A medical ethnographic approach ( 5– 7) using the observational skills of parents and therapists has previously enabled us to better understand reasons for unspecified insomnia ( 8, 9) and connect novel observations such as sensory processing abnormalities ( 10) and restless legs syndrome (RLS) ( 11), which are particularly missed in standard clinical assessments and treated for their daytime sequelae.
Sleep lab assessments do not reveal the full spectrum of possible causes for a SP. A structured and rigorous approach is needed to reduce the significant health economic burden for this population ( 4).Ī major reason for this shortcoming is the multifaceted clinical appearance of SPs in this population SPs may go unrecognized, especially if the parent/caregiver-reported presentation does not match the well-known diagnostic criteria such as sleep apnea ( 2, 3). Although SPs have been reported in up to 80% of children with NDCs ( 2), their role in chronic disease morbidity is rarely recognized, complicating appropriate diagnosis, and treatment ( 1– 3). In children and adolescents with neurodevelopmental conditions (NDCs) and chronic care needs, sleep problems (SPs) constitute one of the most common parental complaints to health care providers ( 1). The case vignette demonstrates how the HVS-recordings revealed the dimension of insomnia caused by restless legs syndrome, and illustrated the cascade of symptoms, challenging behaviors, and resulting medications.Ĭonclusion: The strategy of using HVS, although requiring validation and reliability testing, opens the floor for a new “observational sleep medicine,” which has been useful in describing discomfort-related behavioral movement patterns in patients with communication difficulties presenting with challenging/disruptive sleep/wake behaviors.
(2) We also present a custom software program that facilitates video analysis and note-taking (Annotator ©), and Optical Flow software that automatically quantifies movement for internal quality control of the HVS-recording. (1) We present an HVS-analysis protocol consisting of three steps of analysis at varying replay speeds: (a) basic overview and classification at 16× normal speed (b) second viewing and detailed descriptions at 4–8× normal speed, and (c) viewing, listening, and in-depth descriptions at real-time speed. The equipment consists of a net-book, a camera with infrared optics, and a video capture device.
Results: We suggest an “ideal set of hardware/software” that is reliable, affordable (∼$500) and portable (=2.8 kg) to conduct non-invasive HVS, which allows time-lapse analyses. A case vignette (HVS analysis for a 5.5-year-old girl with major insomnia and several co-morbidities) demonstrates how methodological considerations were addressed and how HVS added value to clinical assessment. Methods: We investigated different combinations of hardware/software for home-videosomnography (HVS) and established a process for qualitative and quantitative analysis of HVS-recordings.
However, low-cost equipment for screening in the home setting has not been identified and tested, nor has a methodology for analysis of video recordings been suggested. Introduction: Advanced video technology is available for sleep-laboratories.