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Validating the Children's Sleep Habits Questionnaire Against Polysomnography and Actigraphy in School-Aged Children
Adria Nora Markovich1, Melissa Anne Gendron1, Penny Violet Corkum2
1Department of Psychology and Neuroscience, Dalhousie University , Halifax, NS , Canada.
Insights
The Children's Sleep Habits Questionnaire (CSHQ) shows low validity when compared to polysomnography and actigraphy for assessing pediatric sleep problems. Clinicians should use caution when relying solely on the CSHQ for diagnosis.
Area of Science:
- Pediatric Sleep Medicine
- Child Development Research
- Clinical Assessment Tools
Background:
- Sleep is crucial for children's development and well-being.
- Accurate assessment of pediatric sleep issues is essential.
- The Children's Sleep Habits Questionnaire (CSHQ) is widely used but lacks validation against gold standards.
Purpose of the Study:
- To validate four CSHQ subscales against polysomnography (PSG) and actigraphy.
- To assess the construct and diagnostic validity of the CSHQ in typically developing school-aged children.
- To determine the reliability of the CSHQ as a screening tool for pediatric sleep problems.
Main Methods:
- Compared CSHQ subscales to PSG and actigraphy in 30 children (ages 6-12).
- Utilized correlation analyses to assess relationships between CSHQ scores and objective sleep measures.
- Conducted sensitivity and specificity analyses for diagnostic accuracy.
Main Results:
- No significant correlations were found between CSHQ subscales and PSG measures.
- Only the CSHQ Night Wakings subscale showed a significant correlation with actigraphy data.
- Sensitivity was consistently low, while specificity was high across analyses.
Conclusions:
- The CSHQ subscales for Sleep Onset Delay, Sleep Duration, Night Wakings, and Sleep Disordered Breathing demonstrate limited construct and diagnostic validity.
- Caution is advised when using the CSHQ as the sole screening instrument for pediatric sleep disorders.
- Further research is needed to refine or identify more accurate pediatric sleep assessment tools.
Abstract:
Sleep is a vital physiological behavior in children's development, and as such it is important to be able to efficiently and accurately assess whether children display difficulties with sleep quality and quantity. The Children's Sleep Habits Questionnaire [CSHQ; (1)] is one of the most commonly used assessment tools for pediatric sleep. However, this instrument has never been validated against the gold standard of sleep measurement [i.e., polysomnography (PSG)], and studies comparing it to actigraphy are limited. Therefore, the current study assessed the validity of four subscales of the CSHQ via direct comparison with PSG and actigraphy for 30 typically developing school-aged children (ages 6-12). No significant correlations between relevant CSHQ subscales and PSG variables were found. In terms of the actigraphy variables, only the CSHQ Night Wakings subscale achieved significance. In addition, sensitivity and specificity analyses revealed consistently low sensitivity and high specificity. Overall, the CSHQ Sleep Onset Delay, Sleep Duration, Night Wakings, and Sleep Disordered Breathing subscales showed low construct validity and diagnostic validity. These results underscore that caution should be taken when using the CSHQ as the sole screening tool for sleep problems in children.
