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Published on: April 18, 2018
Actigraphy: Metrics reveal it is not a valid tool for determining sleep in neonates
Matthew Derbin1, Lauren McKenna1, Donald Chin2
1Department of Pediatrics, University of Massachusetts Medical School, Worcester, MA, USA.
Insights
Actigraphy shows high agreement for detecting sleep in preterm infants but struggles with wakefulness. This method requires further validation for reliable sleep-wake discrimination in neonates.
Area of Science:
- Neonatal development
- Sleep medicine
- Medical technology validation
Background:
- Assessing infant sleep is crucial for development, but current methods are costly and difficult for hospitalized neonates.
- Actigraphy offers a potential low-cost, less invasive alternative for sleep monitoring.
Purpose of the Study:
- To evaluate the accuracy of actigraphy in distinguishing sleep and wake states in preterm infants.
- To compare actigraphy findings against polysomnography (PSG), the established gold standard for sleep assessment.
Main Methods:
- Simultaneous recording of polysomnography (PSG) and actigraphy in 10 preterm infants over 8-10 hour sessions.
- Comparing minute-by-minute PSG sleep-wake scores with actigraphy data using three movement thresholds.
- Assessing tool validity using five metrics, including agreement rate, sensitivity, specificity, and receiver operating characteristic (ROC) curve analysis.
Main Results:
- Actigraphy demonstrated high agreement (85.2%-97.2%) and sensitivity for detecting sleep.
- However, specificity and predictive value for wakefulness were low (12%-46%).
- ROC analysis indicated low discriminatory power (AUC = 0.636), with a key limitation being insufficient autonomous wake periods in infants.
Conclusions:
- Actigraphy, in its current form, cannot be reliably validated for sleep/wake discrimination in preterm infants.
- Further validation requires incorporating sufficient data from both sleep and autonomous wake periods.
- The study highlights limitations in applying actigraphy to the unique sleep patterns of hospitalized preterm neonates.
Abstract:
Study of emerging sleep-wake patterns in neonates is important for promptly identifying and treating abnormal sleep behaviours to ensure healthy infant development and neurobehavioral outcomes. Current methods to assess sleep are costly, labour intensive, and particularly difficult to implement in fragile, hospitalised infants requiring intensive medical care. The aim of the present study was to assess the validity of actigraphy as a tool for detecting sleep in preterm infants, using polysomnography (PSG) as the "gold standard". A total of 10 neonates (mean [SD] 35.8 [1.2] weeks post-menstrual age; five female) hospitalised since birth for prematurity each participated in one 8-10 hr session during which PSG and actigraphy were recorded simultaneously. Inter-feed minute-by-minute PSG Sleep-Wake scores were compared to concurrent actigraph epochs categorised as either "Sleep" or "Wake" using three separate movement-per-minute thresholds (≤20, ≤40, ≤80). Tool validity was assessed using five metrics. A key finding was that for each of the movement thresholds there was high agreement rate, sensitivity, and predictive value of sleep (85.2%-97.2%), whereas specificity and predictive value of wake remained low (12%-46%). Receiver operating characteristic curve analysis also revealed low discriminatory power of actigraphy for estimating sleep (area under the curve = 0.636; Youden's Index J = 0.2173). Lack of sufficient minutes of autonomous wake periods among infants was identified as a key limitation in actigraphy. Findings from the present study suggest actigraphy cannot be validated for Sleep/Wake discrimination in preterm infants and that proper validation requires sufficient data from periods of both Sleep and Wake.
