A comparison of agreement between actigraphy and polysomnography for assessing sleep during posttraumatic amnesia

Bianca Fedele; Dean McKenzie; Gavin Williams; Robert Giles; John Olver

doi:10.5664/jcsm.10174

A comparison of agreement between actigraphy and polysomnography for assessing sleep during posttraumatic amnesia

J Clin Sleep Med. 2022 Nov 1;18(11):2605-2616. doi: 10.5664/jcsm.10174.

Authors

Bianca Fedele^{1

2

3}, Dean McKenzie^{4

5}, Gavin Williams^{1

2

6}, Robert Giles⁷, John Olver^{1

2

3}

Affiliations

¹ Department of Rehabilitation, Epworth HealthCare, Melbourne, Australia.
² Department of Rehabilitation, Epworth Monash Rehabilitation Medicine (EMReM) Unit, Melbourne, Australia.
³ School of Clinical Sciences, Monash University, Melbourne, Australia.
⁴ Research Development and Governance Unit, Epworth HealthCare, Melbourne, Australia.
⁵ Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia.
⁶ Department of Physiotherapy, The University of Melbourne, Melbourne, Australia.
⁷ Sleep Unit, Department of Rehabilitation and Mental Health, Epworth HealthCare, Melbourne, Australia.

Abstract

Study objectives: Sleep disturbance often emerges in the early recovery phase following a moderate to severe traumatic brain injury, known as posttraumatic amnesia. Actigraphy is commonly employed to assess sleep, as it is assumed that patients in posttraumatic amnesia (who display confusion, restlessness, and agitation) would better tolerate this measure over gold-standard polysomnography (PSG). This study evaluated the agreement between PSG and actigraphy for determining (sleep/wake time, sleep efficiency, sleep latency, and awakenings) in patients experiencing posttraumatic amnesia. It also compared the epoch-by-epoch sensitivity, specificity, and accuracy between the Actigraph device's 4 wake threshold settings (low, medium, high, and automatic) to PSG.

Methods: The sample consisted of 24 inpatients recruited from a traumatic brain injury inpatient rehabilitation unit. Ambulatory PSG was recorded overnight at bedside and a Philips Actiwatch was secured to each patient's wrist for the same period.

Results: There were poor correlations between PSG and actigraphy for all parameters (Lin's concordance correlation coefficient = < 0.80). The low threshold displayed the highest correlation with PSG for wake and sleep time, albeit still low. Actigraphy displayed low specificity (ranging from 17.1% to 36.6%). There appears to be a greater disparity between actigraphy and PSG for patients with increased wake time.

Conclusions: Actigraphy, while convenient, demonstrated poorer performance in determining sleep-wake parameters in patients with significantly disturbed sleep. Ambulatory PSG can provide a clearer understanding of the extent of sleep disturbances in these patients with reduced mobility during early rehabilitation. Study findings can help design future protocols of sleep assessment during posttraumatic amnesia and optimize treatment.

Citation: Fedele B, McKenzie D, Williams G, Giles R, Olver J. A comparison of agreement between actigraphy and polysomnography for assessing sleep during posttraumatic amnesia. J Clin Sleep Med. 2022;18(11):2605-2616.

Keywords: actigraphy; brain injuries; polysomnography; rehabilitation; sleep; traumatic.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Actigraphy / methods
Amnesia / complications
Amnesia / diagnosis
Brain Injuries, Traumatic* / complications
Humans
Polysomnography / methods
Reproducibility of Results
Sleep
Sleep Wake Disorders* / complications
Sleep Wake Disorders* / diagnosis