BACKGROUND & AIMS: :The National Sleep Foundation recommends that adolescents (age 14-17 years) sleep 8 to 10 hours per night. Sleep loss is associated with cognitive dysfunction, decreased reaction time, and poorer athletic performance. This study evaluated the effects of sleep on sports injury rate and academic and cognitive performance. Seventeen high school track and field athletes (7 males, 10 females, mean age 15.9 years) wore an actigraph device for 10 weeks and performed a computerized neurocognitive assessment. Overall, 900 nights of nocturnal sleep data were analysed. Total minutes in bed averaged 501 minutes (8 hours and 21 minutes) and total sleep time averaged 378 minutes (6 hours and 18 minutes). Statistically significant correlations were observed between mean total sleep time and age-adjusted scores for the neurocognitive domains of episodic memory (p = .03) and fluid cognition (p = .03). Sleep loss in student-athletes may result in greater cognitive difficulties and impair academic abilities in the classroom.

背景与目标： : 国家睡眠基金会建议青少年 (14-17岁) 每晚睡眠8至10小时。睡眠不足与认知功能障碍，反应时间减少和运动表现较差有关。这项研究评估了睡眠对运动损伤率以及学业和认知能力的影响。17名高中田径运动员 (7名男性，10名女性，平均年龄15.9岁) 佩戴了活动仪10周，并进行了计算机化的神经认知评估。总体而言，分析了900个晚上的夜间睡眠数据。卧床总分钟平均501分钟 (8小时21分钟)，总睡眠时间平均378分钟 (6小时18分钟)。观察到平均总睡眠时间与情节记忆 (p = .03) 和液体认知 (p = .03) 的神经认知域的年龄调整分数之间的统计学显着相关性。学生运动员的睡眠不足可能会导致更大的认知困难，并损害课堂上的学术能力。

BACKGROUND & AIMS: :This paper introduces a new method, bed actigraphy (BACT) for user-friendly sleep-wake monitoring. BACT provides a non-intrusive acquisition of activity data, and in particular does not require that sensors be attached to the subject's body. The system consists of four load-sensing cells supporting the bed, an A/D converter, and a microcontroller with appropriate software. The performance of BACT was compared to that of standard polysomnography (PSG) recordings and wrist-worn actigraphy (ACT). Ten normal volunteers underwent overnight PSG recordings and were examined simultaneously with BACT and ACT. An automatic scoring algorithm scored each 30-s epoch of the BACT recordings for either 'Wake' or 'Sleep.' A sleep specialist manually scored the PSG recordings, and the results were divided into 'Wake' and 'Sleep' categories. The three methods showed a significant correlation when compared with in the contingency test. The mean epoch-by-epoch agreements between the BACT and PSG, ACT and PSG, and BACT and ACT recordings were 95.2, 92.9, and 94.3%, respectively. The mean absolute differences in sleep percentage (SP) between them were 1.8 +/- 0.82, 3.4 +/- 1.45, and 1.9 +/- 1.16 %, respectively. BACT differentiation of the 'Wake' and 'Sleep' stages proved to be sufficiently robust, and its results were comparable to PSG analysis. This finding supports the experimental and clinical value of bed-activity monitoring during sleep.

背景与目标： : 本文介绍了一种用于用户友好的睡眠唤醒监测的新方法，即bed actigraphy (BACT)。BACT提供了活动数据的非侵入式采集，尤其不需要将传感器连接到受试者的身体。该系统由支持床的四个负载传感单元，一个A/D转换器和一个带有适当软件的微控制器组成。将BACT的性能与标准多导睡眠图 (PSG) 记录和腕戴活动图 (ACT) 的性能进行了比较。十名正常志愿者接受了夜间PSG录音，并同时接受了BACT和ACT检查。自动评分算法对BACT录音的每个30年代进行评分，分别为 “唤醒” 或 “睡眠”。睡眠专家手动对PSG录音进行评分，结果分为 “唤醒” 和 “睡眠” 类别。与应急测试相比，这三种方法显示出显着的相关性。BACT和PSG，ACT和PSG以及BACT和ACT记录之间的平均时代协议分别是95.2，92.9和94.3%。他们之间的睡眠百分比 (SP) 的平均绝对差异分别为1.8/- 0.82，3.4/- 1.45和1.9/- 1.16%。事实证明，“觉醒” 和 “睡眠” 阶段的BACT分化足够强大，其结果与PSG分析相当。这一发现支持睡眠期间床活动监测的实验和临床价值。

