Wake detection capacity of actigraphy during sleep.

STUDY OBJECTIVES To evaluate the ability of actigraphy compared to polysomnography (PSG) to detect wakefulness in subjects submitted to 3 sleep conditions with different amounts of wakefulness: a nocturnal sleep episode and 2 daytime recovery sleep episodes, one with placebo and one with caffeine. A second objective was to compare the ability of 4 different scoring algorithms (2 threshold algorithms and 2 regression analysis algorithms) to detect wake in the 3 sleep conditions. DESIGN Three nights of simultaneous actigraphy (Actiwatch-L, Mini-Mitter/Respironics) and PSG recordings in a within-subject design. SETTING Chronobiology laboratory. PARTICIPANTS Fifteen healthy subjects aged between 20 and 60 years (7M, 8F). INTERVENTIONS 200 mg of caffeine and daytime recovery sleep. RESULTS An epoch-by-epoch comparison between actigraphy and PSG showed a significant decrease in actigraphy accuracy with increased wakefulness in sleep conditions due to the low sleep specificity of actigraphy (generally <50%). Actigraphy overestimated total sleep time and sleep efficiency more strongly in conditions involving more wakefulness. Compared to the 2 regression algorithms, the 2 threshold algorithms were less able to detect wake when the sleep episode involved more wakefulness, and they tended to alternate more between wake and sleep in the scoring of long periods of wakefulness resulting in an overestimation of the number of awakenings. CONCLUSION The very low ability of actigraphy to detect wakefulness casts doubt on its validity to measure sleep quality in clinical populations with fragmented sleep or in situations where the sleep-wake cycle is challenged, such as jet lag and shift work.