Advancing Pediatric Sleep Assessment through Spectral Sleep Scoring: A Comparison with Polysomnography

Understanding how sleep changes across development requires methods that are both efficient and sensitive to maturational differences in sleep physiology. Spectral sleep scoring is a promising approach, but has primarily been validated in adult populations. This study presents and validates a spectral scoring approach for pediatric sleep. Participants (n = 192; 9-18y) completed overnight in-lab sleep studies. Visual scoring was determined by registered polysomnographic technologists and confirmed by board certified sleep physicians following AASM guidelines. Visual stages included: wake, non-rapid eye movement (NREM) stage 1 (N1), NREM stage 2 (N2), NREM stage 3 (N3), and rapid-eye movement (REM) sleep. Spectral activity within each epoch was assessed for the following spectral stages: Wake (40-95 Hz), Light (~11- 15.5 Hz), Hi Deep (1-3 Hz), Lo Deep (0.1-1 Hz), and REM (~17-26 Hz). Concordance rates were checked across agreement matrices between visual and spectral stages, with expected high agreement between: 1) visual Wake and spectral Wake; 2) visual N2 and spectral Light; 3) visual N3 and spectral HiDeep/LoDeep; and 4) visual REM and spectral REM. Cohen's κ was calculated from concordance matrices. There was high agreement between visual and spectral stages (71-89%, κ=.76). Our results provide evidence that spectral scoring is a promising method for efficiently scoring pediatric sleep. Moreover, this method provides additional, clinically relevant information that is not readily captured through traditional visual scoring. This may be particularly valuable for assessing sleep physiology in pediatric clinical populations, where developmental differences in EEG patterns may complicate visual scoring.