BACKGROUND & AIMS: :Periodic limb movements of sleep (PLMS) are repetitive, stereotyped movements that can disrupt sleep and result in insomnia, non-restorative sleep, and/or daytime sleepiness. Currently, polysomnography is the gold standard and only clinically acceptable means of quantifying PLMS. Leg-worn actigraphy is an alternative method of measuring PLMS, which may circumvent many of the economic and technical limitations of polysomnography to quantify nocturnal leg movements. However, the use of leg actigraphy as a diagnostic means of assessing PLMS has not been systematically evaluated. In this review, the use of leg-worn actigraphy to measure PLMS is systematically evaluated, using both qualitative and quantitative assessment. Findings demonstrate significant heterogeneity among a limited number of studies in terms of type of actigraph utilized, position of the device on the lower extremity, and methods employed to count PLMS. In general, common accelerometers vary in their sensitivity and specificity to detect PLMS, which is likely related to the technical specifications of a given device. A current limitation in the ability to combine data from actigraphs placed on both legs is also a significant barrier to their use in clinical settings. Further research is required to determine the optimal methods to quantify PLMS using leg actigraphy, as well as specific clinical situations in which these devices may prove most useful.

背景与目标： : 周期性的肢体睡眠运动 (plm) 是重复的，刻板的运动，可能会破坏睡眠并导致失眠，非恢复性睡眠和/或白天嗜睡。目前，多导睡眠监测是定量plm的金标准，并且是临床上可接受的方法。腿部运动描记术是一种测量plm的替代方法，它可以规避多导睡眠描记术量化夜间腿部运动的许多经济和技术限制。但是，尚未系统地评估使用腿部活动描记术作为评估plm的诊断手段。在这篇综述中，使用定性和定量评估系统地评估了使用腿穿的动作描记术来测量plm。研究结果表明，在使用的活动仪类型，设备在下肢的位置以及用于计数plm的方法方面，在数量有限的研究中存在显着的异质性。通常，常见的加速度计检测plm的灵敏度和特异性各不相同，这可能与给定设备的技术规格有关。当前对来自两条腿上的活动图的数据进行组合的能力的限制也是其在临床环境中使用的重大障碍。需要进一步的研究来确定使用腿部活动仪量化plm的最佳方法，以及这些设备可能最有用的特定临床情况。

BACKGROUND & AIMS: :The feasibility and utility of wearable 24-h multimodality neuromonitoring during daily activities are demonstrated. We have developed a fourth-generation ambulatory near infrared spectroscopy device, namely NINscan 4. NINscan 4 enables recording of brain function (via cerebral hemodynamics), systemic hemodynamics, electrocardiography, and actigraphy simultaneously and continuously for up to 24 h at 250-Hz sampling rate, during (and with minor restriction to) daily activities. We present initial 24-h human subject test results, with example analysis including (1) comparison of cerebral perfusion and oxygenation changes during wakefulness and sleep over a 24-h period and (2) capturing of hemodynamic changes prior, during and after sudden waken up in the night during sleep. These results demonstrate the first ambulatory 24-h cerebral and systemic hemodynamics monitoring, and its unique advantages including long-term data collection and analysis capability, ability to catch unpredictable transient events during activities of daily living, as well as coregistered multimodality analysis capabilities. These results also demonstrate that NINscan 4's motion artifact at 1-g head movement is smaller than physiological hemodynamic fluctuations during motionless sleep. The broader potential of this technology is also discussed.

