The use of actigraphy to study sleep disorders in preschoolers: Some concerns about detection of nighttime awakenings

Study Objectives: This study compared actigraphy with videosomnography in preschool-aged children, with special emphasis on the accuracy of detection of nighttime awakenings. Design: Fifty-eight participants wore an actigraph for 1 week and were videotaped for 2 nights while wearing the actigraph. Setting: Participants were solitary sleepers, studied in their homes. Participants: One group (n = 22) was diagnosed with autism, another group (n = 11) had developmental delays without autism, and a third group (n = 25) were typically developing children; age ranged from 28 to 73 months (mean age 47 months); 29 boys and 29 girls. Interventions: N/A. Measurements and Results: Nocturnal sleep and wakefulness were scored from simultaneously recorded videosomnography and actigraphy. The accuracy of actigraphy was examined in an epoch-by-epoch comparison with videosomnography. Findings were 94% overall agreement, 97% sensitivity, and 24% specificity. Statistical corrections for overall agreement and specificity resulted in an 89% weighted-agreement and 27% adjusted specificity. Conclusions: Actigraphy has poor agreement for detecting nocturnal awakenings, compared with video observations, in preschool-aged children.