Lawrence Geoffrey, Muza Rexford
GKT School of Medical Education, King's College London, London, UK.
Sleep Disorders Centre, St Thomas' Hospital, London, UK.
J Thorac Dis. 2018 Jan;10(Suppl 1):S177-S183. doi: 10.21037/jtd.2017.12.127.
Excessive daytime sleepiness (EDS) is a complaint common to many aspects of medicine. There are primary and secondary causes for EDS, with secondary causes including a large number of common conditions. Primary causes, such as narcolepsy, are much rarer. When assessing for primary hypersomnia, restricted or fragmented sleep must be ruled out. This process involves assessment of sleeping habits using a sleep diary and/or actigraphy. Clinicians are suspicious of the accuracy with which patients use the former. This review aims to evaluate the accuracy of a sleep diary study against the 'objective gold standard' actigraphy report.
Data from 35 patients at a Sleep Disorder Centre who underwent both a sleep diary and actigraphy study for suspected primary hypersomnia in 2016 was collected. Mean values of four variables were calculated: 'time of lights out', 'time to fall asleep', 'time of waking' and 'sleep time'. The 'similarity' was assessed. This was a term defined in three different ways: if sleep diary values are accurate to within 20, 30 and 60 min respectively. Percentage 'similarity', mean time differences and standard deviations (SDs) were calculated for each variable. A paired -test was also performed to assess the significance of the time differences between the two modalities.
Least accurate was 'sleep time', with 14.7%, 23.5% and 58.8% of patients within 20, 30 and 60 min of the actigraphy respectively. Mean time difference for this variable was 66 min (versus 33, 15 and 22). 'Time to fall asleep' was most accurate, with 76.5%, 82.4% and 100% 'similarity' respectively.
The clinically acceptable accuracy has no universal definition, so clinicians must use experience and reasoning to determine this level to interpret this data. The review suggests that some variables are entered with high accuracy, and the diary is low cost and adds subjective information that cannot be gathered from actigraphy. Therefore, use is recommended to continue alongside actigraphy.
日间过度嗜睡（EDS）是医学诸多方面常见的一种主诉。EDS有原发性和继发性病因，继发性病因包括大量常见病症。原发性病因，如发作性睡病，则较为罕见。在评估原发性失眠时，必须排除睡眠受限或睡眠碎片化的情况。这一过程涉及使用睡眠日记和/或活动记录仪来评估睡眠习惯。临床医生对患者使用睡眠日记的准确性表示怀疑。本综述旨在对照“客观金标准”活动记录仪报告评估睡眠日记研究的准确性。
收集了2016年睡眠障碍中心35例因疑似原发性失眠而同时进行睡眠日记和活动记录仪研究的患者的数据。计算了四个变量的平均值：“熄灯时间”“入睡时间”“醒来时间”和“睡眠时间”。评估了“相似性”。这一术语有三种不同的定义方式：即睡眠日记值分别精确到20、30和60分钟以内。计算每个变量的“相似性”百分比、平均时间差和标准差（SD）。还进行了配对检验以评估两种方式之间时间差的显著性。
最不准确的是“睡眠时间”，分别有14.7%、23.5%和58.8%的患者其睡眠时间在活动记录仪记录时间的20、30和60分钟以内。该变量的平均时间差为66分钟（相比之下，其他变量分别为33、15和22分钟）。“入睡时间”最准确，“相似性”分别为76.5%、82.4%和100%。
临床上可接受的准确性没有统一的定义，因此临床医生必须运用经验和推理来确定这一水平以解读这些数据。该综述表明，一些变量的记录准确性较高，而且睡眠日记成本低，并能提供从活动记录仪无法获取的主观信息。因此，建议在使用活动记录仪的同时继续使用睡眠日记。