背景与目标： : 证明了日常活动中可穿戴24小时多模态神经监测的可行性和实用性。我们开发了第四代动态近红外光谱装置，即NINscan 4。NINscan 4能够在日常活动期间 (并对其进行少量限制) 以250Hz采样率同时记录脑功能 (通过脑血流动力学)，全身血流动力学，心电图和动态描记术长达24小时。我们提供了最初的24小时人体受试者测试结果，并进行了实例分析，包括 (1) 在24小时内清醒和睡眠期间脑灌注和氧合变化的比较，以及 (2) 在睡眠中突然醒来之前，期间和之后捕获血液动力学变化。这些结果证明了首次动态24小时脑和全身血流动力学监测，其独特的优势包括长期数据收集和分析能力，在日常生活活动中捕捉不可预测的短暂事件的能力，以及共同注册的多模态分析能力。这些结果还表明，NINscan 4在1-g头部运动时的运动伪影小于静止睡眠期间的生理血液动力学波动。还讨论了该技术的更广泛潜力。

BACKGROUND & AIMS: BACKGROUND:Poor sleep, prevalent among cancer survivors, is associated with disrupted hormonal circadian rhythms and poor quality of life. Using a prospective research design, this study aimed to clarify the relationship between objective measures of sleep efficiency and sleep disruption with survival among women with advanced breast cancer. METHOD:We examined sleep quality and duration via wrist-worn actigraphy and sleep diaries for 3 days among 97 women in whom advanced breast cancer was diagnosed (age = 54.6 ± 9.8 years). Sleep efficiency was operationalized using actigraphy as the ratio of total sleep time to total sleep time plus wake after sleep onset. RESULTS:As hypothesized, better sleep efficiency was found to predict a significant reduction in overall mortality (hazard ratio [HR], 0.96; 95% confidence interval [CI], 0.94-0.98; P < 0.001) at median 6 y follow-up. This relationship remained significant (HR, 0.94; 95% CI, 0.91-0.97; P < 0.001) even after adjusting for other known prognostic factors (age, estrogen receptor status, cancer treatment, metastatic spread, cortisol levels, and depression). Secondary hypotheses were also supported (after adjusting for baseline prognostic factors) showing that less wake after sleep onset (HR, 0.41; 95% CI, 0.25-0.67; P < 0.001), fewer wake episodes, (HR, 0.93; 95% CI, 0.88-0.98; P = 0.007); and shorter wake episode duration (HR, 0.29; 95% CI, 0.14-0.58; P < 0.001) also contributed to reductions in overall mortality. CONCLUSIONS:These findings show that better sleep efficiency and less sleep disruption are significant independent prognostic factors in women with advanced breast cancer. Further research is needed to determine whether treating sleep disruption with cognitive behavioral and/or pharmacologic therapy could improve survival in women with advanced breast cancer.

背景与目标：

BACKGROUND & AIMS: OBJECTIVES:Actical® actigraphy is commonly used to monitor athlete sleep. The proprietary software, called Actiware®, processes data with three different sleep-wake thresholds (Low, Medium or High), but there is no standardisation regarding their use. The purpose of this study was to examine validity and bias of the sleep-wake thresholds for processing Actical® sleep data in team sport athletes. DESIGN:Validation study comparing actigraph against accepted gold standard polysomnography (PSG). METHODS:Sixty seven nights of sleep were recorded simultaneously with polysomnography and Actical® devices. Individual night data was compared across five sleep measures for each sleep-wake threshold using Actiware® software. Accuracy of each sleep-wake threshold compared with PSG was evaluated from mean bias with 95% confidence limits, Pearson moment-product correlation and associated standard error of estimate. RESULTS:The Medium threshold generated the smallest mean bias compared with polysomnography for total sleep time (8.5min), sleep efficiency (1.8%) and wake after sleep onset (-4.1min); whereas the Low threshold had the smallest bias (7.5min) for wake bouts. Bias in sleep onset latency was the same across thresholds (-9.5min). The standard error of the estimate was similar across all thresholds; total sleep time ∼25min, sleep efficiency ∼4.5%, wake after sleep onset ∼21min, and wake bouts ∼8 counts. CONCLUSIONS:Sleep parameters measured by the Actical® device are greatly influenced by the sleep-wake threshold applied. In the present study the Medium threshold produced the smallest bias for most parameters compared with PSG. Given the magnitude of measurement variability, confidence limits should be employed when interpreting changes in sleep parameters.

