Agreement Between Actigraphy-Based Sleep Measures and Routine Nursing Sleep Assessments in Acute Psychiatric Inpatient Care
Listed in
This article is not in any list yet, why not save it to one of your lists.Abstract
Introduction
Sleep is routinely assessed by psychiatric mental health nurses in acute inpatient wards, where overnight observation forms part of everyday clinical care. These records are repeatedly collected, but observational assessment and activity-based monitoring capture different aspects of sleep and may not be interchangeable.
Aim
To examine the agreement between actigraphy-based total sleep time and routine nursing sleep assessments in an acute psychiatric inpatient ward.
Method
This cross-sectional observational study included 94 patients admitted to an acute psychiatric ward. Participants wore wrist actigraphy devices for up to seven available nights while sleep duration was concurrently documented by nursing staff as part of routine care. Pearson correlation coefficients assessed linear association and intraclass correlation coefficients (ICC) assessed agreement.
Results
Across all participants, nursing-assessed and actigraphy-based total sleep time showed a moderate linear association (Pearson r = 0.629) and good ICC (0.767). Bland– Altman analysis showed a mean bias of 0.20 hours, with 95% limits of agreement from -1.79 to 2.19 hours. Agreement varied across diagnostic groups and was strongest among patients with bipolar mania (r = 0.826; ICC = 0.886).
Discussion
Routine nursing sleep assessments showed little systematic bias relative to actigraphy at the group level, but wide limits of agreement indicate that the methods are not interchangeable for individual patients. Patient-reported sleep was not measured and should be included in future comparisons.
Implications for Practice
Routine nursing sleep records provide clinically meaningful longitudinal information. Actigraphy may serve as a selective adjunct when an independent estimate is needed, with implementation balanced against equipment, processing and workflow requirements.
Accessible Summary
What is known on the subject?
-
Sleep disturbance is common in acute psychiatric inpatient care, and psychiatric mental health nurses routinely observe and document sleep overnight.
-
Nursing observation, patient report and actigraphy reflect different aspects of sleep; disagreement between methods can occur.
What this paper adds?
-
In 94 acute psychiatric inpatients, routine nursing sleep assessments showed moderate association and good agreement with actigraphy-based total sleep time.
-
Agreement varied across diagnostic groups and was strongest in patients with bipolar mania.
-
The findings support nursing sleep assessment as a clinically meaningful source of information while positioning actigraphy as an adjunct rather than a replacement.
What are the implications for practice?
-
Routine nursing sleep documentation may be useful for longitudinal monitoring in psychiatric inpatient care.
-
Actigraphy may be useful when an independent or more detailed estimate of sleep is needed, but equipment, data-processing and workflow requirements should be considered.
-
Patient-reported sleep was not collected; future work should compare all three perspectives rather than assuming that any single method represents sleep completely.
Relevance to Mental Health Nursing
Psychiatric mental health nurses generate repeated sleep observations as part of routine inpatient care. This study shows that those observations correspond meaningfully with an independent activity-based measure of sleep. The findings support continued clinical use of nursing sleep assessment and suggest a selective adjunctive role for actigraphy when additional objective information is required.
Originality of the study
Previous psychiatric inpatient work has compared nurse-reported sleep with wrist actigraphy. The present study extends this literature in a contemporary acute ward cohort of 94 patients by using repeated monitoring over up to seven available nights, examining three diagnostic groups, and characterizing both association/reliability and absolute agreement. Its contribution is therefore an updated real-world evaluation of routine nursing sleep assessment rather than the first comparison of nursing observation with actigraphy.
Rigour of the study
A pragmatic consecutive sample was observed under routine ward conditions. Sleep was measured concurrently by nursing assessment and wrist actigraphy over multiple nights. Pearson correlation quantified linear association, ICC summarized agreement/reliability, and Bland–Altman analysis quantified mean bias and limits of agreement. Reporting followed the STROBE statement.
Significance of the study
Routine nursing sleep documentation is inexpensive, repeatedly available and embedded in clinical workflow. Demonstrating meaningful agreement with an independent actigraphy-based measure supports its value as a source of longitudinal clinical information. Actigraphy may add information in selected situations, but should complement rather than displace nursing assessment.
