A validation of wrist actigraphy against polysomnography in patients with schizophrenia or bipolar disorder

Abstract

Purpose: Sleep disturbances are frequent in patients with schizophrenia or bipolar disorder. Actigraphy has been established as a generally reliable method to examine these disturbances across varying time spans, but the validity against polysomnography (PSG) is not well investigated for this population. We validated wrist-worn actigraphy against PSG in a population of chronic, medicated patients with schizophrenia or bipolar disorder.

Patients and methods: From a clinical trial, we derived data from 37 patients with schizophrenia and five patients with bipolar disorder who were examined with one-night PSG and concomitant actigraphy. The following sleep variables were compared between the two methods: total sleep time, sleep efficiency, sleep latency, number of awakenings, and time awake after sleep onset. The degree of consistency between the two methods was evaluated using the intra-class correlation coefficient and Bland-Altman plots. Subgroup analyses included splitting the analyses according to sex, diagnosis, and duration of wakefulness after sleep onset. PSG was considered the gold standard.

Results: The intraclass correlation coefficient was high for total sleep time, moderate for the number of awakenings, and low or zero for the other examined sleep variables. These findings were reproduced in the subgroup analyses that compared men and women, as well as patients with bipolar versus schizophrenia spectrum disorders. When excluding patients with extensive periods of wakefulness after the initial sleep period (wake after sleep onset > 100 minutes), the reliability of the actigraphy-derived sleep variables markedly improved.

Conclusion: Actigraphy reliably measures the total sleep time in this specific patient population. For patients without extensive periods of wakefulness after sleep onset, actigraphy might provide a useful measure of sleep efficiency, sleep latency, and number of awakenings.

Keywords: actigraphy; bipolar disorder; polysomnography; schizophrenia; validation.

Figure 1

Dot plot of WASO as measured using PSG (in blue) and actigraphy (in green). Abbreviations: WASO, wake after sleep onset; PSG, polysomnography; min, minute.

Figure 2

Bland–Altman plot of TST. Abbreviations: TST, total sleep time; PSG, polysomnography; SD, standard deviation.

Figure 3

Bland–Altman plot of SE. Abbreviations: SE, sleep efficiency; PSG, polysomnography; SD, standard deviation.

Figure 4

Bland–Altman plot of SL. Abbreviations: AW, number of awakenings; SL, sleep latency; PSG, polysomnography; SD, standard deviation.

Figure 5

Bland–Altman plot of AW. Abbreviations: AW, number of awakenings; PSG, polysomnography; SD, standard deviation.

Figure 6

Bland–Altman plot of WASO. Abbreviations: WASO, wake after sleep onset; PSG, polysomnography; SD, standard deviation.