Validation of Zulu Watch against Polysomnography and Actigraphy for On-Wrist Sleep-Wake Determination and Sleep-Depth Estimation

Abstract

Traditional measures of sleep or commercial wearables may not be ideal for use in operational environments. The Zulu watch is a commercial sleep-tracking device designed to collect longitudinal sleep data in real-world environments. Laboratory testing is the initial step towards validating a device for real-world sleep evaluation; therefore, the Zulu watch was tested against the gold-standard polysomnography (PSG) and actigraphy. Eight healthy, young adult participants wore a Zulu watch and Actiwatch simultaneously over a 3-day laboratory PSG sleep study. The accuracy, sensitivity, and specificity of epoch-by-epoch data were tested against PSG and actigraphy. Sleep summary statistics were compared using paired samples t-tests, intraclass correlation coefficients, and Bland–Altman plots. Compared with either PSG or actigraphy, both the accuracy and sensitivity for Zulu watch sleep-wake determination were >90%, while the specificity was low (~26% vs. PSG, ~33% vs. actigraphy). The accuracy for sleep scoring vs. PSG was ~87% for interrupted sleep, ~52% for light sleep, and ~49% for deep sleep. The Zulu watch showed mixed results but performed well in determining total sleep time, sleep efficiency, sleep onset, and final awakening in healthy adults compared with PSG or actigraphy. The next step will be to test the Zulu watch’s ability to evaluate sleep in industrial operations.