Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2025 Dec;34(6):e14480.
doi: 10.1111/jsr.14480. Epub 2025 Feb 28.

Performance evaluation of an under-mattress sleep sensor versus polysomnography in > 400 nights with healthy and unhealthy sleep

Affiliations

Performance evaluation of an under-mattress sleep sensor versus polysomnography in > 400 nights with healthy and unhealthy sleep

Jack Manners et al. J Sleep Res. 2025 Dec.

Abstract

Consumer sleep trackers provide useful insight into sleep. However, large-scale performance evaluation studies are needed to properly understand sleep tracker accuracy. This study evaluated performance of an under-mattress sensor to estimate sleep and wake versus polysomnography in a large sample, including individuals with and without sleep disorders and during day versus night sleep opportunities, across multiple in-laboratory studies. One-hundred and eighty-three participants (51%/49% male/female, mean [SD] age = 45 [18] years) attended the sleep laboratory for a research study including simultaneous polysomnography and under-mattress sensor (Withings Sleep Analyser) recordings. Epoch-by-epoch analyses determined accuracy, sensitivity and specificity of the Withings Sleep Analyser versus polysomnography. Bland-Altman plots examined bias in sleep duration, efficiency, onset-latency, and wake after sleep onset. Overall Withings Sleep Analyser sleep-wake classification accuracy was 83%, sensitivity 95% and specificity 37%. The Withings Sleep Analyser significantly overestimated total sleep time (48 [81] min), sleep efficiency (9 [15]%) and sleep-onset latency (6 [26] min), and underestimated wake after sleep onset (54 [78] min). Accuracy and specificity were higher for night versus daytime sleep opportunities in healthy individuals (89% and 47% versus 82% and 26%, respectively, p < 0.05). Accuracy and sensitivity were also higher for healthy individuals (89% and 97%) versus those with sleep disorders (81% and 91%, p < 0.05). Withings Sleep Analyser performance is comparable to other consumer sleep trackers, with high sensitivity but poor specificity compared with polysomnography. Withings Sleep Analyser performance was reasonably stable, but more variable in daytime sleep opportunities and in people with a sleep disorder. Contactless, under-mattress sleep sensors show promise for accurate sleep monitoring, noting the tendency to over-estimate sleep particularly where wake time is high.

Keywords: performance evaluation; polysomnography; sleep; sleep measures; sleep trackers; validation study; wearables.

PubMed Disclaimer

Conflict of interest statement

Financial Disclosure: DJE and BL have had an investigator‐initiated research grant supported by Withings. Non‐Financial Disclosures: None.

Figures

FIGURE 1
FIGURE 1
Bland–Altman plots of TST, SE, SOL and WASO during nighttime (left) and daytime (right) sleep opportunities. Red solid lines indicate mean bias, with dashed red 95% CIs. Grey solid lines indicate limits of agreement (mean bias ±1.96 standard deviation), with dashed grey 95% CIs. CI, confidence interval; SE, sleep efficiency; SOL, sleep‐onset latency; TST, total sleep time; WASO, wake after sleep onset.
FIGURE 2
FIGURE 2
Confusion matrices showing Withings Sleep Analyser (WSA) versus polysomnography four‐stage classification for healthy sleepers during nighttime and daytime recordings, and people with a sleep disorder during nighttime recordings.
FIGURE 3
FIGURE 3
Confusion matrices showing four‐stage classification, compared with polysomnography, for WSA versus FC4. Sleep stage classification compared four‐stage estimation (device “wake” = PSG wake; device “light” = PSG N1; device “deep” = PSG N2 + N3; device “REM” = PSG REM). FC4, Fitbit Charge 4; N1, stage 1 sleep; N2, stage 2 sleep; N3, Stage 3 sleep; PSG, polysomnography; REM, rapid eye movement; WSA, Withings Sleep Analyser.
FIGURE 4
FIGURE 4
Withings Sleep Analyser (WSA) versus polysomnography variability in accuracy for (a) daytime versus nighttime sleep opportunities; and (b) individuals with healthy versus disordered sleep. Larger mean coefficients of variation reflect greater multi‐night variability in WSA performance. Wider plots reflect a greater range of variability in performance across individuals in each category.

References

    1. Adão Martins, N. R. , Annaheim, S. , Spengler, C. M. , & Rossi, R. M. (2021). Fatigue monitoring through wearables: A state‐of‐the‐art review. Frontiers in Physiology, 12, 790292. 10.3389/fphys.2021.790292 - DOI - PMC - PubMed
    1. Agnew, H. W., Jr. , Webb, W. B. , & Williams, R. L. (1966). The first night effect: An eeg study of SLEEP. Psychophysiology, 2, 263–266. 10.1111/j.1469-8986.1966.tb02650.x - DOI - PubMed
    1. Bates, D. , et al. (2015). Package ‘Lme4’. convergence 12, 2.
    1. Chang, W. P. , & Peng, Y. X. (2021). Meta‐analysis of differences in sleep quality based on actigraphs between day and night shift workers and the moderating effect of age. Journal of Occupational Health, 63(1), e12262. - PMC - PubMed
    1. Chinoy, E. D. , Cuellar, J. A. , Huwa, K. E. , Jameson, J. T. , Watson, C. H. , Bessman, S. C. , Hirsch, D. A. , Cooper, A. D. , Drummond, S. P. A. , & Markwald, R. R. (2020). Performance of seven consumer sleep‐tracking devices compared with polysomnography. Sleep, 44(5), zsaa291. 10.1093/sleep/zsaa291 - DOI - PMC - PubMed

Publication types