Concordance of Polysomnographic and Actigraphic Measurement of Sleep and Wake in Older Women with Insomnia

Study Objectives: The objective of this secondary analysis was to evaluate concurrent validity of actigraphy and polysomnography (PSG) in older women with insomnia. Methods: Concurrent validity of actigraphy and PSG was examined through (1) comparison of sleep outcomes from each recording method; (2) calculation of sensitivity, specificity, accuracy, and predictive values from epoch-by-epoch data; and (3) statistical and graphical exploration of the relationship between sleep disturbance severity and concordance of actigraphy and PSG. Subjects were 16 community-dwelling older women (mean age 69.4 +/- 8.1) with insomnia who underwent 8 nights of concurrent actigraphy and PSG. Results: Sleep efficiency reflected much greater sleep disturbance on PSG (66.9%) than actigraphy (84.4%). Based on generalized linear models, the parameter estimates for agreement between actigraphy and PSG were statistically significant (p < 0.05) for total sleep time and sleep latency, verged on significance for WASO (p = 0.052), but was not significant for sleep efficiency (p = 0.20). Epoch-by-epoch analysis showed high sensitivity (96.1%), low specificity (36.4%), and modest values on agreement (75.4%) and predictive values of sleep (74.7%) and wake (80.2%). Generalized linear models showed that overall accuracy of actigraphy declined as sleep efficiency declined (unstandardized Beta = 0.741, p < 0.001). Based on this model, sleep efficiency of 73% was the point at which accuracy declined below an acceptable accuracy value of 80%. Conclusions: Actigraphy offers a relatively inexpensive and unobtrusive method for measuring sleep, but it appears to underestimate sleep disturbance, particularly at sleep efficiency levels below 73%, in older women with insomnia.