Concordance of wearable device sleep metrics with patient-reported sleep quality: A systematic review

Abstract

Background: Commercial wearable devices increasingly monitor sleep, but their concordance with patient-reported sleep quality remains poorly characterized. This systematic review evaluates concordance between wearable sleep metrics and validated subjective measures.

Methods: Following PRISMA guidelines, we searched PubMed/MEDLINE, Embase, and Cochrane Library through October 2025 for studies comparing consumer wrist-worn actigraphy-based devices with validated subjective sleep quality measures in adults (≥18 years). Two reviewers independently performed screening, extraction, and QUADAS-2 quality assessment. GRADE criteria evaluated evidence certainty.

Results: Five observational studies (2006 participants) were included. Wearable devices showed poor to moderate agreement with subjective assessments, explaining only 2.5-16.2% variance. Total sleep time moderately correlated with same-day diaries (r = 0.367), but devices failed to capture Pittsburgh Sleep Quality Index scores. Agreement varied substantially by population: good sleepers showed 82.4% concordance versus 39.4% in insomnia patients (p = 0.006). Clinical populations and older adults demonstrated poor agreement. Polysomnography concordance was also poor: sleep efficiency showed fair intraclass correlation coefficient values (0.478-0.570) with systematic overestimation (+1.75% to +7.9%), sleep onset latency correlated poorly (r = 0.033), and wake after sleep onset was underestimated (-7 to -30 min). Evidence certainty ranged from low to moderate.

Conclusions: Commercial wearable sleep trackers demonstrate poor to moderate agreement with validated subjective sleep quality measures, with significant population-specific variation. Device data should complement, not replace, validated subjective assessments, as current technology inadequately captures patient-reported sleep quality and shows systematic bias in objective parameters.

Keywords: Actigraphy; Pittsburgh sleep quality index; Sleep quality; Subjective sleep assessment; Systematic review; Wearable devices.