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Association between subjective and objective measures of pediatric sleep: A systematic review and meta-analysis of
Cecilie Paulsrud1, Steffen U Thorsen2, Tue H Andersen3
1Steno Diabetes Center Copenhagen, Copenhagen University Hospital, Borgmester Ib Juuls Vej 83, 2730, Herlev, Denmark; Department of Pediatrics, Herlev and Gentofte University Hospital, Borgmester Ib Juuls Vej 1, 2730, Herlev, Denmark; Danish Sleep Center for Children and Adolescents, Herlev & Gentofte and Rigshospitalet & Glostrup University Hospitals, Borgmester Ib Juuls Vej 1, 2730, Herlev, Denmark.
Insights
Subjective and objective sleep measures in children and adolescents capture different aspects of sleep, with duration showing the strongest link. These measures cannot replace each other and should be chosen carefully based on research goals.
Area of Science:
- Pediatric Sleep Science
- Child and Adolescent Health
- Sleep Medicine Research
Background:
- Accurate sleep assessment in children and adolescents is crucial for understanding health and development.
- Subjective (self-report) and objective (e.g., actigraphy) sleep measures are commonly used.
- Understanding the correlation between these measures is vital for appropriate interpretation and methodology.
Purpose of the Study:
- To systematically evaluate the correlation between subjective and objective sleep measures in children and adolescents.
- To examine these correlations across four key sleep dimensions: duration, continuity, regularity, and quality.
- To synthesize findings from existing literature through meta-analysis.
Main Methods:
- Conducted a systematic review of studies published up to August 2024.
- Searched major databases including MEDLINE, Embase, CINAHL, and PsycInfo.
- Included 74 studies reporting both subjective and objective sleep measures in participants aged 2-17 years.
- Performed random-effects meta-analyses for dimensions with sufficient studies and assessed heterogeneity.
Main Results:
- Correlations between subjective and objective sleep measures varied significantly across sleep dimensions.
- Strongest correlations were found for sleep duration.
- Weak correlations were observed for sleep onset latency and wake after sleep onset.
- Inconsistent correlations for sleep quality and weak-to-moderate associations for regularity were noted.
- Substantial heterogeneity indicated variability in methods and populations.
Conclusions:
- Subjective and objective sleep measures capture related but distinct sleep aspects in pediatric populations.
- These measures generally cannot substitute for one another.
- Findings highlight the need for cautious interpretation due to interrelation of sleep dimensions.
- Future research should focus on clearer definitions, temporal alignment, and age-appropriate tools.
Objectives:
To evaluate the correlation between subjective and objective sleep measures in children and adolescents without neurodevelopmental disorders across four interrelated dimensions: duration, continuity, regularity, and quality.
Methods:
We conducted a systematic review with a comprehensive database search in MEDLINE, Embase, CINAHL, and PsycInfo (last updated August 2024). Further, we retrieved references of included studies. Studies were included if they reported at least one subjective and one objective sleep measure in participants aged 2-17 years. Seventy-four studies met inclusion criteria. Correlation estimates were synthesized using random-effects meta-analyses when ≥3 studies were available, and heterogeneity was assessed with I2 statistics.
Results:
Correlations between subjective and objective measures varied substantially both within and across sleep dimensions. The strongest correlations were observed for sleep duration. Sleep onset latency and wake after sleep onset showed weak correlations, and for sleep quality correlation estimates were inconsistent, reflecting heterogeneous definitions and assessment tools. Regarding subjective regularity, weak-to-moderate associations were found with objective midpoint of sleep. Substantial to considerable heterogeneity across analyses indicated methodological and population-level variability.
Conclusions:
Subjective and objective sleep measures reflect related but distinct aspects of children's sleep and cannot usually replace one another. Because sleep dimensions are interrelated and not mutually exclusive, findings should be interpreted cautiously. Researchers should choose methods that align with their study goals. Future work should aim for clearer conceptual definitions, improved temporal alignment, and age-appropriate tools.
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