Concordance between subjective and objective measures of infant sleep varies by age and maternal mood: Implications for studies of sleep and cognitive development

Abstract

Infant habitual sleep has been proposed as an important moderator of development in domains such as attention, memory or temperament. To test such hypotheses, we need to know how to accurately and consistently assess habitual sleep in infancy. Common assessment methods include easy to deploy but subjective parent-report measures (diary/sleep questionnaire); or more labour-intensive but objective motor movement measures (actigraphy). Understanding the degree to which these methods provide converging insights is important, but cross-method agreement has yet to be investigated longitudinally. Moreover, it is unclear whether concordance systematically varies with infant or maternal characteristics that could represent confounders in observational studies. This longitudinal study (up to 4 study visits/participant) investigated cross-method concordance on one objective (7-day actigraphy) and three commonly used subjective (7-day sleep diary, Brief Infant Sleep Questionnaire, Sleep & Settle Questionnaire) sleep measures in 76 typically developing infants (age: 4–14 months) and assessed the impact of maternal characteristics (stress, age, education) and infant characteristics (age) on cross-method concordance. In addition, associations between objective and subjective sleep measures and a measure of general developmental status (Ages & Stages Questionnaire) were investigated. A range of equivalence analyses (tests of equivalence, correlational analyses, Bland-Altman plots) showed mixed agreement between sleep measures. Most importantly, cross-method agreement was associated with maternal stress levels and infant age. Specifically, agreement between different measures of night waking was better for mothers experiencing higher stress levels and was higher for younger than older infants; the reverse pattern was true for day sleep duration. Interestingly, objective and subjective measures did not yield the same patterns of association with developmental domains, indicating that sleep method choice can influence which associations are found between sleep and cognitive development. However, results converged across day sleep and problem-solving skills, highlighting the importance of studying day sleep in future studies. We discuss implications of sleep method choice for investigating sleep in the context of studying infant development and behaviour.

Links between Daytime Napping, Night-Time Sleep Quality and Infant Attention: An Eye-Tracking, Actigraphy and Parent-Report Study

“…It is also important to emphasise the exploratory aspect of the current research which is to identifying specific aspects of sleep that should be more thoroughly examined in future research. In particular, the findings of this study further highlight the emphasis that Gosse and colleagues [ 2 ] place on future research in relation to daytime sleep in the context of early cognitive development. These findings are important for the future development of interventions to promote attention development in early childhood.…”

“…However, due to the methodological challenges in obtaining objective data, such as using polysomnography (PSG), researchers typically rely solely on parent-reports of infants’ sleep. Although estimates of children’s sleep habits, such as bedtime and sleep duration, is easily obtained via such parental report, they do not provide an accurate measure of sleep quality with more recent research suggesting that factors such as age of infant and temperament of both infant and parent, can play a role in their accuracy [ 1 , 2 , 3 , 4 , 5 ]. The increased use of actigraphy in recent research has allowed for a more detailed study of sleep, specifically in the factors indicating its quality and not just quantity, and the current study aims to further contribute to the literature of this nascent field [ 6 , 7 ].…”

Night Sleep and Parental Bedtime Practices in Low-Risk Preterm and Full-Term Late Talkers

“…First, the use of subjective measures such as parental questionnaires could lead to bias in the results due to several factors [ 89 , 90 ]. Among these, we can consider children’s biological characteristics: parents of children with medical problems or developmental impairments may underestimate their child’s sleep problems, because they are focused on other problematic conditions or because they do not expect their child to “sleep through the night” as much [ 16 , 91 ].…”

“…Among these, we can consider children’s biological characteristics: parents of children with medical problems or developmental impairments may underestimate their child’s sleep problems, because they are focused on other problematic conditions or because they do not expect their child to “sleep through the night” as much [ 16 , 91 ]. Perceived sleep difficulties may also not be predicted mainly by parental socio-demographic characteristics, i.e., socio-economic status, educational level, age, and culture [ 9 , 92 ], but rather by parental beliefs regarding setting limits, that is the attempt to resist to the child’s demands, child health worries, parental stress, and doubt regarding being a good parent [ 83 , 90 ]. Interestingly, Gossé and colleagues [ 90 ] found that there was a better agreement between objective and subjective measures on night waking parameters in children whose mothers reported higher stress and anxiety levels.…”

Habitual night waking associates with dynamics of waking cortical theta power in infancy

“…Parents completed an in-house sleep diary every day for a week at each time point. For details, see Gossé et al (2022). The sleep diary enquired about an infant's bedtime routines (e.g., lullabies, story reading, or feeding at bedtime), bedtime and wake up times, night wakings, naps, and nap routines.…”