humans; Middle Aged; Quality of Life; Sleep Wake Disorders
PubMed: 32964261
DOI: 10.1007/s00520-020-05777-3 -
BMC Research Notes Nov 2015Given the widespread use of smartphone pedometer applications and the relatively limited number of published validity tests, this study examined the validity of three... (Clinical Trial)
Clinical Trial
BACKGROUND
Given the widespread use of smartphone pedometer applications and the relatively limited number of published validity tests, this study examined the validity of three popular commercial smartphone pedometer applications (i.e., Accupedo, Moves, and Runtastic Pedometer).
PARTICIPANTS
Convenience samples of males and females were recruited for laboratory tests [n = 11; mean: aged 24.18 years (±3.06)] and a free-living test [n = 18; mean: aged 28.78 years (±9.52)].
METHODS
Five conditions were assessed: (a) 20-step test, (b) 40-step stair climbing, (c) treadmill walking and running at different speeds, (d) driving, and (e) 3-day free-living. The Yamax SW-200 pedometer and observed step counts were used as criterion measures.
RESULTS
Analyses identified an unacceptable error percentage in all of the applications compared to the pedometer.
CONCLUSIONS
Given the inaccuracy of these applications, caution is required in their promotion to the public for self-monitoring physical activity and in their use as tools for assessing physical activity in research trials.
Topics: Actigraphy; Adult; Automobile Driving; Exercise Test; Female; Humans; Male; Middle Aged; Reproducibility of Results; Running; Smartphone; Walking; Young Adult
PubMed: 26621351
DOI: 10.1186/s13104-015-1705-8 -
IEEE Journal of Biomedical and Health... Jul 2019Unobtrusive and accurate ambulatory methods are needed to monitor long-term sleep patterns for improving health. Previously developed ambulatory sleep detection methods...
Unobtrusive and accurate ambulatory methods are needed to monitor long-term sleep patterns for improving health. Previously developed ambulatory sleep detection methods rely either in whole or in part on self-reported diary data as ground truth, which is a problem, since people often do not fill them out accurately. This paper presents an algorithm that uses multimodal data from smartphones and wearable technologies to detect sleep/wake state and sleep onset/offset using a type of recurrent neural network with long-short-term memory (LSTM) cells for synthesizing temporal information. We collected 5580 days of multimodal data from 186 participants and compared the new method for sleep/wake classification and sleep onset/offset detection to, first, nontemporal machine learning methods and, second, a state-of-the-art actigraphy software. The new LSTM method achieved a sleep/wake classification accuracy of 96.5%, and sleep onset/offset detection F scores of 0.86 and 0.84, respectively, with mean absolute errors of 5.0 and 5.5 min, res-pectively, when compared with sleep/wake state and sleep onset/offset assessed using actigraphy and sleep diaries. The LSTM results were statistically superior to those from nontemporal machine learning algorithms and the actigraphy software. We show good generalization of the new algorithm by comparing participant-dependent and participant-independent models, and we show how to make the model nearly realtime with slightly reduced performance.
Topics: Actigraphy; Adolescent; Adult; Algorithms; Female; Galvanic Skin Response; Humans; Male; Monitoring, Ambulatory; Neural Networks, Computer; Signal Processing, Computer-Assisted; Skin Temperature; Sleep; Smartphone; Wakefulness; Wearable Electronic Devices; Young Adult
PubMed: 30176613
DOI: 10.1109/JBHI.2018.2867619 -
Journal of Clinical Sleep Medicine :... Mar 2016To compare two commercial sleep devices, an accelerometer worn as a wristband (UP by Jawbone) and a smartphone application (MotionX 24/7), against polysomnography (PSG)... (Comparative Study)
Comparative Study
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.
Topics: Accelerometry; Actigraphy; Adolescent; Child; Child, Preschool; Cohort Studies; Female; Humans; Male; Polysomnography; Reproducibility of Results; Sensitivity and Specificity; Sleep Apnea Syndromes; Smartphone; Wrist
PubMed: 26446248
DOI: 10.5664/jcsm.5580 -
PloS One 2018There is extensive laboratory research studying the effects of acute sleep deprivation on biological and cognitive functions, yet much less is known about naturalistic...
