Cerebral Palsy and Sleep in Children: Actigraphy Shows Validity in Sleep Assessment

In a cross-sectional cohort study, researchers assessed the validity of actigraphy as a sleep assessment tool in children with cerebral palsy and observed their sleep patterns.

Actigraphy was found to be a valid tool for assessing sleep among children with cerebral palsy (CP) and that in general, pediatric CP was associated with poorer sleep efficiency and shorter sleep duration than in children without CP. These findings were published in Sleep Medicine.

CP onsets in early childhood and is categorized by chronic, non-progressive, motor deficits. Sleep issues are reported by up to 40% of children with CP. Despite the high prevalence of sleep problems, there remains no validated study of actigraphy in children with CP and as such, the extent of sleep-related problems remains poorly understood in this patient population.

The objective of the current study was to validate actigraphy as a sleep assessment tool for children with CP and observe their sleep patterns.

The researchers conducted a cross-sectional study and recruited both children with (n=13) and without (n=13) CP. Between 2014 and 2015, participants aged 2-17 years were assessed overnight at the Washington University School of Medicine using wrist and forehead actigraphs. Participants were instructed to wear the wrist actigraphs overnight for one week. These data were used to create a new sleep algorithm for the CP population and to assess sleep patterns among children with CP.

Study participants were aged mean 9 years 11 months (range, 4-17 years), 17 were boys, and 9 were girls. Among the CP cohort, 54% were categorized as having spastic quadriplegic, 23% spastic diplegic, 15% spastic hemiplegic, and 8% unclassified CP subtypes.

On the basis of collected data, the researchers observed that window sizes should be 9 minutes for control individuals and 15 minutes for the CP cohort.

The performance of the newly developed model had a median accuracy of 72%-80%, sensitivity of 87%-91%, and specificity of 60%-71% among the CP group. These values were comparable to those of the control cohort (accuracy, 86%-89%; sensitivity, 88%-92%; specificity, 70%-75%) and had a higher specificity and accuracy than established sleep algorithms.

Compared with control individuals, children with CP had reduced sleep efficiency (64% vs 83%; P =.01), shorter total sleep time (mean, 325 vs 406 min; P =.02), and longer time to wake after sleep onset (mean, 181 vs 113 min; P =.04).

Study limitations included its small sample size and the lack of validating the sleep algorithm among an independent sample.

The researchers concluded, “in general, validation of sleep actigraphy in special populations of children is an important endeavor and requires further attention. Our algorithms can help advance understanding of sleep disturbances in children with CP and monitor response to treatment interventions.”


Xue B, Licis A, Boyd J, Hoyt CR, Ju Y-ES. Validation of actigraphy for sleep measurement in children with cerebral palsy. Sleep Med. Published online January 7, 2022. doi:10.1016/j.sleep.2021.12.016