Selecting a sleep tracker from EEG-based, iteratively improved, low-cost multisensor, and actigraphy-only devices.

AIMS: Evaluate the performance of 6 wearable sleep trackers across 4 classes (EEG-based headband, research-grade actigraphy, iteratively improved consumer tracker, low-cost consumer tracker).

FOCUS TECHNOLOGY: Dreem 3 headband, Actigraph GT9X, Oura Ring Gen3, Fitbit Sense, Xiaomi Mi Band 7, Axtro Fit3.

REFERENCE TECHNOLOGY: In-lab polysomnography with 3-reader, consensus sleep scoring.

SAMPLE: Sixty participants (26 males) across 3 age groups (18-30, 31-50, and 51-70years).

DESIGN: Overnight in a sleep laboratory from habitual sleep time to wake time.

CORE ANALYTICS: Discrepancy and epoch-by-epoch analyses for sleep/wake (2-stage) and sleep-stage (4-stage; wake/light/deep/rapid eye movement) classification (devices vs. polysomnography).

CORE OUTCOMES: EEG-based Dreem performed the best (2-stage kappa=0.76, 4-stage kappa=0.76-0.86) with the lowest total sleep time, sleep efficiency, sleep onset latency, and wake after sleep onset discrepancies vs. polysomnography. This was followed by the iteratively improved consumer trackers: Oura (2-stage kappa=0.64, 4-stage kappa=0.55-0.70) and Fitbit (2-stage kappa=0.58, 4-stage kappa=0.45-0.60) which had comparable total sleep time and sleep efficiency discrepancies that outperformed accelerometry-only Actigraph (2-stage kappa=0.47). The low-cost consumer trackers had poorest overall performance (2-stage kappa<0.31, 4-stage kappa<0.33).

IMPORTANT ADDITIONAL OUTCOMES: Proportional biases were driven by nights with poorer sleep (longer sleep onset latencies and/or wake after sleep onset).

CORE CONCLUSION: EEG-based Dreem is recommended when evaluating poor quality sleep or when highest accuracy sleep-staging is required. Iteratively improved non-EEG sleep trackers (Oura, Fitbit) balance classification accuracy with well-tolerated, and economic deployment at-scale, and are recommended for studies involving mostly healthy sleepers. The low-cost trackers, can log time in bed but are not recommended for research use.