Sleep Measurement in Toddlers From Low-income Families

ABSTRACT: Objectives: (1) To examine toddler sleep in a low-income sample by comparing sleep diaries and actigraphy and (2) to assess whether toddlers are meeting the National Sleep Foundation recommendations (11–14 hours of sleep/24 hours and bedtime before 9 PM). Methods: A convenience sample of mother-toddler dyads was recruited from 2 health care sites serving low-income communities. An actigraph was placed on the toddler's ankle and was worn for 3 days and nights. Mothers concurrently completed a sleep diary. Bedtime, nighttime sleep duration, nap duration, and 24-hour sleep duration were collected by both measures. Actigraphy data were analyzed using a combination of manufacturer's scoring algorithm and manual editing. Descriptive statistics and paired samples t-tests were conducted to examine the differences between sleep estimates by a sleep diary and actigraphy. Results: Twenty toddlers (aged 13–42 months) were included in the analyses. Based on actigraphy, 1 toddler went to bed by 9 PM on all 3 nights. Six toddlers achieved 11 to 14 hours of sleep measured in a 24-hour period for 1 of the 3 days, but when sleep was averaged across the study, none achieved this goal. Compared with actigraphy, sleep diaries underestimated bedtime by 1 hour, overestimated nighttime sleep duration by 2.5 hours, and overestimated 24-hour sleep duration by 2.3 hours, on average for all 3 nights. Conclusion: Mothers reported significantly earlier bedtimes and longer sleep durations for their toddlers compared with actigraphy, suggesting that objective measures differ from sleep diaries in assessing sleep in toddlers from low-income families. Findings should not be generalized to populations of low-income families without replication. Address for reprints: Lauren B. Covington, PhD, MS, RN, University of Delaware, School of Nursing, 100 Discovery Boulevard, 5th floor, Newark, DE 19713; e-mail: lcovingt@udel.edu. Supported in part by funding through the Children's HealthWatch donors, which are listed in http://bit.ly/1eRrd00. L.B. Covington was supported through a grant from Sigma, Global Nursing Excellence, Pi Chapter. Disclosure: The authors declare no conflicts of interest. Received September 23, 2018 Accepted December 26, 2018 Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.

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