Table 3 Criterion and convergent validity of accelerometer-based methods for infants, sorted by methodological study quality, quality of evidence (level of evidence), and study result rating
Study | Study populationa | Outcome(s) & Setting | Comparison measure(s) | Methodological study qualityb | Placement | Device-based methodc | Results | Study result ratingd | Quality of evidencee (level of evidence) | |
|---|---|---|---|---|---|---|---|---|---|---|
Criterion validity | Galland et al. (2012) [30] | n = 31 Age = 13.0 ± 3.1 (10.0 to 22.3) weeks Sex = 27.3% girls | Sleep quality: sleep latency, TST, sleep efficiency, and WASO (duration and number) Laboratory (daytime nap) | Polysomnography to score sleep stages as sleep (active, quiet, intermediate) and wake | VG | Shin | Ac-CS-omni-15 | accuracy = 86.3%, Se = 85.7%, Sp = 84.3%, κ = .66, PABAK = .72; Sleep latency rp = .79*** (underestimated by 3 min*), TST rp = .83***, Sleep efficiency rp = .87***, WASO (duration) rp = .48** (overestimated by 6.5 min***), WASO (number) rp = .35 (overestimated by 3***) | + | Low |
Ac-CS-omni-30 | accuracy = 86.1%, Se = 84.7%, Sp = 87.4%, κ = .66, PABAK = .72 | + | ||||||||
Ac-CS-omni-60 | accuracy = 84.5%, Se = 79.8%, Sp = 90.2%, κ = .63, PABAK = .69 | - | ||||||||
Ac-S0-omni-15 | accuracy = 82.3%, Se = 94.8%, Sp = 57.8%, κ = .55, PABAK = .65; Sleep latency rp = .80*** (underestimated by 5 min***), TST rp = .76*** (overestimated by 11 min*), Sleep efficiency rp = .76*** (overestimated by 16.5%***), WASO (duration) rp = .48** (overestimated by 7 min***), WASO (number) rp = .38* (overestimated by 3***) | ± | ||||||||
Ac-S0-omni-30 | accuracy = 86.3%, Se = 91.0%, Sp = 77.7%, κ = .65, PABAK = .72 | ± | ||||||||
Ac-S0-omni-60 | accuracy = 84.5%, Se = 80.0%, Sp = 89.9%, κ = .63, PABAK = .69 | ± | ||||||||
Ac-PS-omni-15 | accuracy = 84.3%, Se = 95.1%, Sp = 63.1%, κ = .59, PABAK = .69; Sleep latency rp = .93***, TST rp = .80*** (overestimated by 11 min*), Sleep efficiency rp = .81*** (overestimated by 13.6%*), WASO (duration) rp = .50** (overestimated by 3.5 min***), WASO (number) rp = .13 (overestimated by 3***) | ± | ||||||||
Ac-PS-omni-30 | accuracy = 86.8%, Se = 90.8%, Sp = 79.0%, κ = .66, PABAK = .74 | ± | ||||||||
Ac-PS-omni-60 | accuracy = 84.6%, Se = 79.9%, Sp = 90.3%, κ = .63, PABAK = .69 | ± | ||||||||
Ac-WSC-omni-15 | accuracy = 83.2%, Se = 94.6%, Sp = 60.2%, κ = .57, PABAK = .66; Sleep latency rp = .78*** (underestimated by 4 min*), TST rp = .78*** (overestimated by 10 min*), Sleep efficiency rp = .79*** (overestimated by 15.2%*), WASO (duration) rp = .41* (overestimated by 7 min***), WASO (number) rp = .29 (overestimated by 3***) | ± | ||||||||
Ac-WSC-omni-30 | accuracy = 86.5%, Se = 90.9%, Sp = 78.2%, κ = .66, PABAK = .73 | ± | ||||||||
Ac-WSC-omni-60 | accuracy = 84.5%, Se = 80.0%, Sp = 89.9%, κ = .63, PABAK = .69 | ± | ||||||||
Insana, Gozal, & Montgomery-Downs (2010) [31] | n = 22 Age = 14.1 ± 0.6 (13.0 to 15.0) months Sex = 45.5% girls | Sleep quality: TST and WASO (duration) Laboratory (in the hospital) | Polysomnography to score sleep stages as sleep and wake | VG | Ankle | Aw-ACT40-uni-15 | accuracy = 89.6%, Se (89.0 to 96.3%), Sp = 58.9% TST: rp = .83***, ICC = .80, MD = -72.3 (SD = 61.5) min***, d = .70 WASO: rp = .52*, ICC = .65, MD = 13.9 (SD = 30.9) min*, d = .44 | ± | Low | |