背景与目标：

BACKGROUND & AIMS: :Actigraphy is a non-invasive method of monitoring circadian rhythms and motor activity. We systematically reviewed extant evidence until September 2018 pertaining to actigraphy use in schizophrenia, its clinical/biological correlates and posit future research directions. Within 38 included studies involving 2700 subjects, patients with schizophrenia generally have lower motor activity levels, poorer sleep quality and efficiency, increased sleep fragmentation and duration compared with healthy controls. Lowered motor activity and longer sleep duration in patients were associated with greater severity of negative symptoms. Less structured motor activity and decreased sleep quality were associated with greater severity of positive symptoms, worse cognitive functioning involving attention and processing speed, illness chronicity, higher antipsychotic dose, and poorer quality of life. Correlations of actigraphic measures with biological factors are sparse with inconclusive results. Future studies with larger sample sets may adopt a multimodal, longitudinal approach which examines both motor and sleep activity, triangulates clinical, actigraphic and biological measures to clarify their inter-relationships and inform risk prediction of illness onset, course, and treatment response over time.

背景与目标： : 活动描记法是一种监测昼夜节律和运动活动的非侵入性方法。我们系统地回顾了现存的证据，直到与精神分裂症中使用活动性技术有关的2018年9月，其临床/生物学相关性以及未来的研究方向。在38项涉及2700名受试者的研究中，与健康对照组相比，精神分裂症患者通常具有较低的运动活动水平，较差的睡眠质量和效率，增加的睡眠碎片和持续时间。患者的运动活动降低和睡眠时间延长与阴性症状的严重程度相关。较少的结构化运动活动和睡眠质量下降与阳性症状的严重程度，涉及注意力和处理速度的认知功能差，疾病的长期性，较高的抗精神病药剂量和较差的生活质量相关。活动性测量与生物因素的相关性很少，结果不确定。具有较大样本集的未来研究可能会采用多模式，纵向方法，该方法检查运动和睡眠活动，对临床，活动和生物学措施进行三角测量，以阐明它们之间的相互关系，并告知疾病发作，病程和治疗反应随时间推移的风险预测。

BACKGROUND & AIMS: OBJECTIVES:To assess the usefulness of actigraphy for assessment of nighttime sleep measures in patients with Parkinson's disease (PD). DESIGN:Participants underwent overnight sleep assessment simultaneously by polysomnography (PSG) and actigraphy. SETTING:Overnight sleep study in academic sleep research laboratory. PARTICIPANTS:Sixty-one patients (mean age 67.74 ± 8.88 y) with mild to moderate PD. MEASUREMENTS:Sleep measures including total sleep time (TST), sleep efficiency (SE), wake after sleep onset (WASO), and sleep onset latency (SOL) were calculated independently from data derived from PSG and from actigraphy. Different actigraphy scoring settings were compared. RESULTS:No single tested actigraphy scoring setting was optimal for all sleep measures. A customized setting of an activity threshold of 10, with five consecutive immobile minutes for sleep onset, yielded the combination of mean TST, SE, and WASO values that best approximated mean values determined by PSG with differences of 6.05 ± 85.67 min for TST, 1.1 ± 0.641% for SE, and 4.35 ± 59.56 min for WASO. There were significant but moderate correlations between actigraphy and PSG measurements (rs = 0.496, P < 0.001 for TST, rs = 0.384, P = 0.002 for SE, and rs = 0.400, P = 0.001 for WASO) using these settings. Greater disease stage was associated with greater differences between TST (R(2) = 0.099, beta = 0.315, P = 0.018), SE (R(2) = 0.107, beta = 0.327, P = 0.014), and WASO (R(2) = 0.094, beta = 0.307, P = 0.021) values derived by actigraphy and PSG explaining some of the variability. Using a setting of 10 immobile min for sleep onset yielded a mean SOL that was within 1 min of that estimated by PSG. However SOL values determined by actigraphy and PSG were not significantly correlated at any tested setting. CONCLUSIONS:Our results suggest that actigraphy may be useful for measurement of mean TST, SE, and WASO values in groups of patients with mild to moderate Parkinson's disease. However, there is a significant degree of variability in accuracy among individual patients. The importance of determining optimal scoring parameters for each population studied is underscored.

