Objective measurements of sleep for non-laboratory settings as alternatives to polysomnography—a systematic review

Utrecht University, General Health Sciences, Physiotherapy Science, Utrecht, The Netherlands.
Journal of Sleep Research (Impact Factor: 2.95). 03/2010; 20(1 Pt 2):183-200. DOI: 10.1111/j.1365-2869.2009.00814.x
Source: PubMed

ABSTRACT Sleep disturbance influences human health. To examine sleep patterns, it is advisable to utilize valid subjective and objective measures. Laboratory-based polysomnography (PSG) is deemed the gold standard to measure sleep objectively, but is impractical for long-term and home utilization (e.g. resource-demanding, difficult to use). Hence, alternative devices have been developed. This study aimed to review the literature systematically, providing an overview of available objective sleep measures in non-laboratory settings as an alternative to PSG. To identify relevant articles, a specific search strategy was run in EMBASE, PubMed, CINAHL, PsycInfo and Compendex (Engineering Village 2). In addition, reference lists of retrieved articles were screened and experts within this research field were contacted. Two researchers, using specified in/exclusion criteria, screened identified citations independently in three stages: on title, abstract and full text. Data from included articles were extracted and inserted into summarizing tables outlining the results. Of the 2217 electronically identified citations, 35 studies met the inclusion criteria. Additional searches revealed eight papers. Psychometric characteristics of nine different objective measures of sleep pattern alternatives to PSG [(bed) actigraphy, observation, bed sensors, eyelid movement- and non-invasive arm sensors, a sleep switch and a remote device] were evaluated. Actigraphy is used widely and has been validated in several populations. Alternative devices to measure sleep patterns are becoming available, but most remain at prototype stage and are validated insufficiently. Future research should concentrate on the development and further validation of non-invasive, inexpensive and user-friendly sleep measures for non-laboratory settings.

