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Exploring the Congruence of actigraphy and the Pediatric Autism Insomnia rating Scale
Megan L Wenzell1, Cynthia R Johnson2, Luc Lecavalier3
1Case Western Reserve University Frances Payne Bolton School of Nursing, 9501 Euclid Ave, Cleveland, OH, 44106, USA.
Insights
Actigraphy and the Pediatric Autism Insomnia Rating Scale (PAIRS) do not agree in assessing sleep problems in children with autism spectrum disorder (ASD). This suggests different aspects of sleep are measured by each method.
Area of Science:
- Pediatric Sleep Medicine
- Autism Spectrum Disorder Research
- Biomedical Engineering (Sleep Monitoring)
Background:
- Insomnia is a prevalent issue in children with autism spectrum disorder (ASD).
- The Pediatric Autism Insomnia Rating Scale (PAIRS) was recently developed and validated to assess sleep problems in this population.
- Understanding the agreement between subjective/parent-reported measures and objective measures is crucial for accurate diagnosis and treatment.
Purpose of the Study:
- To explore the associations and agreements between actigraphy (an objective sleep measure) and the PAIRS (a parent-rated scale) in children with ASD.
- To determine if PAIRS effectively identifies children with poor sleep as defined by actigraphy parameters.
Main Methods:
- 134 children with ASD, with and without sleep problems, were assessed using parent-rated and clinician measures.
- A subset of 70 children underwent wrist-worn actigraphy for five consecutive nights.
- Spearman correlations and Cohen's Kappa were used to evaluate associations and agreements between PAIRS scores and actigraphy indices (TST, SE%).
Main Results:
- No significant correlations were found between PAIRS scores and actigraphy indices (SOL, WASO, TST, SE%).
- A substantial proportion of children were classified as "poor sleepers" by actigraphy for Total Sleep Time (48.6%) and Sleep Efficiency (52.9%), compared to PAIRS (32.9%).
- Agreements between PAIRS and actigraphy for identifying poor sleepers were low (Kappa = 0.11 for TST, 0.27 for SE%).
Conclusions:
- Actigraphy and the PAIRS demonstrate poor agreement in assessing sleep in children with ASD.
- Actigraphy primarily measures movement and estimates specific sleep parameters like TST and SE%.
- PAIRS provides a broader assessment, incorporating subjective sleep disturbance and sleep-related functional impairment.
Objective/Background:
Insomnia is common in children with autism spectrum disorder (ASD). We recently developed and validated the 21-item Pediatric Autism Insomnia Rating Scale (PAIRS). This report explores the associations and agreements between actigraphy and PAIRS.
Participants Methods:
Children with ASD, with and without sleep problems, were assessed with a battery of parent-rated and clinician measures (N = 134). In a subset (n = 70), a wrist-worn actigraph measured sleep for five consecutive nights. Parents completed logs for scoring sleep intervals. Spearman correlations evaluated associations with the PAIRS and actigraphy indices (sleep onset latency = SOL, wake after sleep onset = WASO, total sleep time = TST, sleep efficiency = SE%). Agreements on "poor sleepers" based on PAIRS total score (≥33) and conventional thresholds for TST and SE% were evaluated with Cohen's Kappa and McNemar's test.
Results:
Actigraphy data were averaged over 4.64 ± 0.68 nights in 70 children (mean age = 7.3 ± 2.9, 74.3 % male). There were no significant correlations between PAIRS and any actigraphy indices. On TST, 48.6 % (n = 34) and on SE% 52.9 % (n = 37) were classified as "poor sleepers" compared to 32.9 % (n = 23) on PAIRS (kappa = 0.11 for TST and 0.27 for SE%). P-values on McNemar's Chi square test for PAIRS with TST and with SE% were 0.072 and 0.011, respectfully.
Conclusions:
These results suggest that actigraphy and PAIRS do not agree. Actigraphy TST captures movement and an estimate of specific sleep parameters. PAIRS is a broader measure that incorporates sleep disturbance and sleep-related impairment.