Aw-ACT80-uni-15 | TST: rp = .84***, ICC = .86, MD = 52.1 (SD = 60.4) min**, d = .50 WASO: rp = .52*, ICC = .65, MD = 6.4 (SD = 26.8) min | ± | ||||||||
Rioualen et al. (2015) [32] | n = 24 Age = 2.5 ± 0.7 days Sex = 50.0% girls | Sleep stage: wake, active sleep, and quiet sleep Laboratory (in the hospital) | Polysomnography to score sleep stages as sleep (active, quiet) and wake | VG | Wrist | Aw-ASA40-uni-60 | Se = 93%, 95% CI (89 to 96) Sp = 20%, 95% CI (14 to 27) | ± | Low | |
Ankle | Aw-ASA40-uni-60 | accuracy = 58.5%, Se = 87%, 95% CI (81 to 93), Sp = 31%, 95% CI (24 to 39) | - | |||||||
Lewicke, Sazonov, & Schuckers (2004) [35] | n = 25 Age = n.r Sex = n.r | Sleep stage: wake, active sleep, and quiet sleep Laboratory | Polysomnography to score sleep stages as sleep (active, quiet, indeterminate) and wake | I | Left hip | mSCA-LVQ-uni-30 | Training: accuracy = 80.7%, Se = 94.6%, Sp = 48.2% Validation: accuracy = 75.3%, Se = 92.3%, Sp = 42.4% | ± | Very low | |
Convergent validity | Camerota et al. (2018) [33] | n = 82 Age = 3.6 ± 0.6 (2.7 to 5.2) months Sex = 43% girls | Sleep quality: sleep onset time, rise time, sleep period, WASO (number and duration), TST, and longest sleep period Free-living (at home) | Videosomnography to score sleep stages as sleep and wake | VG | Left ankle | Aw-ACTdef-uni-15 | κ = .47, Se = 52%, Sp = 95% Sleep onset time: r = .79*, underestimated by 29 min***, d = .43 Rise time: r = .76* Sleep period: r = .78*, overestimated by 23.6 min*, d = .28 WASO: (number) r = .47*, underestimated by 1.1***, d = .54; (duration): r = .59*, overestimated by 58.4 min***, d = 72 TST: r = .54* Longest sleep period: r = .38*, overestimated by 35.5 min*, d = .28 | - | Moderate (level 2) |
Greenspan et al. (2021) [29] | n = 16 Age = 3.1 ± 1.1 (1.8 to 5) months Sex = 51% girls | Body position: supine (parallel to floor stomach facing up), reclined (trunk tilted about 45° posteriorly from upright), upright (90°), inclined (trunk tilted about 45° anteriorly from upright), and prone (parallel to floor stomach facing down) Free-living (structured and free play) | DVO to score body position by two independent raters using outlined definitions | VG | Trunk | GG-Gr-HA/VA/DA-1 | κw = .84, 95% CI (.83 to .84) Supine: accuracy = 90.7%, rsp = .97*** Reclined: accuracy = 73.5%, rsp = .89*** Upright: accuracy = 83.1%, rsp = .97*** Inclined: accuracy = 41.4%, rsp = .67** Prone: accuracy = 78.4%, rsp = .96*** | ± | Low (level 1) | |
Jun & Choi (2020) [40] | n = 9 Age = 144 ± 284.5 (2 to 720) days Sex = 59.1% girls | Activity type: sleeping (without substantial movement), strong movement (struggling with crying or in agony), weak movement (moving in comfy state), and movement by external force (from nurse or caregiver) Laboratory (at the hospital) | DVO to score activity type by two independent raters using a 3-stage classification scheme | A | Chest | ICM-DNN-HA/VA/DA-4 | accuracy = .96, F-score = .95, precision = .98, recall = .93, Sp = .98 Sleep: accuracy = .97, F-score = .99, precision = .99, recall = 1.0, Sp = .94 Strong movement: accuracy = .97, F-score = .95, precision = .96, recall = .94, Sp = .99 Weak movement: accuracy = .95, F-score = .93, precision = .97, recall = .90, Sp = .99 External force: accuracy = .95, F-score = .95, precision = 1.0, recall = .89, Sp = 1.0 | + | Very low (level 1) | |
