Abstract
Introduction: Behavioral sleep disorders, including chronic insomnia (CI), are generally assessed by subjective parent interview. However, evidence suggests that parental report of children’s overnight behaviors is unreliable, perhaps due to recall bias or confusion due to sleep deprivation. Video technology has been used clinically to capture complex behavioral disorders in children during the day. However, there is no standardized means of analyzing child and parent behavior at bedtime or during the night. We aimed to create an algorithm for this purpose. Methods: Child brain tumor survivors (a population previously shown to have a high prevalence of CI) were screened for difficulties initiating and maintaining sleep using sub-scales from the Sleep Disturbance Scale for Children. Those who screened positive (n = 3) then completed a detailed parent interview to confirm a clinical diagnosis of CI. One night of home video footage was obtained from initial settling period to morning waking (SOMNOmedics camera). Footage was imported into BORIS© software and a coding system for parent and child behavior was developed over multiple iterations until agreeable inter-rater reliability (>70%) was achieved between two independent coders. Results: The final coding categories were: 1) time domains, 2) physical environment, 3) child global status, 4) location, 5) activity, and 6) physical interaction. This achieved 74% inter-reliability in its last iteration. Discussion: A statistically acceptable behavior scoring algorithm was achieved. With further development, this tool could be applied clinically to investigate behavioral insomnia and in research to provide more objective outcome measurement.
Highlights
Behavioral sleep disorders, including chronic insomnia (CI), are generally assessed by subjective parent interview
CI leads to insufficient sleep which can be detrimental to a child’s behaviour [3], cognitive function [4], and brain development [5]
Three children aged between 3 and 8 years, who were deemed to be at risk of CI following screening, were recruited
Summary
Behavioral sleep disorders, including chronic insomnia (CI), are generally assessed by subjective parent interview. Evidence suggests that parental report of children’s overnight behaviors is unreliable, perhaps due to recall bias or confusion due to sleep deprivation. Video technology has been used clinically to capture complex behavioral disorders in children during the day. We aimed to create an algorithm for this purpose. Chronic insomnia (CI) is the commonest childhood sleep disorder [1]. According to the Third Edition of the International Classification of Sleep Disorders (ICSD-3), a diagnosis of CI requires 1) difficulty initiating and/or maintaining sleep, 2) adequate opportunity to do so, and 3) subsequent daytime dysfunction. Scoring Algorithm for Behavioral Insomnia for at least 3 months [2]. The commonest CI in childhood is behavioral insomnia.
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