Actigraphy and diary-assessed sleep in first-trimester pregnant women: a Bland-Altman analysis

Study objectives: To evaluate the agreement between actigraphy and sleep diaries in pregnant women and to examine the impact of sleep-related symptoms on this agreement. Methods: A total of 251 first-trimester pregnant women were recruited from prenatal clinics at a university-affiliated hospital in Taipei, Taiwan. Participants completed standardized symptom questionnaires and wore an actigraph for 7 days while maintaining a concurrent sleep diary. The Bland-Altman method was applied to assess the agreement between actigraphy and diary-derived sleep measures. Unpaired t-tests were performed to analyze associations between sleep-related symptoms and discrepancies in sleep measures between the two methods. Results: Mean differences for sleep onset, offset, sleep onset latency, and daytime sleep duration, along with their 95 % limits of agreement, were within ±30 min. Total sleep time and wake after sleep onset had wider 95 % limits of agreement, ranging from ±68 to ±88 min and ±58 to ±74 min, respectively. Women with elevated symptoms of depression or insomnia showed greater discrepancies in sleep onset latency than those without such symptoms (both p = .01). Conclusions: Actigraphy and sleep diaries show an acceptable level of agreement for tracking sleep onset time, offset time, sleep onset latency, and daytime sleep duration in first-trimester pregnant women, but insufficient agreement for total sleep time and wake after sleep onset, with women experiencing depressive or insomnia symptoms more likely to misperceive their sleep. Healthcare professionals should consider integrating actigraphy into clinical and research settings to enhance early identification and management of sleep disturbances in pregnant women.