Practice parameters for the use of actigraphy in the military operational context: the Walter Reed Army Institute of Research Operational Research Kit-Actigraphy (WORK-A)

Background The Walter Reed Army Institute of Research (WRAIR) Operational Research Kit-Actigraphy (WORK-A) is a set of unique practice parameters and actigraphy-derived measures for the analysis of operational military sleep patterns. The WORK-A draws on best practices from the literature and comprises 15 additional descriptive variables. Here, we demonstrate the WORK-A with a sample of United States Army Reserve Officers' Training Corps (ROTC) cadets (n = 286) during a month-long capstone pre-commissioning training exercise. Methods The sleep of ROTC cadets (n = 286) was measured by Philips Actiwatch devices during the 31-day training exercise. The preliminary effectiveness of the WORK-A was tested by comparing differences in sleep measures collected by Actiwatches as calculated by Philips Actiware software against WORK-A-determined sleep measures and self-report sleep collected from a subset of ROTC cadets (n = 140). Results Actiware sleep summary statistics were significantly different from WORK-A measures and self-report sleep (allP <= 0.001). Bedtimes and waketimes as determined by WORK-A major sleep intervals showed the best agreement with self-report bedtime (22:21 +/- 1:30 vs. 22:13 +/- 0:40,P = 0.21) and waketime (04:30 +/- 2:17 vs. 04:31 +/- 0:47,P = 0.68). Though still significantly different, the discrepancy was smaller between the WORK-A measure of time in bed (TIB) for major sleep intervals (352 +/- 29 min) and self-report nightly sleep duration (337 +/- 57 min,P = 0.006) than that between the WORK-A major TIB and Actiware TIB (177 +/- 42,P <= 0.001). Conclusions Default actigraphy methods are not the most accurate methods for characterizing soldier sleep, but reliable methods for characterizing operational sleep patterns is a necessary first step in developing strategies to improve soldier readiness. The WORK-A addresses this knowledge gap by providing practice parameters and a robust variety of measures with which to profile sleep behavior in service members.