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Observational Study
. 2021 Jan 29;25(1):42.
doi: 10.1186/s13054-020-03447-8.

The feasibility and reliability of actigraphy to monitor sleep in intensive care patients: an observational study

L J Delaney  1   2 , E Litton  3   4 , K L Melehan  5   6 , H-C C Huang  7   8   9 , V Lopez  10   11 , F Van Haren  7   12
Affiliations
Observational Study

The feasibility and reliability of actigraphy to monitor sleep in intensive care patients: an observational study

L J Delaney et al. Crit Care. .

Abstract

Background: Sleep amongst intensive care patients is reduced and highly fragmented which may adversely impact on recovery. The current challenge for Intensive Care clinicians is identifying feasible and accurate assessments of sleep that can be widely implemented. The objective of this study was to investigate the feasibility and reliability of a minimally invasive sleep monitoring technique compared to the gold standard, polysomnography, for sleep monitoring.

Methods: Prospective observational study employing a within subject design in adult patients admitted to an Intensive Care Unit. Sleep monitoring was undertaken amongst minimally sedated patients via concurrent polysomnography and actigraphy monitoring over a 24-h duration to assess agreement between the two methods; total sleep time and wake time.

Results: We recruited 80 patients who were mechanically ventilated (24%) and non-ventilated (76%) within the intensive care unit. Sleep was found to be highly fragmented, composed of numerous sleep bouts and characterized by abnormal sleep architecture. Actigraphy was found to have a moderate level of overall agreement in identifying sleep and wake states with polysomnography (69.4%; K = 0.386, p < 0.05) in an epoch by epoch analysis, with a moderate level of sensitivity (65.5%) and specificity (76.1%). Monitoring accuracy via actigraphy was improved amongst non-ventilated patients (specificity 83.7%; sensitivity 56.7%). Actigraphy was found to have a moderate correlation with polysomnography reported total sleep time (r = 0.359, p < 0.05) and wakefulness (r = 0.371, p < 0.05). Bland-Altman plots indicated that sleep was underestimated by actigraphy, with wakeful states overestimated.

Conclusions: Actigraphy was easy and safe to use, provided moderate level of agreement with polysomnography in distinguishing between sleep and wakeful states, and may be a reasonable alternative to measure sleep in intensive care patients. Clinical Trial Registration number ACTRN12615000945527 (Registered 9/9/2015).

Keywords: Actigraphy; Intensive care; Polysomnography; Sleep; Sleep disturbance; Sleep quality.

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Conflict of interest statement

Nil competing interests to declare.

Figures

Fig. 1
Fig. 1
Consort diagram
Fig. 2
Fig. 2
Bland–Altman plots: Horizontal line drawn at the mean difference and at the mean difference plus and minus 1.96 times the standard deviation of the differences, with the y-axis reporting mean duration determine by polysomnography. a Polysomnography versus Actigraphy assessment of total sleep time. b Polysomnography versus Actigraphy assessment of wakeful states for the study cohort. Graphs c and d depict Polysomnography versus Actigraphy assessment of total sleep time amongst mechanically ventilated patients (c) and Polysomnography versus Actigraphy assessment of wakeful states for patients receiving mechanical ventilation (d). Non-ventilated patient total sleep time (PSG vs ACTG), and wake time (PSG vs ACTG) is represented in graph e and f
Fig. 2
Fig. 2
Bland–Altman plots: Horizontal line drawn at the mean difference and at the mean difference plus and minus 1.96 times the standard deviation of the differences, with the y-axis reporting mean duration determine by polysomnography. a Polysomnography versus Actigraphy assessment of total sleep time. b Polysomnography versus Actigraphy assessment of wakeful states for the study cohort. Graphs c and d depict Polysomnography versus Actigraphy assessment of total sleep time amongst mechanically ventilated patients (c) and Polysomnography versus Actigraphy assessment of wakeful states for patients receiving mechanical ventilation (d). Non-ventilated patient total sleep time (PSG vs ACTG), and wake time (PSG vs ACTG) is represented in graph e and f
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