Comparing polysomnography, actigraphy, and sleep diary in the home environment: The Study of Women’s Health Across the Nation (SWAN) Sleep Study

• Type of Material: Article
• Authors: H. Matthew Lehrer, University of Pittsburgh; Zhigang Yao, National University of Singapore; Robert Krafty, Emory University; Marissa A. Evans, University of Pittsburgh; Daniel J. Buysse, University of Pittsburgh; Howard M. Kravitz, Rush University; Karen A. Matthews, University of Pittsburgh; Ellen B. Gold, University of California Davis; Sioban D. Harlow, University of Michigan; Laura B. Samuelsson, University of Pittsburgh; Martica H. Hall, University of Pittsburgh
• Language: English
• Date: 2022-02-19
• Publisher: Oxford University Press
• Publication Version: Final Published Version
• Copyright Statement: © The Author(s) 2022. Published by Oxford University Press on behalf of Sleep Research Society.
• License: Creative Commons Attribution 4.0 International
• Final Published Version (URL): http://dx.doi.org/10.1093/sleepadvances/zpac001
• Title of Journal or Parent Work: Sleep Advances
• Volume: 3
• Issue: 1
• Grant/Funding Information: The Study of Women’s Health Across the Nation (SWAN) has grant support from the National Institutes of Health (NIH), DHHS, through the National Institute on Aging (NIA), the National Institute of Nursing Research (NINR), and the NIH Office of Research on Women’s Health (ORWH) (Grants U01NR004061; U01AG012505, U01AG012535, U01AG012531, U01AG012539, U01AG012546, U01AG012553, U01AG012554, U01AG012495). Funding for the SWAN Sleep Study is from the National Institute on Aging (Grants AG019360, AG019361, AG019362, AG019363). Sleep data were processed with the support of RR024153. The content of this manuscript is solely the responsibility of the authors and does not necessarily represent the official views of the NIA, NINR, ORWH or the NIH. Support for investigator effort was also provided by the National Heart, Lung, and Blood Institute (T32HL082610 to HML; T32HL07560 to MAE) and the National Institute of General Medical Sciences (R01GM113243 to RTK). The funding sources were not involved in study design, data collection, analysis, writing of the report, or in the decision to submit the article for publication.
• Keywords: actigraphy; methods; middle-aged women; sleep; sleep diary; polysomnography; self-report
• Research Categories: Health Sciences, Medicine and Surgery; Psychology, Cognitive

Abstract

Study Objectives Polysomnography (PSG) is considered the “gold standard” for assessing sleep, but cost and burden limit its use. Although wrist actigraphy and self-report diaries are feasible alternatives to PSG, few studies have compared all three modalities concurrently across multiple nights in the home to assess their relative validity across multiple sleep outcomes. This study compared sleep duration and continuity measured by PSG, actigraphy, and sleep diaries and examined moderation by race/ethnicity. Methods Participants from the Study of Women’s Health Across the Nation (SWAN) Sleep Study included 323 White (n = 147), African American (n = 120), and Chinese (n = 56) middle-aged community-dwelling women (mean age: 51 years, range: 48–57). PSG, wrist actigraphy (AW-64; Philips Respironics, McMurray, PA), and sleep diaries were collected concurrently in participants’ homes over three consecutive nights. Multivariable repeated-measures linear models compared time in bed (TIB), total sleep time (TST), sleep efficiency (SE), sleep latency (SL), and wake after sleep onset (WASO) across modalities. Results Actigraphy and PSG produced similar estimates of sleep duration and efficiency. Diaries yielded higher estimates of TIB, TST, and SE versus PSG and actigraphy, and lower estimates of SL and WASO versus PSG. Diary SL was shorter than PSG SL only among White women, and diary WASO was lower than PSG and actigraphy WASO among African American versus White women. Conclusions Given concordance with PSG, actigraphy may be preferred as an alternative to PSG for measuring sleep in the home. Future research should consider racial/ethnic differences in diary-reported sleep continuity.