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Infant nocturnal wakefulness: a longitudinal study comparing three sleep assessment methods.

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Actigraphy, sleep diaries, and questionnaires show declining infant night wakings but poor agreement. Objective and subjective infant sleep assessments are crucial, especially after six months.

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Area of Science:

  • Developmental Pediatrics
  • Sleep Medicine
  • Biotechnology

Background:

  • Accurate assessment of infant sleep is vital for understanding developmental trajectories.
  • Nocturnal wakefulness, including minutes awake after sleep onset (WASO) and number of night-wakings (NW), are key sleep parameters.
  • Convergence of objective (actigraphy) and subjective (parental reports) measures is often assumed but requires empirical validation.

Purpose of the Study:

  • To evaluate the agreement between actigraphy, sleep diaries, and the Brief Infant Sleep Questionnaire (BISQ) for assessing infant nocturnal wakefulness.
  • To examine the longitudinal convergence of these sleep assessment methods from 3 to 18 months postpartum.
  • To determine the clinical utility of combining objective and subjective infant sleep monitoring tools.

Main Methods:

  • A longitudinal study involving 226 families, with data collected at 3, 6, 12, and 18 months postpartum.
  • Infant sleep was simultaneously monitored using wrist actigraphy, daily sleep diaries, and the BISQ for five consecutive nights at each time point.
  • Outcome measures included WASO, NW, sleep latency, sleep duration, and sleep onset, analyzed using trajectory analyses, correlation, Krippendorff's α, and Bland-Altman methods.

Main Results:

  • All three methods indicated a decline in NW and WASO from 3 to 18 months postpartum.
  • Statistically significant correlations were observed between actigraphy, diaries, and BISQ for all sleep variables across all assessment points.
  • However, agreement rates between actigraphy and parental reports (diaries and BISQ) for NW and WASO were poor, with disagreement increasing over time.

Conclusions:

  • While objective and subjective measures of infant nocturnal wakefulness are correlated, their absolute agreement is generally poor.
  • The increasing discrepancy between actigraphy and parental reports on NW suggests diminishing parental awareness of infant awakenings as infants develop self-soothing skills.
  • Integrating both objective (actigraphy) and subjective (parental reports) sleep assessment methods is recommended, particularly for infants older than 6 months.