Validating Movement-Based Sleep Assessment in a Pediatric Sample with Developmental Disabilities and Associated Motor Impairment and Intellectual Disability
2022-04
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Validating Movement-Based Sleep Assessment in a Pediatric Sample with Developmental Disabilities and Associated Motor Impairment and Intellectual Disability
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2022-04
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Individuals with developmental disabilities (DD) have increased rates of sleep disorders compared to their typically-developing peers. Poor sleep can have serious negative consequences for the individual and their family’s health and quality of life, underscoring the need for appropriate sleep assessment and intervention. Objective measures of sleep offer advantages over commonly-used proxy-report sleep measures, such as the ability to directly measure sleep as it is happening and not requiring recall. Polysomnography (PSG) is the current gold-standard, but it has a high resource and personnel burden, limiting its availability and utility for the number of children with DD who need sleep assessment. Actigraphy (ACT) is an alternative objective, non-invasive, cost-effective tool that measures movement via a watch-like device to score sleep and wake. ACT has been extensively validated against PSG in typically-developing adults and children, but there is limited validation in DDs. The purpose of this study was to conduct an initial validation of ACT in the largest sample of children with DD and associated motor impairment and intellectual disability to date. Fifty-one participants wore an ACT device while undergoing standard-of-care PSG. Results indicated that the low movement threshold setting of ACT analyses (i.e. less movement required to score wake) had the best specificity without sacrificing excellent sensitivity, compared to the medium and high thresholds. Overall, ACT had high ability to detect true sleep (0.93), but weak ability to detect true wake (0.45). This pattern is consistent with the broad ACT validation literature. However, these data show wide variability in agreement, indicating ACT shows high agreement for some but poor agreement for others. Summary-level comparisons and Bland-Altman plots showed ACT slightly over estimated onset latency and sleep efficiency, over estimated total sleep time, but underestimated wake after sleep onset. There was wide variability in individual differences between PSG and ACT. There may be relationships with motor impairment and age, but future work with a larger sample is needed to elucidate these potential relations. This work is necessary to provide guidance on ACT’s use in DD populations with associated motor impairment and intellectual disability.
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University of Minnesota Ph.D. dissertation. April 2022. Major: Educational Psychology. Advisor: Frank Symons. 1 computer file (PDF); viii, 62 pages.
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Merbler, Alyssa. (2022). Validating Movement-Based Sleep Assessment in a Pediatric Sample with Developmental Disabilities and Associated Motor Impairment and Intellectual Disability. Retrieved from the University Digital Conservancy, https://hdl.handle.net/11299/241437.
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