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    • "The data it captures are downloaded and analysed to map activity and inactivity segments from which wake-sleep periods are then inferred (Chesson et al., 2007). In their review of 25 actigraphy studies, Van de water et al. (2011) determined that actigraphy was the most appropriate objective measure available to inform general sleep patterns in a non-laboratory setting. Sleep is also measured subjectively. "
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    ABSTRACT: Background Sleep is a dynamic and essential part of human life and health. In healthcare settings, nurses are strategically placed to promote sleep and sleep health. In this regard, nursing actions should be based upon effective methods of assessment of patient sleep. Standardised sleep assessment does not currently occur in the care of acute hospitalised patients. Use of an appropriate measurement tool would help evaluate inpatient sleep. An effective, efficient sleep assessment tool is needed to aid clinicians. Such assessment would provide specific nursing intervention to be tailored to individual patients. Objective The objective of this paper was to examine the literature on sleep measurement to identify subjective sleep assessment tools that may be suitable for routine use with hospitalised patients, and to evaluate their reliability and validity. Method A review of existing literature was undertaken to identify and evaluate subjective sleep measurement tools. Results The initial literature searches identified 402 articles, of which ten met the criteria for review. These reported on three subjective sleep measurement scales: the Richards-Campbell Sleep Questionnaire; the St Mary's Hospital Sleep Questionnaire; and the Verran Snyder-Halpern Sleep Scale. The Richards-Campbell Sleep Questionnaire is brief and easy to use. In specific samples, its items correlate with domains reflecting sleep quality and has shown excellent internal consistency. Equivocal results and scoring challenges were found with the St Mary's Hospital Sleep Questionnaire. The Verran Snyder-Halpern Sleep Scale captured sleep disturbance and total sleep time, but time-to-complete is more burdensome than the Richards-Campbell Sleep Questionnaire. Conclusions The current use of sleep assessment instruments in the acute hospital setting is restricted mainly to research activities. Of the three tools identified that could be used clinically to measure inpatient sleep, and although it was developed for use in the intensive care setting, the Richards-Campbell Sleep Questionnaire held greatest potential due to its ease and rapidity of use. However, it has yet to be validated for use with general hospital inpatients, and further research is required in this area.
    International journal of nursing studies 09/2014; DOI:10.1016/j.ijnurstu.2014.02.001 · 2.25 Impact Factor
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    • "Unfortunately, for many cases, it lacks detail (such as the REM–NREM distinction) and accuracy [10], [11]. No other methods reached the point beyond prototype or have been sufficiently validated to fill the gap between PSG and ACT [12]. Over the years, however, extensive research has been performed on changes in heart rate (HR) and breathing rate (BR) across sleep stages and other related events. "
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    ABSTRACT: Polysomnography (PSG) is considered the gold standard to assess sleep accurately, but it can be expensive, time-consuming, and uncomfortable, specifically in long-term sleep studies. Actigraphy, on the other hand, is both cheap and user-friendly, but depending on the application lacks detail and accuracy. Our aim was to evaluate cardiorespiratory and movement signals in discriminating between wake, rapid-eye-movement (REM), light (N1N2), and deep (N3) sleep. The dataset comprised 85 nights of PSG from a healthy population. Starting from a total of 750 characteristic variables (features), problem-specific subsets of 40 features were forwardly selected using the combination of a wrapper method (Cohen's kappa statistic on radial basis function (RBF)-kernel support vector machine (SVM) classifier) and filter method (minimum redundancy maximum relevance criterion on mutual information). Final classification was performed using an RBF-kernel SVM. Non-subject-specific wake versus sleep classification resulted in a Cohen's kappa value of 0.695, while REM versus NREM resulted in 0.558 and N3 versus N1N2 in 0.553. The broad pool of initial features gave insight in which features discriminated best between the different classes. The classification results demonstrate the possibility of making long-term sleep monitoring more widely available.
    IEEE Journal of Biomedical and Health Informatics 03/2014; 18(2):661-669. DOI:10.1109/JBHI.2013.2276083 · 1.98 Impact Factor
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    • "The overall agreement rate between actigraphy and polysomnography ranged from 72.1 to 96.5%, sensitivity ranged from 86.5 to 98.7% and specificity ranged from 27.7 to 67.1% (Van de Water et al., 2011). In general, actigraphic estimates of sleep duration, sleep percentage, and WASO are considered valid (Martin and Hakim, 2011; Van de Water et al., 2011). The sleep fragmentation index has not been validated against polysomnographic measures, but has been associated with health outcomes (Hinderliter et al., 2013; Knutson et al., 2011). "
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    ABSTRACT: Sleep comprises one-third of one's life, yet little is known about sleep in developing countries. Furthermore, many studies in industrialized countries have reported that sleep duration and quality decline with aging, but whether this association persists globally is unknown. This study's objectives were to characterize sleep in a community without electricity in Haiti and to examine associations between measures of sleep and age. Fifty-eight Haiti residents (50% women) in four age groups, 18-30, 31-50, 51-64, and ≥65 years participated. Three days of wrist actigraphy were used to estimate sleep patterns. Mean (standard deviation) values of sleep measures were: 20:57 (0:40) for sleep onset, 4:54 (0:43) for sleep end, 9.3 (1.2) h for time in bed, 7.0 (1.0) h for sleep duration, 54 (24) min awake after sleep onset, and 88.7 (5.4)% for sleep maintenance (percentage of sleep period actually spent sleeping). There were no significant differences in the sleep measures between men and women. Regression analyses adjusting for sex, household size, and number of people sleeping in the same room indicated that only sleep fragmentation differed by age group. Specifically, mean fragmentation was higher in the youngest age group than all other age groups, which did not differ from one another. Average time in bed in this Haitian sample was greater than previously reported for industrialized countries like the United States (9.3 versus. 7-8 h);, however, actual sleep duration averaged only 7 h. No age-related decline in sleep duration or quality was observed in Haiti. Am. J. Hum. Biol., 2013. © 2013 Wiley Periodicals, Inc.
    American Journal of Human Biology 01/2014; 26(1). DOI:10.1002/ajhb.22481 · 1.93 Impact Factor