title: Examination of wrist and hip actigraphy using a novel sleep estimation procedure ☆
abstract: OBJECTIVE
  Improving and validating sleep scoring algorithms for actigraphs enhances their usefulness in clinical and research applications. The MTI®device (ActiGraph, Pensacola, FL) had not been previously validated for sleep. The aims were to (1) compare the accuracy of sleep metrics obtained via wrist- and hip-mounted MTI®actigraphs with polysomnographic (PSG) recordings in a sample that included both normal sleepers and individuals with presumed sleep disorders; and (2) develop a novel sleep scoring algorithm using spline regression to improve the correspondence between the actigraphs and PSG.
  
  
  METHODS
  Original actigraphy data were amplified and their pattern was estimated using a penalized spline. The magnitude of amplification and the spline were estimated by minimizing the difference in sleep efficiency between wrist- (hip-) actigraphs and PSG recordings. Sleep measures using both the original and spline-modified actigraphy data were compared to PSG using the following: mean sleep summary measures; Spearman rank-order correlations of summary measures; percent of minute-by-minute agreement; sensitivity and specificity; and Bland-Altman plots.
  
  
  RESULTS
  The original wrist actigraphy data showed modest correspondence with PSG, and much less correspondence was found between hip actigraphy and PSG. The spline-modified wrist actigraphy produced better approximations of interclass correlations, sensitivity, and mean sleep summary measures relative to PSG than the original wrist actigraphy data. The spline-modified hip actigraphy provided improved correspondence, but sleep measures were still not representative of PSG.
  
  
  CONCLUSIONS
  The results indicate that with some refinement, the spline regression method has the potential to improve sleep estimates obtained using wrist actigraphy.
authors.affiliation: Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA.
authors.forename: Meredith A
authors.initials: MA
authors.lastname: Ray
authors.affiliation: College of Nursing and Health Innovation, Arizona State University, Phoenix, AZ, USA ; Phoenix VA Health Care System, Phoenix, AZ, USA ; School of Nutrition and Health Promotion, Arizona State University, Phoenix, AZ, USA.
authors.forename: Shawn D
authors.initials: SD
authors.lastname: Youngstedt
authors.affiliation: Division of Epidemiology, Biostatistics, and Environmental Health, School of Public Health, University of Memphis, Memphis, TN, USA.
authors.forename: Hongmei
authors.initials: H
authors.lastname: Zhang
authors.affiliation: Department of Epidemiology and Biostatistics, College of Public Health, University of Georgia, Athens, GA, USA.
authors.forename: Sara Wagner
authors.initials: SW
authors.lastname: Robb
authors.affiliation: Division of Social and Behavioral Sciences, School of Public Health, University of Memphis, Memphis, TN, USA ; South Carolina Statewide Cancer Prevention and Control Program, University of South Carolina, Columbia, SC, USA.
authors.forename: Brook E
authors.initials: BE
authors.lastname: Harmon
authors.affiliation: Departments of Population Health and Psychiatry, New York University School of Medicine, New York, NY, USA.
authors.forename: Girardin
authors.initials: G
authors.lastname: Jean-Louis
authors.affiliation: Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA.
authors.forename: Bo
authors.initials: B
authors.lastname: Cai
authors.affiliation: South Carolina Statewide Cancer Prevention and Control Program, University of South Carolina, Columbia, SC, USA.
authors.forename: Thomas G
authors.initials: TG
authors.lastname: Hurley
authors.affiliation: Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA ; South Carolina Statewide Cancer Prevention and Control Program, University of South Carolina, Columbia, SC, USA.
authors.forename: James R
authors.initials: JR
authors.lastname: Hébert
authors.affiliation: SleepMed, Columbia, SC, USA.
authors.forename: Richard K
authors.initials: RK
authors.lastname: Bogan
authors.affiliation: Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA ; South Carolina Statewide Cancer Prevention and Control Program, University of South Carolina, Columbia, SC, USA ; WJB Dorn VA Medical Center, Columbia, SC, USA.
authors.forename: James B
authors.initials: JB
authors.lastname: Burch
keywords: Actigraphy; Penalized spline; Polysomnography