背景与目标：

BACKGROUND & AIMS: Two alternative methods for detecting sleep, wrist actigraphy (ACT) and behavioral response monitoring (BRM), were compared to polysomnography (PSG). In the BRM paradigm, a threshold intensity visual or auditory stimulus generated by a palm-top computer was presented about once per minute, and subjects pressed a microswitch if the stimulus was detected. A response within 5 seconds of the stimulus was scored as "wake" and a failure to respond as "sleep." Four males and four females underwent two nights of simultaneous in-home PSG, BRM, and ACT. Each night, subjects underwent a protocol designed to generate five sleep latency trials. Subjects were awakened by alarm clocks at approximately 1-hour intervals and remained awake for 10 minutes before returning to bed for another sleep onset latency (SOL) trial. Minute-by-minute comparisons were made for PSG versus ACT and BRM. All measures were fairly sensitive in detecting sleep, but BRM was more accurate in determining SOL and subsequent wakefulness. Behavioral response monitoring using a tone resulted in more responses and arousals prior to and during light stages of sleep than BRM using a light. It is concluded that BRM has some important advantages as a simple, minimally invasive method for monitoring sleep.

背景与目标： 将两种用于检测睡眠的替代方法，腕关节活动描记术 (ACT) 和行为反应监测 (BRM) 与多导睡眠描记术 (PSG) 进行了比较。在BRM范例中，大约每分钟一次呈现由掌上电脑产生的阈值强度视觉或听觉刺激，如果检测到刺激，则受试者按下微动开关。刺激后5秒内的响应被评分为 “唤醒”，而未能响应为 “睡眠”。四名男性和四名女性同时经历了两晚的家庭PSG，BRM和ACT。每天晚上，受试者都会接受一项旨在产生五次睡眠潜伏期试验的协议。受试者每隔约1小时被闹钟唤醒，并保持清醒10分钟，然后返回床上进行另一次睡眠发作潜伏期 (SOL) 试验。对PSG与ACT和BRM进行了每分钟的比较。所有措施在检测睡眠方面都相当敏感，但BRM在确定SOL和随后的清醒方面更为准确。与使用光照的BRM相比，使用音调进行行为反应监测会在睡眠之前和睡眠期间产生更多的反应和唤醒。结论是，BRM作为一种简单，微创的睡眠监测方法具有一些重要的优势。

BACKGROUND & AIMS: :There have been limited studies of the validation of actigraphy for the determination of sleep and wake in children and in this study we aimed to compare wrist actigraphy with polysomnography (PSG). We studied 45 children (29 M/16 F), aged between 1 and 12 years (5.8 +/- 2.7 years, mean +/- SD). Actigraphic data were collected during standard overnight PSG. Data from the actiwatch were analysed over four separate activity threshold settings (low, medium, high, auto). Actigraphic data were compared epoch-by-epoch with the matching PSG. Sleep time was not different from PSG values for the low or auto activity thresholds, but was significantly less on the medium and high activity thresholds (P < 0.05). In contrast, the low and auto activity thresholds significantly underestimated wake time (P < 0.05), whilst that recorded on the medium and high activity thresholds were not different to PSG values. Agreement rates across the thresholds were all high ranging from 85.1% to 88.6%. Predictive value for sleep and sensitivity were also high with values ranging from 91.6% to 94.9% and 90.1% to 97.7%, respectively. In contrast, predictive value for wake and specificity were low ranging between 46.7-65.6% and 39.4-68.9%, respectively. There was no effect of subject age, OAHI or PSG arousal index on AR for any of the activity thresholds. We conclude that actigraphy is a reliable method for determining sleep in children when compared against PSG. Actigraphy may be a useful tool in paediatric sleep clinics and research.

