40 years of actigraphy in sleep medicine and current state of the art algorithms.

For the last 40 years, actigraphy or wearable accelerometry has provided an objective, low-burden and ecologically valid approach to assess real-world sleep and circadian patterns, contributing valuable data to epidemiological and clinical insights on sleep and sleep disorders. The proper use of wearable technology in sleep research requires validated algorithms that can derive sleep outcomes from the sensor data. Since the publication of the first automated scoring algorithm by Webster in 1982, a variety of sleep algorithms have been developed and contributed to sleep research, including many recent ones that leverage machine learning and / or deep learning approaches. However, it remains unclear how these algorithms compare to each other on the same data set and if these modern data science approaches improve the analytical validity of sleep outcomes based on wrist-worn acceleration data. This work provides a systematic evaluation across 8 state-of-the-art sleep algorithms on a common sleep data set with polysomnography (PSG) as ground truth. Despite the inclusion of recently published complex algorithms, simple regression-based and heuristic algorithms demonstrated slightly superior performance in sleep-wake classification and sleep outcome estimation. The performance of complex machine learning and deep learning models seem to suffer from poor generalization. This independent and systematic analytical validation of sleep algorithms provides key evidence on the use of wearable digital health technologies for sleep research and care.

Quantification of acceleration as activity counts in ActiGraph wearable.

Digital clinical measures based on data collected by wearable devices have seen rapid growth in both clinical trials and healthcare. The widely-used measures based on wearables are epoch-based physical activity counts using accelerometer data. Even though activity counts have been the backbone of thousands of clinical and epidemiological studies, there are large variations of the algorithms that compute counts and their associated parameters-many of which have often been kept proprietary by device providers. This lack of transparency has hindered comparability between studies using different devices and limited their broader clinical applicability. ActiGraph devices have been the most-used wearable accelerometer devices for over two decades. Recognizing the importance of data transparency, interpretability and interoperability to both research and clinical use, we here describe the detailed counts algorithms of five generations of ActiGraph devices going back to the first AM7164 model, and publish the current counts algorithm in ActiGraph's ActiLife and CentrePoint software as a standalone Python package for research use. We believe that this material will provide a useful resource for the research community, accelerate digital health science and facilitate clinical applications of wearable accelerometry.

Saltatory conduction in unmyelinated axons: clustering of Na(+) channels on lipid rafts enables micro-saltatory conduction in C-fibers.

THE ACTION POTENTIAL (AP), THE FUNDAMENTAL SIGNAL OF THE NERVOUS SYSTEM, IS CARRIED BY TWO TYPES OF AXONS: unmyelinated and myelinated fibers. In the former the action potential propagates continuously along the axon as established in large-diameter fibers. In the latter axons the AP jumps along the nodes of Ranvier-discrete, anatomically specialized regions which contain very high densities of sodium ion (Na(+)) channels. Therefore, saltatory conduction is thought as the hallmark of myelinated axons, which enables faster and more reliable propagation of signals than in unmyelinated axons of same outer diameter. Recent molecular anatomy showed that in C-fibers, the very thin (0.1 µm diameter) axons of the peripheral nervous system, Nav1.8 channels are clustered together on lipid rafts that float in the cell membrane. This localized concentration of Na(+) channels resembles in structure the ion channel organization at the nodes of Ranvier, yet it is currently unknown whether this translates into an equivalent phenomenon of saltatory conduction or related-functional benefits and efficiencies. Therefore, we modeled biophysically realistic unmyelinated axons with both conventional and lipid-raft based organization of Na(+) channels. We find that APs are reliably conducted in a micro-saltatory fashion along lipid rafts. Comparing APs in unmyelinated fibers with and without lipid rafts did not reveal any significant difference in either the metabolic cost or AP propagation velocity. By investigating the efficiency of AP propagation over Nav1.8 channels, we find however that the specific inactivation properties of these channels significantly increase the metabolic cost of signaling in C-fibers.

Axonal noise as a source of synaptic variability.

Post-synaptic potential (PSP) variability is typically attributed to mechanisms inside synapses, yet recent advances in experimental methods and biophysical understanding have led us to reconsider the role of axons as highly reliable transmission channels. We show that in many thin axons of our brain, the action potential (AP) waveform and thus the Ca++ signal controlling vesicle release at synapses will be significantly affected by the inherent variability of ion channel gating. We investigate how and to what extent fluctuations in the AP waveform explain observed PSP variability. Using both biophysical theory and stochastic simulations of central and peripheral nervous system axons from vertebrates and invertebrates, we show that channel noise in thin axons (<1 µm diameter) causes random fluctuations in AP waveforms. AP height and width, both experimentally characterised parameters of post-synaptic response amplitude, vary e.g. by up to 20 mV and 0.5 ms while a single AP propagates in C-fibre axons. We show how AP height and width variabilities increase with a ¾ power-law as diameter decreases and translate these fluctuations into post-synaptic response variability using biophysical data and models of synaptic transmission. We find for example that for mammalian unmyelinated axons with 0.2 µm diameter (matching cerebellar parallel fibres) axonal noise alone can explain half of the PSP variability in cerebellar synapses. We conclude that axonal variability may have considerable impact on synaptic response variability. Thus, in many experimental frameworks investigating synaptic transmission through paired-cell recordings or extracellular stimulation of presynaptic neurons, causes of variability may have been confounded. We thereby show how bottom-up aggregation of molecular noise sources contributes to our understanding of variability observed at higher levels of biological organisation.