How to Measure Sleep in Children and Adolescents? Lessons from Questionnaires, Wearables, and Home-Based Polysomnography - Cecilie Paulsrud

Background

Sleep is essential for children’s and adolescents’ cognitive, emotional, and physical development, making accurate sleep assessment important in both clinical practice and research. Measuring sleep in pediatric populations is challenging due to developmental differences, night-to-night variability, tolerance of equipment, and discrepancies between subjective and objective sleep measures.

Objective

The aim of this presentation is to describe how sleep can be measured in children and adolescents, based on clinical and research experience with subjective questionnaires and objective assessment methods, and to discuss the strengths and limitations of each approach.

Methods

The presentation draws on studies and clinical experience using the Sleep Screening Questionnaire for Children and Adolescents (SSQ-CA), actigraphy (AG), polysomnography (PSG), home sleep testing, and videosomnography (VSG). These methods have been applied in healthy children and adolescents as well as in pediatric populations with chronic conditions, including type 1 diabetes. Key considerations include feasibility, tolerability, validity, and the ability to assess sleep continuity, circadian timing, and sleep architecture.

Results

Subjective measures such as SSQ-CA provide insight into perceived sleep quality, habits, and daytime consequences, but show in many sleep parameters limited correspondence with objective measured sleep. AG enables multi-night assessment of sleep timing and continuity under habitual conditions but does not capture sleep stages. PSG remains the gold standard for assessing sleep architecture, although laboratory-based recordings may affect natural sleep and limit feasibility. Home-based PSG and sleep testing allow multi-night recordings with acceptable data quality and improved ecological validity. VSG offers a non-invasive method to assess sleep–wake patterns and nocturnal behaviors but provides limited information on sleep stages.

Conclusion

No single method captures all aspects of pediatric sleep. Optimal assessment requires a tailored combination of subjective and objective measures, guided by the research or clinical question and the child’s age and tolerance.