Biscarini Francesco, Vandi Stefano, Riccio Caterina, Raggini Linda, Neccia Giulia, Plazzi Giuseppe, Pizza Fabio
Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy.
UOC Clinica Neurologica, IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy.
Sleep. 2024 Dec 11;47(12). doi: 10.1093/sleep/zsae189.
The role of actigraphy in central disorders of hypersomnolence (CDH) is expanding but evidence of reliability with polysomnography (PSG) is scarce and provided only during nighttime. We explored the agreement between actigraphy and continuous 24-hour PSG at CDH diagnosis.
Forty-four consecutive drug-naïve patients (28 narcolepsy and 16 idiopathic hypersomnia [IH]) underwent actigraphy during 24 hours of free-running PSG, during multiple sleep latency test (MSLT) and 13 of them also during maintenance of wakefulness test (MWT). Daytime and nighttime sleep features and MSLT and MWT mean sleep latencies (mSL) were estimated with the actigraphic algorithms by Cole-Kripke (CK), Sadeh (Sad), and University of California San Diego (UCSD). Agreement to corresponding PSG measures was assessed with Bland-Altman plots.
Nighttime-total sleep time (TST) in narcolepsy was significantly underestimated with CK (bias 27.8 minutes, 95% CI 13.7 to 41.9) and Sad (bias 56.7 minutes, 95% CI 38.8/74.5). Daytime-TST was overestimated in IH and narcolepsy with all algorithms (CK: bias -42.2, 95% CI -67/-17.4; Sad: bias -30.2 minutes, 95% CI -52.7/-7.7; UCSD bias -86.9 minutes, 95% CI -118.2/-55.6). 24-hour-TST was overestimated by CK and UCSD in IH (CK: bias -58.5 minutes, 95% CI -105.5/-11.5; UCSD: bias -118.8 minutes, 95% CI -172.5/-65), and by UCSD in narcolepsy (bias -68.8 minutes, 95% CI -109.3/-38.2). In the entire cohort, actigraphy overestimated MSLT mSL but not MWT mSL.
Conventional actigraphic algorithms overestimate 24-hour TST in IH and underestimate nighttime TST in narcolepsy. These discrepancies call for the cautious application of actigraphy in the diagnostic process of CDH and the development of new quantitative signal analysis approaches.
活动记录仪在中枢性睡眠增多障碍（CDH）中的作用正在扩大，但与多导睡眠图（PSG）可靠性的证据稀缺，且仅在夜间提供。我们探讨了在CDH诊断时活动记录仪与连续24小时PSG之间的一致性。
44例连续未用过药物的患者（28例发作性睡病和16例特发性嗜睡症[IH]）在自由运行PSG的24小时期间、多次睡眠潜伏期试验（MSLT）期间进行了活动记录，其中13例患者在清醒维持试验（MWT）期间也进行了活动记录。通过Cole-Kripke（CK）、Sadeh（Sad）和加利福尼亚大学圣地亚哥分校（UCSD）的活动记录算法估计白天和夜间睡眠特征以及MSLT和MWT的平均睡眠潜伏期（mSL）。用Bland-Altman图评估与相应PSG测量值的一致性。
发作性睡病患者夜间总睡眠时间（TST）被CK（偏差27.8分钟，95%CI 13.7至41.9）和Sad（偏差56.7分钟，95%CI 38.8/74.5）显著低估。在IH和发作性睡病患者中，所有算法均高估了白天TST（CK：偏差-42.2，95%CI -67/-17.4；Sad：偏差-30.2分钟，95%CI -52.7/-7.7；UCSD偏差-86.9分钟，95%CI -118.2/-55.6）。CK和UCSD高估了IH患者的24小时TST（CK：偏差-58.5分钟，95%CI -105.5/-11.5；UCSD：偏差-118.8分钟，95%CI -172.5/-65），UCSD高估了发作性睡病患者的24小时TST（偏差-68.8分钟，95%CI -109.3/-38.2）。在整个队列中，活动记录仪高估了MSLT的mSL，但未高估MWT的mSL。
传统的活动记录算法高估了IH患者的24小时TST，低估了发作性睡病患者的夜间TST。这些差异要求在CDH诊断过程中谨慎应用活动记录仪，并开发新的定量信号分析方法。
