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

H Matthew Lehrer; Zhigang Yao; Robert T Krafty; Marissa A Evans; Daniel J Buysse; Howard M Kravitz; Karen A Matthews; Ellen B Gold; Sioban D Harlow; Laura B Samuelsson; Martica H Hall

doi:10.1093/sleepadvances/zpac001

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

Sleep Adv. 2022 Feb 19;3(1):zpac001. doi: 10.1093/sleepadvances/zpac001. eCollection 2022.

Authors

Affiliations

¹ Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA, USA.
² Department of Statistics and Applied Probability, National University of Singapore, Singapore, Singapore.
³ Deparment of Biostatistics and Bioinformatics, Emory University, Atlanta, GA, USA.
⁴ Department of Psychology, University of Pittsburgh, Pittsburgh, PA, USA.
⁵ Department of Psychiatry and Behavioral Sciences, Rush University Medical Center, Chicago, IL, USA.
⁶ Department of Preventive Medicine, Rush University Medical Center, Chicago, IL, USA.
⁷ Department of Public Health Sciences, University of California, Davis School of Medicine, Davis, CA, USA.
⁸ Department of Epidemiology, University of Michigan, Ann Arbor, MI, USA.

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.

Keywords: actigraphy; methods; middle-aged women; polysomnography; self-report; sleep; sleep diary.

Abstract

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