Comparison of multichannel and single-channel wrist-based devices with polysomnography to measure sleep in children and adolescents

Abstract

Study Objectives: To compare sleep parameters produced by the Fitbit Charge 3 (Fitbit) and Actigraph GT9X accelerometer (Actigraph) to polysomnography in children and adolescents. Methods: Participants (n = 56, ages 9.2 ± 3.3 years) wore a Fitbit and an Actigraph on their nondominant wrist concurrently with polysomnography during an overnight observation at a children's sleep laboratory. Total sleep time, sleep efficiency, wake after sleep onset, sleep onset, and sleep offset were extracted fromthe Fitabase and Actilife software packages, respectively, with the Sadeh algorithm. Bland-Altman plots were used to assess the agreement betweenwearable devices and polysomnography. Results: Seventy-nine percent of participants were diagnosed with OSA. Compared with polysomnography, the Fitbit and the Actigraph underestimated total sleep time by 6.1minutes (absolutemean bias [AMB] = 27.7minutes) and 31.5 minutes (AMB = 38.2minutes), respectively. The Fitbit overestimated sleepefficiency by 3.0% (AMB = 6.3%), and the Actigraph underestimated sleep efficiency by 12.9% (AMB = 13.2%). The Fitbit overestimated wake after sleep onset by 18.8 minutes (AMB = 23.9 minutes), and the Actigraph overestimated wake after sleep onset by 56.1 minutes (AMB = 54.7 minutes). In addition, the Fitbit and the Actigraph underestimated sleep onset by 1.2 minutes (AMB = 13.9 minutes) and 10.2 minutes (AMB = 18.1 minutes), respectively. Finally, the Fitbit and the Actigraph overestimated sleep offset by 6.0 minutes (AMB = 12.0 minutes) and 10.5 minutes (AMB = 12.6 minutes). Linear regression indicated significant trends, with the Fitbit underestimating wake after sleep onset and sleep efficiency at higher values. Conclusions: TheFitbit provided comparable and in some instances better sleep estimateswith polysomnography compared to theActigraph. Findings support the use of multichannel devices to measure sleep in children and adolescents. Additional studies are needed in healthy children over several nights and in free-living settings.