ActiGraph GT3X+ and Actical Wrist and Hip Worn Accelerometers for Sleep and Wake Indices in Young Children Using an Automated Algorithm: Validation With Polysomnography

Objectives: Our count-scaled algorithm automatically scores sleep across 24 hours to process sleep timing, quantity, and quality. The aim of this study was to validate the algorithm against overnight PSG in children to determine the best site placement for sleep. Methods: 28 children (5-8 years) with no history of sleep disturbance wore two types of accelerometers (ActiGraph GT3X+ and Actical) at two sites (left hip, non-dominant wrist) for 24-h. Data were processed using the count-scaled algorithm. PSG data were collected using an in-home Type 2 device. PSG-actigraphy epoch sensitivity (sleep agreement) and specificity (wake agreement) were determined and sleep outcomes compared for timing (onset and offset), quantity [sleep period time (SPT) and total sleep time (TST)], and quality metrics [sleep efficiency and waking after sleep onset (WASO)]. Results: Overall, sensitivities were high (89.1% to 99.5%) and specificities low (21.1% to 45.7%). Sleep offset was accurately measured by actigraphy, regardless of brand or placement site. By contrast, sleep onset agreed with PSG using hip-positioned but not wrist-positioned devices (difference ActiGraph : PSG 21 min, P < .001; Actical : PSG 14 min, P < .001). The ActiGraph at the wrist accurately detected WASO and sleep efficiency, but under (-34 min, P < .001) and overestimated (5.8%, P < .001) these at the hip. The Actical under- and over-estimated these variables respectively at both sites. Results for TST varied ranging from significant differences to PSG of -26 to 21 min (ActiGraph wrist and hip respectively) and 9 min (ns) to 59 min for Actical (wrist and hip respectively). Conclusion: Overall the count-scaled algorithm produced high sensitivity at the expense of low specificity in comparison with PSG. A best site placement for estimates of all sleep variables could not be determined, but overall the results suggested ActiGraph GT3X+ at the hip may be superior for sleep timing and quantity metrics, whereas the wrist may be superior for sleep quality metrics. Both devices placed at the hip performed well for sleep timing but not for sleep quality. Differences are likely linked to freedom of movement of the wrist vs the trunk (hip) during overnight sleep.