Abstract
ObjectivesTo establish agreement between self-reported and actigraphy-based total sleep time (TST). To determine the impact of self-reported sleep problems on these measurements. DesignCross-sectional study using data from Wave 3 of The Irish Longitudinal Study on Ageing (2014–2015). ParticipantsCommunity-dwelling older adults, aged ≥50 years, with self-reported sleep information and ≥4 days of actigraphy-based TST (n = 1520). MeasurementSelf-reported total sleep time, daytime sleepiness, insomnia symptoms (trouble falling asleep, trouble waking too early) measured during a structured self-interview. Actigraphy-based total TST was collected using GENEactiv wrist-worn accelerometers. Demographic characteristics and health information were controlled for. Analyses included descriptive statistics, reliability and agreement analysis using paired t-tests, intra-class correlations and Bland-Altman analysis. Linear regression was used to model associations with measurement discrepancies. ResultsParticipants reported that they slept 7.0 hours (SD: 1.4, Range: 2.0–13.0 hours) on average, compared to 7.7 hours (SD: 1.2 hours, Range: 3.0–13.0 hours) recorded by accelerometry. Trouble falling asleep or waking too early “most of the time” were associated with under-reporting of sleep by 2.3, and 2.2 hours respectively. Agreement between measurements had an intra-class correlation of 0.18 and wide 95% limits of agreement (-3.90 to 2.55 hours). Under-reporting of sleep was independently associated with insomnia symptoms. ConclusionThe agreement between self-reported and actigraphy-based TST in community dwelling older adults was low. Self-reported insomnia symptoms were independently associated with under-reporting of sleep. Studies seeking to measure sleep duration should consider inclusion of questions measuring experience of insomnia symptoms to account for potential influence on measurements.
Highlights
Sleep is a restorative process and plays a vital role in preservation of cognitive, physical and mental health.[1,2,3] Poor sleep quality and duration has been associated with adverse health outcomes such as cognitive impairment, cardiovascular disease, depression, and mortality, many of which older adults are at increased risk of.[1,4,5,6,7,8] Measurement of sleep can be achieved both subjectively and objectively
This study aims to 1) establish the overall level of agreement between self-reported total sleep time and actigraphy-based total sleep time and 2) to determine the impact self-reported sleep problems have on measurement agreement using three short sleep problem questions
Those who experienced trouble falling asleep, or waking too early “most of the time” were found to under-report their sleep by over two hours on average. This is consistent with other findings which showed that poor self-reported sleep quality was associated with shorter reported total sleep time (TST) when compared to measured sleep.[11,12,14]
Summary
Sleep is a restorative process and plays a vital role in preservation of cognitive, physical and mental health.[1,2,3] Poor sleep quality and duration has been associated with adverse health outcomes such as cognitive impairment, cardiovascular disease, depression, and mortality, many of which older adults are at increased risk of.[1,4,5,6,7,8] Measurement of sleep can be achieved both subjectively and objectively. Laboratory based polysomnography is considered the gold standard for sleep measurement, but is expensive and impractical to consider for use in large community dwelling populations.[15] Activity based monitoring through the use of accelerometer devices has been shown to be an effective tool for sleep research.[16] These have become a feasible method for capturing objective sleep in large population studies. Wrist-worn devices are cost-effective and allow for non-invasive objective measurement of sleep in natural settings over long periods of time
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