背景与目标： : 关于确定儿童睡眠和觉醒的动作学验证的研究有限，在这项研究中，我们旨在将手腕动作学与多导睡眠图 (PSG) 进行比较。我们研究了45名儿童 (29 M/16 F)，年龄在1至12岁之间 (5.8/- 2.7岁，平均/- SD)。在标准夜间PSG期间收集了活动数据。在四个独立的活动阈值设置 (低，中，高，自动) 上分析了来自actiwatch的数据。活动性数据与匹配的PSG进行了逐个比较。睡眠时间与低或自动活动阈值的PSG值没有差异，但在中高活动阈值上明显较少 (P <0.05)。相反，低活动阈值和自动活动阈值显着低估了唤醒时间 (P <0.05)，而在中高活动阈值上记录的唤醒时间与PSG值没有差异。从85.1% 到88.6%，跨阈值的协议率都很高。睡眠和敏感性的预测值也很高，分别为91.6% 至94.9% 和90.1% 至97.7%。相反，唤醒和特异性的预测值分别在46.7-65.6% 和39.4-68.9% 之间较低。对于任何活动阈值，受试者年龄，OAHI或PSG唤醒指数对AR均无影响。我们得出的结论是，与PSG相比，活动描记法是确定儿童睡眠的可靠方法。Actigraphy可能是儿科睡眠诊所和研究中的有用工具。

BACKGROUND & AIMS: A study comparing actigraphy and polysomnography in the detection of leg movements was performed in a group of 35 patients with sleep disorders. Visual scoring used epochs of 5-second duration, and in each epoch, electromyographic activity of tibialis anterior muscle was classified in eight types on the basis of its duration and amplitude. Activity levels of the actigraphic data were logged in 5-second intervals and stored in memory for computer retrieval. To assess the reproducibility of actigraphic detection scoring, in 10 patients actigraphic and polysomnographic data were compared during two consecutive nights. Despite a high correlation between polysomnography and actigraphy in the detection of muscular activity (r = 0.78; P = 0.001), no agreement was obtained between the two analyses according to the Bland and Altman method of concordance (mean bias-117.5). The greater agreement was found for electromyographic activity lasting more than 3 seconds and with an amplitude of more than 50 microV. In the group of patients examined during two consecutive nights the scoring error did not differ significantly. The results demonstrated that (1) despite a significant correlation between actigraphic and polysomnographic data, actigraphy substantially underestimated leg electromyographic activity and therefore could not be used routinely for diagnostic purposes; and (2) because error scoring did not undergo significant changes across the two nights, actigraphy may be used for follow-up evaluation.

背景与目标： 在一组35名睡眠障碍患者中进行了一项比较运动描记术和多导睡眠描记术检测腿部运动的研究。视觉评分使用5秒持续时间的时间，并且在每个时期，根据其持续时间和幅度将胫骨前肌的肌电图活动分为八种类型。活动数据的活动级别以5秒的间隔记录，并存储在内存中用于计算机检索。为了评估活动检测评分的可重复性，在连续两个晚上比较了10名患者的活动和多睡眠图数据。尽管多导睡眠图和肌动图在肌肉活动检测中具有高度相关性 (r = 0.78; P = 0.001)，但根据Bland和Altman一致性方法 (平均偏倚-117.5)，两种分析之间没有达成一致。发现肌电图活动持续3秒以上且振幅超过50微伏的一致性更大。在连续两个晚上检查的患者组中，评分错误没有显着差异。结果表明 :( 1) 尽管活动和多导睡眠图数据之间存在显着相关性，但活动图大大低估了腿部肌电活动，因此不能常规用于诊断目的; (2) 由于错误评分在两晚中没有发生重大变化，actigraphy可用于后续评估。

