"Diagnosis by behavioral observation" home-videosomnography - a rigorous ethnographic approach to sleep of children with neurodevelopmental conditions

Osman S Ipsiroglu; Yi-Hsuan Amy Hung; Forson Chan; Michelle L Ross; Dorothee Veer; Sonja Soo; Gloria Ho; Mai Berger; Graham McAllister; Heinrich Garn; Gerhard Kloesch; Adriano Vilela Barbosa; Sylvia Stockler; William McKellin; Eric Vatikiotis-Bateson

doi:10.3389/fpsyt.2015.00039

"Diagnosis by behavioral observation" home-videosomnography - a rigorous ethnographic approach to sleep of children with neurodevelopmental conditions

Front Psychiatry. 2015 Mar 17:6:39. doi: 10.3389/fpsyt.2015.00039. eCollection 2015.

Authors

Affiliations

¹ Sleep/Wake Behavior Clinic and Research Laboratory, Department of Pediatrics, Faculty of Medicine, University of British Columbia , Vancouver, BC , Canada ; Faculty of Science, Thompson Rivers University , Kamloops, BC , Canada ; Treatable Intellectual Disability Endeavour , Vancouver, BC , Canada.
² Sleep/Wake Behavior Clinic and Research Laboratory, Department of Pediatrics, Faculty of Medicine, University of British Columbia , Vancouver, BC , Canada.
³ Austrian Institute of Technology , Vienna , Austria ; Technical University of Vienna , Vienna , Austria.
⁴ Department of Neurology, Medical University of Vienna , Vienna , Austria.
⁵ Department of Electronics, Federal University of Minas Gerais , Belo Horizonte , Brazil.
⁶ Treatable Intellectual Disability Endeavour , Vancouver, BC , Canada ; Division of Biochemical Diseases, Department of Pediatrics, Faculty of Medicine, University of British Columbia , Vancouver, BC , Canada.
⁷ Treatable Intellectual Disability Endeavour , Vancouver, BC , Canada ; Department of Anthropology, Faculty of Arts, University of British Columbia , Vancouver, BC , Canada.
⁸ Department of Linguistics, University of British Columbia , Vancouver, BC , Canada.

Abstract

Introduction: Advanced video technology is available for sleep-laboratories. 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.

Methods: We investigated different combinations of hardware/software for home-videosomnography (HVS) and established a process for qualitative and quantitative analysis of HVS-recordings. 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.

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. The equipment consists of a net-book, a camera with infrared optics, and a video capture device. (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. (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. 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.

Conclusion: 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.

Keywords: Willis Ekbom disease; behavioral observation; ethnography; neurodevelopmental conditions; pediatric; restless legs syndrome; sleep; videosomnography.