Airaksinen et al. (2020) [39] | n = 22 Age = 6.7 ± 0.8 (4.5 to 7.7) months Sex = 59.1% girls | Body position: prone (navel on floor), supine (lower back on floor), side left/right, crawl posture (supported by hands, and knees or feet); Movement: macro still (no movement), turn left/right (change of posture along prone-side-supine axis), pivot left/right (change of facing whole body direction, without movement), crawl proto (practice crawl without moving during prone/side posture and move multiple limbs during supine posture), crawl commando (crawl with forward movement) Laboratory (semi-structured) | DVO to score body position and movement by three independent raters using a developed annotation scheme | A | Arms + legs; proximally | SM-CNN-VM-2 | Movement track: F-score = 80% Full agreement: posture: accuracy = 99.1%, movement: accuracy = 90.7%; All frames: posture: accuracy = 98.2%, movement: accuracy = 81.7% Most frequent confusions in prone-side-supine axis as well as between crawl posture and prone Individual sensors lower performance (left arm posture: accuracy = 71%, movement: accuracy = 70%, left leg posture: accuracy = 90%, movement: accuracy = 68%) compared to four-sensor setup (posture: accuracy = 95%, movement: accuracy = 80%), and two-sensor setup (right leg + arm posture: accuracy = 94%, movement: accuracy = 78%; left leg + arm posture: accuracy = 95%, movement: accuracy = 79%; left + right arm posture: accuracy = 85%, movement: accuracy = 72%; left + right leg posture: accuracy = 93%, movement: accuracy = 72%) | + Arm: - Arms: ± Leg: ± Legs: ± Combined 2-sensor: ± ; 4-sensor: + | Very low (level 1) | |
SM-SVM-VM-2 | Movement track: F-score consistently 5–10% lower performance in prone positions (crawl proto*, turn right***; pivot left*) Posture classification comparable between CNN and SVM | ± | ||||||||
Smith et al. (2015) [41] | n = 12 Age = 6.8 ± 2.9 (1 to 12) months Sex = 66.7% girls | Activity type: leg movement (change of limb position) Laboratory | DVO to score activity type by one rater | D | Legs | Op-AAV-VM-n.r | accuracy = 92.7%, Se = 92.0% | + | Very low (level 1) | |
Hewitt et al. (2019) [34] | n = 32 Age = 15.2 ± 6.4 (4.7 to 24.9) weeks Sex = 40.6% girls | Body position: prone on floor (tummy with both hips touching the floor), prone supported (held in prone, on parent’s chest), and non-prone (supine, left/right side lying, reclined in car seat/pram, upright, supported sitting, cradle hold) Laboratory (structured positions) | DVO to score body position by one rater (one randomly chosen video was scored by four independent raters) using outlined definitions | D | Right hip | AG-He-VA/HA-1 | Prone: accuracy = 90%, MD = -18.3 s, LoA (-97.0 to 60.3) Non-prone: accuracy = 99.9%, MD = -0.2 s, LoA (-1.2 to 0.9) Prone supported: accuracy = 63.6%, MD = -127.3 s, LoA (-324.7 to 70.2) | ± | Very low (level 1) | |
GA-Ai-VA/HA-1 | Prone: accuracy = 95.4%, MD = -8.4 s, LoA (-78.2—61.3) Non-prone: accuracy = 98%, MD = 31.2 s, LoA (-154.9 to 92.4) Prone supported: accuracy = 52.2%, MD = -166.9 s, LoA (-390.7 to 56.8) | ± | ||||||||
