Alternatives to polysomnography (PSG): A validation of wrist actigraphy and a partial-PSG system

The objective of this study was to assess the validity of a sleep/wake activity monitor, an energy expenditure activity monitor, and a partial-polysomnography system at measuring sleep and wake under identical conditions. Secondary aims were to evaluate the sleep/wake thresholds for each activity monitor and to compare the three devices. To achieve these aims, two nights of sleep were recorded simultaneously with polysomnography (PSG), two activity monitors, and a partial-PSG system in a sleep laboratory. Agreement with PSG was evaluated epoch by epoch and with summary measures including total sleep time (TST) and wake after sleep onset (WASO). All of the devices had high agreement rates for identifying sleep and wake, but the partial-PSG system was the best, with an agreement of 91.6 % +/- 5.1 %. At their best thresholds, the sleep/wake monitor (medium threshold, 87.7 % +/- 7.6 %) and the energy expenditure monitor (very low threshold, 86.8 % +/- 8.6 %) had similarly high rates of agreement. The summary measures were similar to those determined by PSG, but the partial-PSG system provided the most consistent estimates. Although the partial-PSG system was the most accurate device, both activity monitors were also valid for sleep estimation, provided that appropriate thresholds were selected. Each device has advantages, so the primary consideration for researchers will be to determine which best suits a given research design.