Objective and Subjective Assessments of Sleep in Children: Comparison of Actigraphy, Sleep Diary Completed by Children and Parents' Estimation.

Stéphanie Mazza,Hélène Bastuji,Amandine E Rey

doi:10.3389/fpsyt.2020.00495

Abstract

In research and clinical contexts, parents’ report and sleep diary filled in by parents are often used to characterize sleep-wake rhythms in children. The current study aimed to investigate children self-perception of their sleep, by comparing sleep diaries filled in by themselves, actigraphic sleep recordings, and parental subjective estimation. Eighty children aged 8–9 years wore actigraph wristwatches and completed sleep diaries for 7 days, while their parents completed a sleep-schedule questionnaire about their child’ sleep. The level of agreement and correlation between sleep parameters derived from these three methods were measured. Sleep parameters were considered for the whole week and school days and weekends separately and a comparison between children with high and low sleep efficiency was carried out. Compared to actigraphy, children overestimated their sleep duration by 92 min and demonstrated significant difficulty to assess the amount of time they spent awake during the night. The estimations were better in children with high sleep efficiency compared to those with low sleep efficiency. Parents estimated that their children went to bed 36 min earlier and obtained 36.5 min more sleep than objective estimations with actigraphy. Children and parents’ accuracy to estimate sleep parameters was different during school days and weekends, supporting the importance of analyzing separately school days and weekends when measuring sleep in children. Actigraphy and sleep diaries showed good agreement for bedtime and wake-up time, but not for SOL and WASO. A satisfactory agreement for TST was observed during school days only, but not during weekends. Even if parents provided more accurate sleep estimation than children, parents’ report, and actigraphic data were weakly correlated and levels of agreement were insufficient. These results suggested that sleep diary completed by children provides interesting measures of self-perception, while actigraphy may provide additional information about nocturnal wake times. Sleep diary associated with actigraphy could be an interesting tool to evaluate parameters that could contribute to adjust subjective perception to objective sleep values.

Highlights

Twenty-five to 40% of healthy children and adolescents suffer from behavioral sleep problems affecting quality, timing or duration [1, 2]
Bedtimes reported in sleep diary and parents’ report significantly differed from actigraphy
A significant difference was found during weekends between sleep diaries and parents’ reports, bedtime estimated in sleep diaries was 14.1 min earlier compared to parents’ reports (t75 = 32.5, p = .04, d = 0.21) and more distant from actigraphy measure

Summary

Introduction

Twenty-five to 40% of healthy children and adolescents suffer from behavioral sleep problems affecting quality, timing or duration [1, 2]. A variety of objective and subjective tools have been used to assess sleep-wake rhythms in children and adolescents, including polysomnography (PSG), actigraphy, sleep diary, and parental report questionnaires. These methods differ with respect to cost, duration, ease of use, level of intrusiveness, and type of data they provide. Parental reports with questionnaires have often been used to evaluate children’ sleep [9] This method can provide a detailed description of the child’s sleep schedule, night awakenings and sleep-related behaviors such as bedtime resistance, parasomnia (e.g., sleepwalking and night terrors) and markers of sleep-disordered breathing (snoring, restless and disrupted sleep). Simple questionnaires are suitable for screening and monitoring of a large population, sleep diaries are preferred for more detailed assessment of sleep-wake rhythms

Methods

Results

Discussion

Conclusion