The (mis)perception of sleep: factors influencing the discrepancy between self-reported and objective sleep parameters

Study Objectives: Self-reported perception of sleep often differs from objective sleep study measures, but factors predicting the discrepancy between self-reported and objective sleep parameters are controversial, and a comparison of laboratory vs ambulatory polysomnography (PSG) is lacking. Methods: We retrospectively analyzed PSGs conducted between 2012 and 2016. Linear regression was applied to predict the discrepancy between self-reported and objective sleep parameters (total sleep time, sleep efficiency, sleep latency, using age, sex, arousal index, type of sleep disorder, and PSG type [laboratory vs ambulatory] as regressors). Results: A total of 303 PSGs were analyzed (49% women, median age 48 years), comprising patients with insomnia (32%), sleep-related breathing disorders (27%), sleep-related movement disorders (15%), hypersomnia/narcolepsy (14%), and parasomnias (12%). Sleep disorder was the best predictor of discrepancy between self-reported and objective total sleep time, and patients with insomnia showed higher discrepancy values compared to all other patient groups (P <.001), independent of age and PSG type (P > .05). Contributory effects for higher discrepancy values were found for lower arousal index. Patients with insomnia underestimated both total sleep time (median discrepancy: 46 minutes, P <.001) and sleep efficiency (median discrepancy: 11%, P <.001). No significant predictor for discrepancy of sleep latency was found. Conclusions: Misperception of sleep duration and efficiency is common in sleep lab patients, but most prominent in insomnia, independent of age, sex, or laboratory vs ambulatory recording setting. This underlines the role of PSG in patients with a clinical diagnosis of insomnia and its use in cognitive behavioral therapy.

Automated summary

Patients in sleep lab often misperceive sleep duration and efficiency, particularly those with insomnia, with lower arousal index contributing to higher discrepancy values. PSG plays a crucial role in diagnosing and treating insomnia patients, regardless of age, sex, or recording setting.