Agreement Rates Between Actigraphy, Diary, and Questionnaire for Children's Sleep Patterns

Child Development Center, University Children's Hospital Zurich, Steinwiesstrasse 75, CH-8032 Zurich, Switzerland.
JAMA Pediatrics (Impact Factor: 5.73). 05/2008; 162(4):350-8. DOI: 10.1001/archpedi.162.4.350
Source: PubMed


To describe sleep-wake patterns in kindergarten children by measures derived from questionnaire, diary, and actigraphy and to report rates of agreement between methods according to Bland and Altman.
Cross-sectional study, data from 7 nights of actigraph recordings and sleep diary and from a questionnaire.
Children studied in their homes.
Fifty children, aged 4 to 7 years.
Sleep start, sleep end, assumed sleep, actual sleep time, and nocturnal wake time derived from different methods.
Differences between actigraphy and diary were +/- 28 minutes for sleep start, +/- 24 minutes for sleep end, and +/- 32 minutes for assumed sleep, indicating satisfactory agreement between methods, whereas for actual sleep time and nocturnal wake time, agreement rates were not sufficient (+/- 106 minutes and +/- 55 minutes, respectively). Agreement rates between actigraphy and questionnaire as well as between diary and questionnaire were insufficient for all variables. Sex and age of children and socioeconomic status did not influence the differences between methods for all variables.
Actigraphy and diary may be interchangeably used for the assessment of sleep start, sleep end, and assumed sleep but not for nocturnal wake times. The diary is a cost-effective and valid source of information about children's sleep-schedule times, while actigraphy may provide additional information about nocturnal wake times or may be used if parents are unable to report in detail. It is insufficient to collect information by a questionnaire or an interview asking about children's normal sleep patterns.

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Available from: Helene Werner, Jan 06, 2015
    • "First, most of the studies using objective sleep measures included relatively small samples and hence had low statistical power. Second, studies based on self-report are limited by the possibility that shared method variance inflate the observed associations (Werner et al. 2008; Wilson et al. 2013). "
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    ABSTRACT: The aims of this paper are to study the associations between objective and subjective sleep in pregnant women, to examine which specific aspects of women's sleep are associated with depressive and anxiety symptoms and to test the moderating role of depressive and anxiety symptoms in the relations between objective and subjective sleep. The sample included 148 pregnant women. Objective sleep was measured by actigraphy for five nights at the participants' home, and subjective sleep was measured with the Pittsburgh sleep quality index. Depressive symptoms were assessed with the Edinburgh postnatal depression scale and anxiety symptoms with the Beck anxiety inventory. Significant associations were found between the subjective sleep measures and the depressive and anxiety scores, but there were no significant associations between actigraphic sleep measures and the depressive and anxiety scores. Depressive and anxiety scores emerged as significant moderators of the links between objective and subjective sleep. The findings suggest that emotional distress (i.e., depressive and anxiety symptoms severity) during pregnancy is associated with subjective sleep disturbances but not with objective sleep disturbances. Importantly, only among women with higher levels of emotional distress was subjective sleep quality associated with objective sleep quality. These findings may suggest that women with higher levels of emotional distress are not necessarily biased in their perception of sleep quality. However, they may perceive fragmented sleep as more detrimental to their wellbeing.
    Archives of Women s Mental Health 08/2015; DOI:10.1007/s00737-015-0554-8 · 2.16 Impact Factor
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    • "One limitation of the existing research is the aforementioned reliability of child sleep duration data [17] [19]. Most normative studies have relied on parents' summary recall of their children's sleep patterns via questionnaires [17] [22], which are less accurate than actigraphy and sleep diaries [23]. Time-use diaries, which reliably and validly record daily activities, have now been extended to large population cohorts spanning multiple child ages [24] [25], yielding population norms for sleep parameters in US children aged 0–18 years [26] and Australian children aged 0–9 years [18]. "
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    ABSTRACT: Aim: Using national Australian time-diary data, we aimed to empirically determine sleep duration thresholds beyond which children have poorer health, learning, quality of life, and weight status and parents have poorer mental health. Methods: Design/Setting: Cross-sectional data from the first three waves of the Longitudinal Study of Australian Children. Participants: A nationally representative sample of 4983 4-5-year-olds, recruited in 2004 from the Australian Medicare database and followed biennially; 3631 had analyzable sleep information and a concurrent measure of health and well-being for at least one wave. Main measures: Exposure: At each wave, a parent completed 24-h time-use diaries for one randomly selected weekday and one weekend day, including a "sleeping/napping" category. Outcomes: Parent-reported child mental health, health-related quality of life, and maternal/paternal mental health; teacher-reported child language, literacy, mathematical thinking, and approach to learning; and assessed child body mass index and girth. Results: Linear regression analyses revealed weak, inconsistent relationships between sleep duration and outcomes at every wave. For example, children with versus without psychosocial health-related quality of life problems slept slightly less at 6-7 years (adjusted mean difference 0.12 h; 95% confidence interval 0.01-0.22, p = 0.03), but not at 4-5 (0.00; -0.10 to 0.11, p = 1.0) or 8-9 years (0.09; -0.02 to 0.22, p = 0.1). Empirical exploration using fractional polynomials demonstrated no clear thresholds for sleep duration and any adverse outcome at any wave. Conclusions: Present guidelines in terms of children's short sleep duration appear misguided. Other parameters such as sleep timing may be more meaningful for understanding optimal child sleep.
    Sleep Medicine 08/2015; DOI:10.1016/j.sleep.2015.08.013 · 3.15 Impact Factor
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    • "In addition to the novel findings discussed above, it is worth noting two other findings that replicate previous research . First, our results are consistent with literature suggesting that parent reports systematically overestimate child sleep relative to actigraphy (Dayyat et al., 2011; Werner et al., 2008). Interestingly, this finding also reflects a more general tendency for parent report of child health variables to diverge from objective measurements. "
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    ABSTRACT: Objective To develop and evaluate adjustment factors to convert parent-reported time in bed to an estimate of child sleep time consistent with objective measurement. Methods A community sample of 217 chil-dren aged 4–9 years (mean age ¼ 6.6 years) wore actigraph wristwatches to objectively measure sleep for 7 days while parents completed reports of child sleep each night. After examining the moderators of the dis-crepancy between parent reports and actigraphy, 3 adjustment factors were evaluated. Results Parent report of child sleep overestimated nightly sleep duration by $24 min per night relative to actigraphy. Child age, gender, and sleep quality all had small or nonsignificant associations with correspondence between parent report and actigraph. Empirically derived adjustment factors significantly reduced the discrepancy be-tween parent report and objective measurement. Conclusions Simple adjustment factors can enhance the correspondence and utility of parent reports of child sleep duration for clinical and research purposes.
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