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Updated: Aug 19, 2025
Preterm EEG: A Multimodal Neurophysiological Protocol
Published on: February 18, 2012
Sleep assessment in preterm infants: Use of actigraphy and aEEG
Özge Ülgen1, Hatice Ezgi Barış1, Öykü Özbörü Aşkan1
1Marmara University, School of Medicine, Department of Pediatrics, Division of Social Pediatrics, Istanbul, Turkey.
Insights
Objective monitoring of sleep in preterm infants is crucial for neurodevelopment. Actigraphy showed moderate agreement with direct observation, suggesting its utility in neonatal intensive care units (NICU).
Area of Science:
- Neonatal care
- Sleep science
- Neurodevelopmental outcomes
Background:
- Objective sleep monitoring is essential for preterm infants in the NICU to prevent adverse neurodevelopmental outcomes.
- Current methods require validation against gold standards for accuracy.
Purpose of the Study:
- To assess the concordance of actigraphy and amplitude-integrated electroencephalogram (aEEG) with direct observation (DO) for sleep/wake states in preterm infants.
- To determine the reliability of these methods for NICU monitoring.
Main Methods:
- Prospective observational study in a level III NICU.
- Compared 24-hour actigraphy and 8-hour aEEG data with 8-hour direct observation (DO).
- Utilized sensitivity-specificity analysis, Cohen's kappa, PABAK, and Bland Altman plots.
Main Results:
- Seventeen preterm infants were studied (11252 epochs).
- Actigraphy showed varying sensitivity and specificity depending on threshold, with moderate agreement (kappa 0.14-0.17) with DO.
- Amplitude-integrated electroencephalogram (aEEG) demonstrated moderate agreement (PABAK 0.44) with DO, with no significant differences in sleep parameters.
Conclusions:
- Actigraphy at a medium threshold is suitable for monitoring sleep in typically developing preterm infants in the NICU.
- aEEG presents a potential adjunctive method for evaluating sleep/wake states in the NICU setting.
Objective:
Objective methods to monitor the sleep of preterm infants at the neonatal intensive care unit (NICU) are required to prevent potentially adverse neurodevelopmental outcomes. This study aimed to determine the concordance of actigraphy and amplitude-integrated electroencephalogram (aEEG) against gold standard direct observation (DO) in assessing sleep/wake states of typically developing preterm infants.
Methods:
This prospective observational study was conducted in a single center level III NICU. Sleep variables were measured using Philips Respironics Mini-Mitter® Actiwatch-2 for 24 h and compared with 8-h matched data of aEEG and DO. Sensitivity-specificity analysis, Cohen's kappa, prevalence-adjusted and bias-adjusted kappa (PABAK), and Bland Altman plots were generated.
Results:
Seventeen preterm infants were recruited. A total of 11252 epochs were studied. Sensitivity (86.4%), agreement rate (67.9%), and predictive value for wake (47.9%) for the actigraphy were highest at the automatic activity threshold whereas specificity (54.5%) and predictive value for sleep (75.5%) were highest at low threshold. The sensitivity of aEEG was 79.3% and the specificity was 54.3%. At all thresholds, the agreement was largely equivalent with low kappas (0.14-0.17) and PABAK coefficients (0.22-0.35) for actigraphy and DO. Moderate agreement was observed between aEEG and DO according to the PABAK coefficient (0.44). Mean differences in sleep parameters were not different between DO and aEEG as well as DO/aEEG and actigraphy at medium threshold (p > 0.05).
Conclusions:
Actigraphy at medium threshold can be used in depicting sleep in typically developing preterm infants at NICU. aEEG may be an alternative adjunctive method to actigraphy for the evaluation of sleep/wake states in the NICU setting.
Clinical Trial Registration Number:
NCT04145362.