There is extensive laboratory research studying the effects of acute sleep deprivation on biological and cognitive functions, yet much less is known about naturalistic patterns of sleep loss and the potential impact on daily or weekly functioning of an individual. Longitudinal studies are needed to advance our understanding of relationships between naturalistic sleep and fluctuations in human health and performance, but it is first necessary to understand the efficacy of current tools for long-term sleep monitoring. The present study used wrist actigraphy and sleep log diaries to obtain daily measurements of sleep from 30 healthy adults for up to 16 consecutive weeks. We used non-parametric Bland-Altman analysis and correlation coefficients to calculate agreement between subjectively and objectively measured variables including sleep onset time, sleep offset time, sleep onset latency, number of awakenings, the amount of wake time after sleep onset, and total sleep time. We also examined compliance data on the submission of daily sleep logs according to the experimental protocol. Overall, we found strong agreement for sleep onset and sleep offset times, but relatively poor agreement for variables related to wakefulness including sleep onset latency, awakenings, and wake after sleep onset. Compliance tended to decrease significantly over time according to a linear function, but there were substantial individual differences in overall compliance rates. There were also individual differences in agreement that could be explained, in part, by differences in compliance. Individuals who were consistently more compliant over time also tended to show the best agreement and lower scores on behavioral avoidance scale (BIS). Our results provide evidence for convergent validity in measuring sleep onset and sleep offset with wrist actigraphy and sleep logs, and we conclude by proposing an analysis method to mitigate the impact of non-compliance and measurement errors when the two methods provide discrepant estimates.
Topics: Actigraphy; Adolescent; Adult; Documentation; Female; Guideline Adherence; Healthy Volunteers; Humans; Longitudinal Studies; Male; Personality; Sleep; Wrist; Young Adult
PubMed: 29377925
DOI: 10.1371/journal.pone.0191883 -
Annals of the American Thoracic Society Sep 2018Poor sleep quality is common in the intensive care unit (ICU) and may be associated with adverse outcomes. Hence, ICU-based efforts to promote sleep are gaining...
RATIONALE
Poor sleep quality is common in the intensive care unit (ICU) and may be associated with adverse outcomes. Hence, ICU-based efforts to promote sleep are gaining attention, motivating interest in methods to measure sleep in critically ill patients. Actigraphy evaluates rest and activity by algorithmically processing gross motor activity data, usually collected by a noninvasive wristwatch-like accelerometer device. In critically ill patients, actigraphy has been used as a surrogate measure of sleep; however, its use has not been systematically reviewed.
OBJECTIVES
To conduct a systematic review of ICU-based studies that used actigraphy as a surrogate measure of sleep, including its feasibility, validity, and reliability as a measure of sleep in critically ill patients.
METHODS
We searched PubMed, EMBASE, CINAHL, Proquest, and Web of Science for studies that used actigraphy to evaluate sleep in five or more patients in an ICU setting.
RESULTS
Our search yielded 4,869 citations, with 13 studies meeting eligibility criteria. These 13 studies were conducted in 10 countries, and eight (62%) were published since 2008. Across the 13 studies, the mean total sleep time of patients in the ICU, as estimated using actigraphy, ranged from 4.4 to 7.8 hours at nighttime and from 7.1 to 12.1 hours over a 24-hour period, with 1.4 to 49.0 mean nocturnal awakenings and a sleep efficiency of 61 to 75%. When compared side-by-side with other measures of sleep (polysomnography, nurse assessments, and patient questionnaires), actigraphy consistently yielded higher total sleep time and sleep efficiency, fewer nighttime awakenings (vs. polysomnography), and more overall awakenings (vs. nurse assessment and patient questionnaires). None of the studies evaluated the association between actigraphy-based measures of sleep and outcomes of patients in the ICU.
CONCLUSIONS
In critically ill patients, actigraphy is being used more frequently as a surrogate measure of sleep; however, because actigraphy only measures gross motor activity, its ability to estimate sleep is limited by the processing algorithm used. Prior ICU-based studies involving actigraphy were heterogeneous and lacked data regarding actigraphy-based measures of sleep and patient outcomes. Larger, more rigorous and standardized studies are needed to better understand the role of actigraphy in evaluating sleep and sleep-related outcomes in critically ill patients.
Topics: Actigraphy; Critical Illness; Feasibility Studies; Humans; Intensive Care Units; Nurses; Polysomnography; Reproducibility of Results; Self Report; Sleep
PubMed: 29944386
DOI: 10.1513/AnnalsATS.201801-004OC