Automatic-Scoring Actigraph Compares Favourably to a Manually-Scored Actigraph for Sleep Measurement in Healthy Adults

Introduction  Actigraphy has been used widely in sleep research due to its non-invasive, cost-effective ability to monitor sleep. Traditionally, manually-scored actigraphy has been deemed the most appropriate in the research setting; however, technological advances have seen the emergence of automatic-scoring wearable devices and software. Methods  A total of 60-nights of sleep data from 20-healthy adult participants (10 male, 10 female, age: 26 ± 10 years) were collected while wearing two devices concomitantly. The objective was to compare an automatic-scoring device (Fatigue Science Readiband™ [AUTO]) and a manually-scored device (Micro Motionlogger® [MAN]) based on the Cole-Kripke method. Manual-scoring involved trained technicians scoring all 60-nights of sleep data. Sleep indices including total sleep time (TST), total time in bed (TIB), sleep onset latency (SOL), sleep efficiency (SE), wake after sleep onset (WASO), wake episodes per night (WE), sleep onset time (SOT) and wake time (WT) were assessed between the two devices using mean differences, 95% levels of agreement, Pearson-correlation coefficients ( r ), and typical error of measurement (TEM) analysis. Results  There were no significant differences between devices for any of the measured sleep variables ( p  ≥0.05). All sleep indices resulted in very-strong correlations ( all r  ≥0.84) between devices. A mean difference between devices of <1 minutes for TST was associated with a TEM of 15.5 minute (95% CI =12.3 to 17.7 minutes). Conclusion  Given there were no significant differences between devices in the current study, automatic-scoring actigraphy devices may provide a more practical and cost-effective alternative to manually-scored actigraphy in healthy populations.

Operation early-bird: Investigating altered light exposure in military barracks on sleep and performance-a placebo-controlled study

The manipulation of light exposure in the evening has been shown to modulate sleep, and may be beneficial in a military setting where sleep is reported to be problematic. This study investigated the efficacy of low-temperature lighting on objective sleep measures and physical performance in military trainees. Sixty-four officer-trainees (52 male/12 female, mean ± SD age: 25 ± 5 years) wore wrist-actigraphs for 6 weeks during military training to quantify sleep metrics. Trainee 2.4-km run time and upper-body muscular-endurance were assessed before and after the training course. Participants were randomly assigned to either: low-temperature lighting (LOW, n = 19), standard-temperature lighting with a placebo "sleep-enhancing" device (PLA, n = 17), or standard-temperature lighting (CON, n = 28) groups in their military barracks for the duration of the course. Repeated-measures ANOVAs were run to identify significant differences with post hoc analyses and effect size calculations performed where indicated. No significant interaction effect was observed for the sleep metrics; however, there was a significant effect of time for average sleep duration, and small benefits of LOW when compared with CON (d = 0.41-0.44). A significant interaction was observed for the 2.4-km run, with the improvement in LOW (Δ92.3 s) associated with a large improvement when compared with CON (Δ35.9 s; p = 0.003; d = 0.95 ± 0.60), but not PLA (Δ68.6 s). Similarly, curl-up improvement resulted in a moderate effect in favour of LOW (Δ14 repetitions) compared with CON (Δ6; p = 0.063; d = 0.68 ± 0.72). Chronic exposure to low-temperature lighting was associated with benefits to aerobic fitness across a 6-week training period, with minimal effects on sleep measures.

Sleep duration and physical performance during a 6-week military training course

Sleep is vital in influencing effective training adaptations in the military. This study aimed to assess the relationship between sleep and changes in physical performance over 6 weeks of military training. A total of 22 officer-trainees (age: 24 ± 5 years) from the New Zealand Defence Force were used for this prospective cohort study. Participants wore wrist-actigraphs to monitor sleep, completed subjective wellbeing questionnaires weekly, and were tested for: 2.4-km run time-trial, maximum press-up and curl-ups before and after 6 weeks of training. Average sleep duration was calculated over 36 nights (6:10 ± 0:28 hr:min), and sleep duration at the mid-point (6:15 hr:min) was used to stratify the trainees into two quantile groups (UNDERS: 5:51 ± 0:29 hr:min, n = 11) and (OVERS: 6:27 ± 0:09 hr:min, n = 11). There were no significant group × time interactions for 2.4-km run, press-ups or curl-ups (p > .05); however, small effects were observed in favour of OVERS for 2.4-km run (59.8 versus 44.9 s; d = 0.26) and press-ups (4.7 versus 3.2 reps; d = 0.45). Subjective wellbeing scores resulted in a significant group × time interaction (p < .05), with large effect sizes in favour of the OVERS group for Fatigue in Week 1 (d = 0.90) and Week 3 (d = 0.87), and Soreness in Week 3 (d = 1.09) and Week 4 (d = 0.95). Sleeping more than 6:15 hr:min per night over 6 weeks was associated with small benefits to aspects of physical performance, and moderate to large benefits on subjective wellbeing measures when compared with sleeping < 6:15 hr:min.

Shared responsibility for managing fatigue: Hearing the pilots

In commercial aviation, fatigue is defined as a physiological state of reduced mental or physical performance capability resulting from sleep loss, extended wakefulness, circadian phase, and/or workload. The International Civil Aviation Organisation mandates that responsibility for fatigue risk management is shared between airline management, pilots, and support staff. However, to date, the majority of research relating to fatigue mitigations in long range operations has focused on the mitigations required or recommended by regulators and operators. Little research attention has been paid to the views or operational experience of the pilots who use these (or other) mitigations. This study focused on pilots’ views and experiences of in-flight sleep as the primary fatigue mitigation on long range flights. It also sought information about other fatigue mitigation strategies they use. Thematic analysis was used to explore written comments from diary and survey data collected during long range and ultra-long range trips (N = 291 pilots on three different aircraft types, 17 different out-and-back trips, and four airlines based on three continents). The findings indicate that the recommended fatigue mitigation strategies on long-haul flights (particularly in-flight sleep) are effective and well-utilised, consistent with quantitative findings from the same trips. Importantly however, the analyses also highlight areas that require further investigation, including flight preparation strategies in relation to the uncertainty of in-flight break allocation. There were two strategies for sleep prior to a flight: maximising sleep if pilots were expecting later breaks in the flight; or minimising sleep if they were expecting breaks earlier or at unfavourable times in the circadian cycle. They also provide a broader view of the factors that affect the amount and quality of pilots’ in-flight sleep, about which evidence has previously been largely anecdotal. The study underscores the value of including the views and experience of pilots in fatigue risk management.