BACKGROUND & AIMS: INTRODUCTION:Adolescence is a time of rapid changes in sleep habits and rising prevalence of sleepiness. The importance of measuring sleep in this population is increasingly recognized. In adults, measurements of sleep by actigraphy correlate well with sleep data from EEG recordings. Since actigraphy is increasingly utilized in adolescent sleep studies, more information is needed about reliability in this age group. This analysis investigated which actigraphy data mode is optimal for data collection in adolescents and explored the level of agreement between actigraphy and polysomnography (PSG) in population subgroups. METHODS:181 adolescents aged 12-16 years were concurrently monitored with PSG and wrist actigraphy (measured in 3 data modes: Time Above Threshold [TAT], Zero Crossing Mode [ZCM], and Proportional Integration Mode [PIM]) to measure total sleep time (TST). RESULTS:The sample was 50% male, 55% African American, 9% with sleep disordered breathing (SDB; apnea-hypopnea index > or = 5). Intraclass correlation coefficients (ICC) for TST between actigraphy and PSG were low to moderate and were highest for TAT (0.41) compared to ZCM (0.32) and PIM (0.34). Subgroup analyses revealed that ICCs were higher among those without SDB (0.55) than those with SDB (0.00), and for girls (0.66) compared with boys (0.31). CONCLUSIONS:Results suggest that actigraphy provides a reasonably good estimate of TST in adolescents without SDB. Recognition of the variation in sleep estimates among different data collection modes, among population subgroups, and across the age spectrum, may be of fundamental importance in the interpretation of actigraphy data for sleep duration estimation.

背景与目标：

BACKGROUND & AIMS: STUDY OBJECTIVE:Actigraphy, a method of inferring sleep from the presence or absence of wrist movement, has been well validated against polysomnography in trials with people without insomnia. However, the small amount of literature on validation with insomniacs has revealed an actigraphy bias toward overscoring sleep. The current validation trial with insomniacs used the largest number of subjects to date in such research and attracted participants with diverse demographic characteristics. DESIGN:People with insomnia slept 1 night in the laboratory while simultaneously being monitored by polysomnography, actigraphy (high-sensitivity algorithm of the Mini Mitter AW64 Actiwatch), and morning sleep diary. SETTING:Sleep disorders center. PARTICIPANTS:Participants were 57 volunteers from the community, 26 men and 31 women, ranging in age from 21 to 87 years. All participants satisfied conservative criteria for insomnia. The sample included subjects with primary insomnia, subjects with comorbid insomnia, and hypnotic users with current insomnia complaints. INTERVENTIONS:N/A. MEASUREMENTS AND RESULTS:Actigraphy was successfully validated on 4 measures of sleep pattern--number of awakenings, wake time after sleep onset, total sleep time, and sleep efficiency percentage--based on nonsignificant mean differences and significant correlation between actigraphy and polysomnography. Sleep-onset latency with actigraphy was not significantly different from polysomnography but was weakly correlated with polysomnography. Hypnotic use contributed to actigraphic overscoring of sleep. CONCLUSIONS:Actigraphy proved to be a satisfactory objective measure of sleep on 4 of 5 sleep parameters, but these results are specific to this particular instrument using this particular algorithm and should not be construed as a blanket endorsement of actigraphy for measuring insomnia.

