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Agreement Between Actigraphy and Diary-Recorded Measures of Sleep in Children With Epilepsy
Shao-Yu Tsai1, Wang-Tso Lee2, Chien-Chang Lee3
1Lambda Beta-at-Large, Associate Professor, School of Nursing, College of Medicine, National Taiwan University, Taipei, Taiwan.
Insights
Actigraphy and parent diaries show fair agreement for sleep onset/offset in children with epilepsy, but poor agreement for total sleep time. Parent estimates are less accurate for weekend sleep and when children sleep alone.
Area of Science:
- Pediatric Neurology
- Sleep Medicine
- Epilepsy Research
Background:
- Sleep disturbances are common in children with epilepsy.
- Accurate sleep assessment is crucial for managing epilepsy and its comorbidities.
- Parental diaries are often used but may lack precision.
Purpose of the Study:
- To characterize sleep patterns in young children with epilepsy.
- To evaluate agreement between actigraphy and parent diaries for sleep metrics.
Main Methods:
- A cross-sectional study involving 89 children with epilepsy (toddlers and preschoolers).
- Participants wore wrist actigraphy for 7 days while parents completed sleep diaries.
- Agreement was assessed using the Bland and Altman method, analyzing weekdays vs. weekends and co-sleeping vs. sleeping alone.
Main Results:
- Acceptable agreement was found for sleep onset, sleep offset, and daytime sleep.
- Insufficient agreement was observed for actual nighttime sleep and wake after sleep onset.
- Discrepancies were greater on weekends and when children slept alone.
Conclusions:
- Parental sleep diaries alone may provide misleading data for children with epilepsy.
- Actigraphy offers a more reliable method for assessing sleep in this population.
- Caregiver reporting accuracy is influenced by sleep context (weekends, co-sleeping).
Purpose:
To describe sleep patterns in young children with epilepsy and to examine levels of agreement between measurements derived from actigraphy and diary recordings.
Design:
Cross-sectional study.
Methods:
Eighty-nine toddlers and preschool-aged children with epilepsy wore an actigraph on their wrists for 7 consecutive days. Parents and caregivers maintained a concurrent sleep diary while the child was wearing the monitor. Levels of agreement between actigraphy and diary recordings were examined using the Bland and Altman method separately for all recording days, weekdays, and weekends.
Findings:
Discrepancies between actigraphy-derived and diary-documented sleep onset, sleep offset, actual sleep at night, wake after sleep onset, and daytime sleep were ±35, ±15, ±82, ±70, and ±29 min, respectively. Differences between actigraphy and diary-derived sleep variables were consistently greater for weekends than for weekdays. Discrepancies between actigraphy and diary-derived actual sleep at night were significantly greater for children who slept alone than for those who co-slept with a parent.
Conclusions:
Our study demonstrates an acceptable agreement between actigraphy and diary recordings for sleep onset, sleep offset, and daytime sleep, but insufficient agreement for actual sleep at night and wake after sleep onset, with parents of children sleeping alone more likely to misestimate child sleep behaviors. Deviation of weekend sleep from weekdays further decreased the accuracy of parental sleep estimates and increased the discrepancies between actigraphy and diary.
Clinical Relevance:
Sleep in children with epilepsy assessed using diary recordings alone could be misleading, and actigraphy should be preferred over diaries when resources are available.
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