Validation of a Consumer Sleep Wearable Device With Actigraphy and Polysomnography in Adolescents Across Sleep Opportunity Manipulations

Study Objectives: To compare the quality and consistency in sleep measurement of a consumer wearable device and a research-grade actigraph with polysomnography (PSG) in adolescents. Methods: Fifty-eight healthy adolescents (aged 15-19 years; 30 males) underwent overnight PSG while wearing both a Fitbit Alta HR and a Philips Respironics Actiwatch 2 (AW2) for 5 nights, with either 5 hours or 6.5 hours time in bed (TIB) and for 4 nights with 9 hours TIB. AW2 data were evaluated using two different wake and immobility thresholds. Discrepancies in estimated total sleep time (TST) and wake after sleep onset (WASO) between devices and PSG, as well as epochby-epoch agreements in sleep/wake classification, were assessed. Fitbit-generated sleep staging was compared to PSG. Results: Fitbit and AW2 under default settings similarly underestimated TST and overestimated WASO (TST: medium setting (M10) <= 38 minutes, Fitbit <= 47 minutes; WASO: M10 <= 38 minutes; Fitbit <= 42 minutes). AW2 at the high motion threshold setting provided readings closest to PSG (TST: <= 12 minutes; WASO: <= 18 minutes). Sensitivity for detecting sleep was >= 90% for both wearable devices and further improved to 95% by using the high threshold (H5) setting for the AW2 (0.95). Wake detection specificity was highest in Fitbit (>= 0.88), followed by the AW2 at M10 (>= 0.80) and H5 thresholds (<= 0.73). In addition, Fitbit inconsistently estimated stage N1 + N2 sleep depending on TIB, underestimated stage N3 sleep (21-46 min), but was comparable to PSG for rapid eye movement sleep. Fitbit sensitivity values for the detection of N1 + N2, N3 and rapid eye movement sleep were >= 0.68, >= 0.50, and >= 0.72, respectively. Conclusions: A consumer-grade wearable device can measure sleep duration as well as a research actigraph. However, sleep staging would benefit from further refinement before these methods can be reliably used for adolescents.