Ankle | AG-He-VA/DA-1 | Prone: accuracy = 87.9%, MD = -22.1 s, LoA (-124.0 to 79.7) Non-prone: accuracy = 96.3%, MD = -56.6 s, LoA (-209.5 to 96.3) Prone supported: accuracy = 53.3%, MD = -163.1 s, LoA (-431.7 to 105.6) | ± | |||||||
Chest | MB-He-VA/HA/DA-1 | Prone: accuracy = 79.2%, MD = -38 s, LoA (-194.5 to 118.5) Non-prone: accuracy = 99.9%, MD = 2.0 s, LoA (-14.0 to 10.8) Prone supported: accuracy = 66.1%, MD = -113 s, LoA (-355.6 to 129.6) | - | |||||||
Horger et al. (2021) [37] | n = 9 Agestart = 7.96 ± 2.51 (0.89 to 8.19) months Ageend = 10.89 ± 1.14 (9.5 to 13.08) months Sex = 44.0% girls | Sleep quality: sleep onset, morning wake time, WASO, sleep efficiency, and sleep duration Free-living (at home) | Videosomnography to score sleep quality | D | Left ankle | MM-PSinf-uni-60 | Sleep onset: rp= .94**, MD = 0.76 min, SD = 34.5 min Morning wake: rp= .74, MD = -14.1 min, SD = 40.4 min WASO: rp= .20, MD = 1.2, SD = 3.9 Sleep efficiency: rp= .30 Sleep duration: rp= .36 | - | Very low (level 2) | |
MM-PS-uni-60 | Sleep onset: rp= .86** Morning wake: rp= .55 WASO: rp= .27 Sleep efficiency: rp= .51 Sleep duration: rp= .12 | - | ||||||||
Sadeh et al. (1995) [38] | n = 41 (10 newborns; 11 3-month-olds; 10 6-month-olds; 10 12-month-olds) Age = 0 to 12 months Sex = 46.4% girls | Sleep stage: sleep (active and quiet) and wake Free-living (newborns at hospital; others at home) | DO using Thoman’s observation scheme (1975, 1995) to score sleep stage as sleep (active and quiet), wake, sleep–wake transition and uncertain | D | Left ankle | AMA-PS-uni-60 | All infants: accuracy = 83.4% (sleep–wake = 95.6%; wake = 93.5%; active sleep = 74.9% and quiet sleep = 78.0%) (excl. 12-month-olds) Newborns: accuracy = 74.9% (wake = 82.8%; active sleep = 74.4.1%, quiet sleep = 54.9%) 3-month-olds: accuracy = 87.3% (wake = 92.5%, active sleep = 78.3%, quiet sleep = 87.2%; sleep–wake = 93.8%); 6-month-olds: accuracy = 83.2% (wake = 97.8%, active sleep = 66.4%, quiet sleep = 76.7%; sleep–wake = 97.9%); 12-month-olds: wake = 99.3%; sleep–wake = 97.2% Wake time: r (.85 to .99), % active sleep time: r (.78 to .98), % quiet sleep time: r (.36 to .85) (lowest correlations in newborns) Wake: MD (0.2 to 3.5%), sleep: MD (0.4 to 11.3%) | ± < 3 months: - > 3 months: + | Very low (level 3) | |
Gnidovec, Neubauer, & Zidar (2002) [36] | n = 10 Age = 1 to 6 months Sex = 40% girls | Sleep stage: Sleep (active and quiet) and wake (active and quiet) Free-living (at home) | DO using Thoman’s observation scheme (1990) to score sleep stage as sleep (active and quiet), wake (active and quiet), sleep–wake transition and uncertain | I | Left ankle | Gw-ASW-uni-10 | 1-month: accuracy = 72.0% (sleep = 88.7%, wake = 57.5%); 3-months: accuracy = 90.1% (sleep = 97.0%, wake = 84.5%); 6-months: accuracy = 95.0% (sleep = 88.4%, wake = 98.0%) After 3rd month 88.9% and 6th month 94.4% accuracy (calibration sample n = 5) Invalid discrimination between active- and quiet sleep all age groups < 75%, best for 3-month-olds (accuracy = 74.3%; active sleep: accuracy = 49.3%, quiet sleep: accuracy = 88.3%), as compared to 1-month (accuracy = 58.5%; active sleep: accuracy = 35.9%, quiet sleep: accuracy = 90.5%) and 6-months (accuracy = 66.5%; active sleep: accuracy = 39.9%, quiet sleep: accuracy = 87.1%) | ± 1 month: - > 3 months: + | Very low (level 3) |