Validity of Actigraphy and Sleep Diary Compared With Home Polysomnography in Patients With Sleep Apnea and Insomnia Symptoms

Objective To evaluate the validity of actigraphy and sleep diaries against home polysomnography (PSG) and to determine whether their performance differs according to sleep apnea and insomnia.Methods Participants underwent one-night home PSG with actigraphy and next-morning sleep diary completion. Parameters included total sleep time (TST), sleep efficiency (SE), sleep latency (SL), and wake after sleep onset (WASO). The apnea subgroup was defined as apnea–hypopnea index (AHI) ≥15, and the insomnia symptoms subgroup as Pittsburgh Sleep Quality Index >5 and AHI <15. Mean differences, correlations, correlation comparisons, and agreement with PSG were evaluated.Results A total of 63 adults (mean age 49.7±14.0 years; 27 male) were included. Overall, actigraphy overestimated TST and SE and underestimated SL, whereas sleep diaries overestimated SL. Both tools were significantly correlated with PSG across all parameters, with sleep diaries showing a stronger correlation with PSG for SL (r=0.817 vs. 0.438, p<0.001). In both the apnea and insomnia symptoms subgroups, actigraphy was significantly correlated with PSG only for TST (ρ=0.594 and 0.462). In contrast, sleep diaries were significantly correlated with PSG for all parameters in the insomnia symptoms subgroup (ρ=0.668–0.781), but only for WASO in the apnea subgroup (ρ=0.440).Conclusion Both actigraphy and sleep diaries showed validity relative to PSG, but their clinical use should be tailored to the underlying sleep disorder. Sleep diaries may be particularly informative in insomnia, whereas actigraphy may be relatively more useful in sleep apnea.