Abstract
Introduction: Advanced video technology is available for sleep-laboratories. However, low-cost equipment for screening in the home setting has not been identified and tested, nor has a methodology for analysis of video recordings been suggested.Methods: We investigated different combinations of hardware/software for home-videosomnography (HVS) and established a process for qualitative and quantitative analysis of HVS-recordings. A case vignette (HVS analysis for a 5.5-year-old girl with major insomnia and several co-morbidities) demonstrates how methodological considerations were addressed and how HVS added value to clinical assessment.Results: We suggest an “ideal set of hardware/software” that is reliable, affordable (∼$500) and portable (=2.8 kg) to conduct non-invasive HVS, which allows time-lapse analyses. The equipment consists of a net-book, a camera with infrared optics, and a video capture device. (1) We present an HVS-analysis protocol consisting of three steps of analysis at varying replay speeds: (a) basic overview and classification at 16× normal speed; (b) second viewing and detailed descriptions at 4–8× normal speed, and (c) viewing, listening, and in-depth descriptions at real-time speed. (2) We also present a custom software program that facilitates video analysis and note-taking (Annotator©), and Optical Flow software that automatically quantifies movement for internal quality control of the HVS-recording. The case vignette demonstrates how the HVS-recordings revealed the dimension of insomnia caused by restless legs syndrome, and illustrated the cascade of symptoms, challenging behaviors, and resulting medications.Conclusion: The strategy of using HVS, although requiring validation and reliability testing, opens the floor for a new “observational sleep medicine,” which has been useful in describing discomfort-related behavioral movement patterns in patients with communication difficulties presenting with challenging/disruptive sleep/wake behaviors.
Highlights
Advanced video technology is available for sleep-laboratories
We report a patient with chronic and early onset familial restless legs syndrome (RLS) where, at the initial assessment, the patient herself could not find the words or the means to explain the problem despite being an articulate child
We suggested that after a treatment period of ~3 years, all the patient’s daytime diagnoses would need to be re-evaluated
Summary
Advanced video technology is available for sleep-laboratories. low-cost equipment for screening in the home setting has not been identified and tested, nor has a methodology for analysis of video recordings been suggested. In children and adolescents with neurodevelopmental conditions (NDCs) and chronic care needs, sleep problems (SPs) constitute one of the most common parental complaints to health care providers [1]. A major reason for this shortcoming is the multifaceted clinical appearance of SPs in this population; SPs may go unrecognized, especially if the parent/caregiver-reported presentation does not match the well-known diagnostic criteria such as sleep apnea [2, 3]. A medical ethnographic approach [5,6,7] using the observational skills of parents and therapists has previously enabled us to better understand reasons for unspecified insomnia [8, 9] and connect novel observations such as sensory processing abnormalities [10] and restless legs syndrome (RLS) [11], which are missed in standard clinical assessments and treated for their daytime sequelae
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