Sleep Assessments for Children With Severe Cerebral Palsy: A Scoping Review.
Jennifer A Hutson, LeAnn Snow
PMID 33543110WHAT IT FOUND
No single sleep assessment captures all relevant domains for children with severe cerebral palsy undergoing postural care.
Clinicians should pair the Sleep Disturbance Scale for Children with actigraphy to track changes over months, as no individual instrument met all suitability criteria.
Key findings
01None of the six reviewed sleep instruments individually met the criteria for use as a stand-alone outcome measure in children with GMFCS IV and V cerebral palsy.
02Pairing the Sleep Disturbance Scale for Children (SDSC) with actigraphy was recommended as the best approach to capture relevant sleep domains over time.
03Actigraphy requires further testing for sensitivity and specificity in this population, particularly regarding its ability to differentiate sleep from wakefulness in children who rarely move.
STILL TO COME
How it was doneWhat they foundWhat it means for PTsWhat it means for OTsWhat it means for SLPs
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What it does not show
Only one investigator analyzed the instruments using Coster’s criteria, which may introduce bias. The review included only five original research studies, limiting the breadth of evidence on which instruments are actually used. Detailed psychometric properties were not analyzed because they were not the primary focus. The SDSC used in the review was the original version; the newer SDSC-R, validated for CP, was noted but not analyzed. Actigraphy's validity in children with severe CP who have limited movement is uncertain and requires further research.
Declared interests
The review received no funding and the authors declared no conflicts of interest.
The easy way to misread this
Do not assume that actigraphy alone is sufficient for measuring sleep in children with severe cerebral palsy. The review found that actigraphy may not accurately differentiate sleep from wakefulness in children who rarely move, and it was only rated 'mostly adequate' (yellow light) for capturing relevant domains. It should be paired with the SDSC and potentially a sleep diary.