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Invalidity of one actigraphy brand for identifying sleep and wake among infants.

ABSTRACT: Few commercially available brands of actigraphs (ACT) have been subjected to rigorous validation with infant participants. The purpose of this study was to examine the agreement between concurrent polysomnography (PSG) and one brand of ACT (AW-64, Mitter Co. Inc.) using appropriate statistical techniques among a sample of healthy infants.Twenty-two healthy infants (14.1+/-0.6 months) had one night of ankle ACT recording during research PSG at Kosair Children's Hospital Sleep Research Center in Louisville, Kentucky. Macroanalyses were conducted using the Bland-Altman concordance technique to assess agreement between total sleep time (TST) and wake after sleep onset (WASO) simultaneously measured by PSG and ACT, using two ACT algorithm settings. Microanalyses were also calculated to examine sensitivity, specificity, and accuracy of ACT within each PSG-identified sleep state. Correlations were calculated between PSG-identified arousals and the discrepancies between ACT and PSG.The Bland-Altman concordance technique revealed that ACT underestimated TST by 72.25 (SD=61.48) minutes and by > or = 60 min among 54.55% of infants. Furthermore, ACT overestimated WASO by 13.85 (SD=30.94) minutes and by > or = 30 min among 40.91% of infants. Sensitivity, specificity, and accuracy analyses revealed that ACT adequately identified sleep, but poorly identified wake. PSG and ACT discrepancies were positively associated with PSG-identified arousals (r=.45).Improved device and/or software development is needed before the AW-64 can be considered a valid method for identifying infant sleep and wake.

SUBMITTER: Insana SP

PROVIDER: S-EPMC2819582 | biostudies-literature | 2010 Feb

REPOSITORIES: biostudies-literature

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Invalidity of one actigraphy brand for identifying sleep and wake among infants.

Insana Salvatore P SP Gozal David D Montgomery-Downs Hawley E HE

Sleep medicine 20100118 2

<h4>Study objectives</h4>Few commercially available brands of actigraphs (ACT) have been subjected to rigorous validation with infant participants. The purpose of this study was to examine the agreement between concurrent polysomnography (PSG) and one brand of ACT (AW-64, Mitter Co. Inc.) using appropriate statistical techniques among a sample of healthy infants.<h4>Methods</h4>Twenty-two healthy infants (14.1+/-0.6 months) had one night of ankle ACT recording during research PSG at Kosair Child ...[more]

PMID: 20083430

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Project description:Detecting the effectiveness of behavioral interventions to reduce infant night-waking requires valid sleep measures. Although viewed as an objective measure, actigraphy has overestimated night-waking. Sleep diaries are criticized for only documenting night-waking with infant crying. To support potential outcome measure validity, we examined differences between sleep diaries and actigraphy in detecting night-waking and sleep duration. We recruited 5.5 to 8-month-old infants for a behavioral sleep intervention trial conducted from 2009 to 2011. Intervention (sleep education and support) and control groups (safety education and support) collected infant diary and actigraphy data for 5 days. We compared night-time sleep actigraphy with diary data at baseline (194 cases), and 6 weeks (166 cases) and 24 weeks post-education (118 cases). We hypothesized numbers of wakes and wakes of ≥20 min would be higher and longest sleep time and total sleep time shorter by actigraphy compared with diaries. Using paired t-tests, there were significantly more actigraphy night wakes than diary wakes at baseline (t = 29.14, df = 193, p < 0.001), 6 weeks (t = 23.99, df = 165, p < 0.001), and 24 weeks (t = 22.01, df = 117, p < 0.001); and significantly more night wakes of ≥20 min by actigraphy than diary at baseline (t = 5.03, df = 183, p < 0.001), and 24 weeks (t = 2.19, df = 107, p < 0.05), but not 6 weeks (t = 1.37, df = 156, n.s.). Longest sleep duration was significantly higher by diary than actigraphy at baseline (t = 14.71, df = 186, p < 0.001), 6 weeks (t = 7.94, df = 158, p < 0.001), and 24 weeks (t = 17.18, df = 114, p < 0.001). Night sleep duration was significantly higher by diary than actigraphy at baseline (t = 9.46, df = 185, p < 0.001), 6 weeks (t = 13.34, df = 158, p < 0.001), and 24 weeks (t = 13.48, df = 114, p < 0.001). Discrepancies in actigraphy and diary data may indicate accurate actigraphy recording of movement but not sleep given active infant sleep and self-soothing.

Project description:BackgroundPrevious studies demonstrated a short-term relationship between infant sleep-wake states and oral feeding performance, with state being an indication of infants' neurobehavioral readiness for feeding. However, the relationship between sleep-wake states and feeding skills has not been evaluated longitudinally during hospitalization.ObjectivesThe purpose of this study was to examine preterm infants' sleep-wake state developmental trajectories and their associations with feeding progression during hospitalization.MethodsThis descriptive and exploratory study was a secondary analysis using data from a longitudinal two-group, randomized controlled trial evaluating the effects of early and late cycled light on health and developmental outcomes among extremely preterm infants who were born ≤28 weeks of gestational age. Sleep-wake states were assessed for two 2-hour interfeeding periods per day (day and night hours), 30 weeks postmenstrual age, and every 3 weeks until discharge. Occurrences of active sleep, quiet sleep, and waking were recorded every 10 seconds. Feeding progression was assessed based on an infant's postmenstrual age at five milestones: first enteral feeding, full enteral feeding, first oral feeding, half oral feeding, and full oral feeding. Trajectory analyses were used to describe developmental changes in sleep-wake states, feeding progression patterns, and associations between feeding progression and sleep-wake trajectories.ResultsActive sleep decreased while waking, and quiet sleep increased during hospitalization. Two distinct feeding groups were identified: typical and delayed feeding progression. In infants with delayed feeding progression, rates of active and quiet sleep development during the day were delayed compared to those with typical feeding progression. We also found that infants with delayed feeding progression were more likely to be awake more often during the night compared to infants with typical feeding progression.DiscussionsFindings suggest that delays in sleep-wake state development may be associated with delays in feeding progression during hospitalization. Infants with delayed feeding skill development may require more environmental protection to further support their sleep development.

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Invalidity of one actigraphy brand for identifying sleep and wake among infants.

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Invalidity of one actigraphy brand for identifying sleep and wake among infants.

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