LAUSR

Sleep disturbance and chronic health conditions are common in military and veteran populations. These individuals may have difficulty accurately and consistently completing sleep diaries, which traditionally have been used as a prominent data input in scoring actigraphy. While actigraphy is considered an objective sleep measure, the process of manually scoring actigraphy data can be subjective, particularly in military/veteran and clinical populations. Few studies utilize and report clear actigraphy scoring guidelines. To promote internal consistency and replicability in actigraphy scoring procedures, this study developed a detailed actigraphy scoring protocol for cases without sleep diary data and performed an inter-rater reliability analysis using a sample of veterans with Gulf War Illness (GWI). One hundred fifty-nine nights of actigraphy (Phillips Respironics) data from a random subsample of 25 veterans with GWI were independently, manually scored using the protocol. Mean values for the start and end of rest intervals and derived sleep parameters—time in bed (TIB), total sleep time (TST), and sleep efficiency (SE)—and mean differences were calculated. Inter-rater reliability was evaluated using intra-class correlation (ICC). No significant differences were observed between manual scorers for mean values for the end of manually scored rest intervals and derived sleep parameters (TIB, TST, and SE). There were significant differences in the start of a rest interval, though the magnitude of the difference (0:06 ± 28) was less than the clinically important 15-minute difference noted in the literature. ICC demonstrated excellent agreement between manual scorers for rest interval start (0.98) and end times (0.99), TIB (0.94), TST (0.98), and SE (0.97). This protocol may serve as a reproducible set of guidelines for researchers manually scoring actigraphy and enhance internal consistency for studies using this actigraphy scoring software, especially for those working with military populations and clinical populations with significant sleep disturbance and related difficulties yielding quality sleep diary data. Veterans Affairs, Office of Research and Development, Clinical Science Research and Development under Merit Review Grant #SPLD-013-13S.