Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2023 Jan 1;19(1):35-43.
doi: 10.5664/jcsm.10246.

Device-based and subjective measurements of sleep in children with cerebral palsy: a comparison of sleep diary, actigraphy, and bed sensor data

Ilse Margot van Rijssen  1 , Raquel Yvette Hulst  1 , Jan Willem Gorter  1   2   3 , Anke Gerritsen  1 , Johanna Maria Augusta Visser-Meily  1   2 , Jeroen Dudink  4 , Jeanine M Voorman  1   2 , Sigrid Pillen  5   6 , Olaf Verschuren  1
Affiliations

Device-based and subjective measurements of sleep in children with cerebral palsy: a comparison of sleep diary, actigraphy, and bed sensor data

Ilse Margot van Rijssen et al. J Clin Sleep Med. .

Abstract

Study objectives: To investigate how subjective assessments and device-based measurements of sleep relate to each other in children with cerebral palsy (CP).

Methods: Sleep of children with CP, classified at Gross Motor Function Classification System levels I-III, was measured during 7 consecutive nights using 1 subjective (ie, sleep diary) and 2 device-based (ie, actigraphy and bed sensor) instruments. The agreement between the instruments was assessed for all nights and separately for school- and weekend nights, using intraclass correlation coefficients (ICC) and Bland-Altman plots.

Results: A total of 227 nights from 38 children with CP (53% male; median age [range] 6 [2-12] years), were included in the analyses. Sleep parameters showed poor agreement between the 3 instruments, except for total time in bed, which showed satisfactory agreement between (1) actigraphy and sleep diary (ICC > 0.86), (2) actigraphy and bed sensor (ICC > 0.84), and (3) sleep diary and bed sensor (ICC > 0.83). Furthermore, agreement between sleep diary and bed sensor was also satisfactory for total sleep time (ICC > 0.70) and wakefulness after sleep onset (ICC = 0.55; only during weekend nights).

Conclusions: Researchers and clinicians need to be aware of the discrepancies between instruments for sleep monitoring in children with CP. We recommend combining both subjective and device-based measures to provide information on the perception as well as an unbiased estimate of sleep. Further research needs to be conducted on the use of a bed sensor for sleep monitoring in children with CP.

Citation: van Rijssen IM, Hulst RY, Gorter JW, et al. Device-based and subjective measurements of sleep in children with cerebral palsy: a comparison of sleep diary, actigraphy, and bed sensor data. J Clin Sleep Med. 2023;19(1):35-43.

Keywords: accelerometry; ballistocardiography; measures; sleep; sleep diary.

PubMed Disclaimer

Conflict of interest statement

All authors have contributed to, reviewed, and approved this manuscript. Work for this study was performed at the Center of Excellence for Rehabilitation Medicine, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht University and De Hoogstraat Rehabilitation, Utrecht, The Netherlands. This study was supported by a grant from JKF Kinderfonds, a foundation aimed at improving the quality of life of children and adolescents with physical disabilities in The Netherlands. The authors report no conflicts of interest.

Figures

Figure 1
Figure 1. Representation of a night containing all sleep parameters.
SOL = sleep onset latency, TBT = total time in bed, TST = total sleep time, WASO = wakefulness after sleep onset.
Figure 2
Figure 2. Bland-Altman plots to visually assess the bias and limits of agreement of TBT between sleep diary and actigraphy, sleep diary and bed sensor, and actigraphy and bed sensor for all days, school days, and weekend days.
The y-axis represents the differences between the 2 measurements; the x-axis represents the average TBT of the 2 instruments. The blue horizontal lines represent the bias and the 95% limits of agreement. TBT = total time in bed.
See this image and copyright information in PMC

Similar articles

See all similar articles

Cited by

References

    1. Horwood L , Mok E , Li P , Oskoui M , Shevell M , Constantin E . Prevalence of sleep problems and sleep-related characteristics in preschool- and school-aged children with cerebral palsy . Sleep Med. 2018. ; 50 : 1 – 6 . - PubMed
    1. Dutt R , Roduta-Roberts M , Brown CA . Sleep and children with cerebral palsy: a review of current evidence and environmental non-pharmacological interventions . Children (Basel). 2015. ; 2 ( 1 ): 78 – 88 . - PMC - PubMed
    1. Newman CJ , O’Regan M , Hensey O . Sleep disorders in children with cerebral palsy . Dev Med Child Neurol. 2006. ; 48 ( 7 ): 564 – 568 . - PubMed
    1. Lélis ALPA , Cardoso MVLM , Hall WA . Sleep disorders in children with cerebral palsy: an integrative review . Sleep Med Rev. 2016. ; 30 : 63 – 71 . - PubMed
    1. Horwood L , Li P , Mok E , Oskoui M , Shevell M , Constantin E . Health-related quality of life in Canadian children with cerebral palsy: what role does sleep play? Sleep Med. 2019. ; 54 : 213 – 222 . - PubMed

Publication types