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BACKGROUND & AIMS: :Selective serotonin reuptake inhibitors (SSRIs) are an efficacious and effective treatment for pediatric obsessive-compulsive disorder (OCD) but have received scrutiny due to a potential side effect constellation called activation syndrome. While recent research introduced a subjective measure of activation syndrome, objective measures have not been tested. This pilot study, using data from a larger randomized-controlled trial, investigated the potential of actigraphy to provide an objective measure of activation symptoms in 44 youths with OCD beginning an SSRI medication regimen. Data were collected over the first four weeks of a multi-site, parallel, double-blind, randomized, placebo controlled psychopharmacological treatment study and statistical modeling was utilized to test how activation syndrome severity predicts daily and nightly activity levels. Results indicated that youths with higher activation symptoms had lower daytime activity levels when treatment averages were analyzed; in contrast youths who experienced onset of activation symptoms one week were more likely to have higher day-time and night-time activity ratings that week. Results support actigraphy as a potential objective measure of activation symptoms. Subsequent studies are needed to confirm these findings and test clinical applications for use by clinicians to monitor activation syndrome during SSRI treatment. National Institutes of Health (5UO1 MH078594-01); NCT00382291.

背景与目标： : 选择性5-羟色胺再摄取抑制剂 (SSRIs) 是治疗小儿强迫症 (OCD) 的有效方法，但由于潜在的称为激活综合征的副作用而受到审查。尽管最近的研究引入了激活综合征的主观度量，但尚未对客观度量进行测试。这项初步研究使用了一项较大的随机对照试验的数据，研究了在开始SSRI药物治疗方案的44名患有强迫症的年轻人中，激活成像技术提供了客观的激活症状的潜力。在多部位，平行，双盲，随机，安慰剂对照的心理药物治疗研究的前四周收集了数据，并利用统计模型来测试激活综合征的严重程度如何预测每日和每晚的活动水平。结果表明，当分析治疗平均值时，具有较高激活症状的年轻人的白天活动水平较低; 相比之下，一周出现激活症状的年轻人更有可能在该周具有较高的白天和夜间活动评分。结果支持作为激活症状的潜在客观度量。需要随后的研究来证实这些发现并测试临床应用，以供临床医生在SSRI治疗期间监测激活综合征。美国国立卫生研究院 (5UO1 MH078594-01); Nct00382291。

BACKGROUND & AIMS: OBJECTIVE:To compare periodic leg movement (PLM) counts obtained with polysomnography (PSG) to those obtained from actigraphy with two devices (Actiwatch and PAM-RL). METHODS:Twenty-four patients underwent full night actigraphy with Actiwatch from both legs and simultaneous PSG. Out of these patients, 10 had additional actigraphy with PAM-RL. Bilateral and unilateral PLM indices (PLMI) for both actigraphs were calculated for time in bed and compared to polysomnographic PLMI. Additionally, a comparison between the two different actigraphs was performed. RESULTS:PLMI obtained with Actiwatch were significantly lower than those obtained with PSG (21.2+/-25.6/h versus 34.4+/-30.7/h; p<0.001), whereas the PLMI from PAM-RL were significantly higher than in PSG (63.6+/-39.3/h versus 37.0+/-33.5/h; p=0.009). In direct comparison, Actiwatch gave significantly lower PLMI than the PAM-RL (p=0.005). The correlations between Actiwatch and PSG (rho=0.835, p<0.001), PAM-RL and PSG (rho=0.939, p<0.001), and Actiwatch and PAM-RL (rho=0.915, p<0.001) were significant. Unilateral actigraphy compared to standard PSG gave less consistent findings. When comparing different settings of the PAM-RL, manual threshold setting resulted in PLMI that were no longer different from PSG (p=0.074), in contrast to the default threshold setting. CONCLUSIONS:The Actiwatch underestimated and the PAM-RL overestimated PLMI compared to PSG. Whereas PLMI obtained with two actigraphs and PSG were highly correlated, they differed in mean values. Therefore, PSG, actigraphy and also the different actigraphs cannot be interchanged in longitudinal studies, and actigraphy should not be used for diagnostic decision making based on PLM indices. The best approximation to PSG PLMI was achieved by using manual threshold setting with the PAM-RL.

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