Parental report of infant sleep behavior by electronic versus paper-and-pencil diaries, and their relationship to actigraphic sleep measurement

Reliable, valid and cost-effective methods for the assessment of infant sleep and sleep problems are of major importance. In this study, the first aim was to assess the agreement of an electronic diary as well as a paper diary with actigraphy for measuring infant sleep patterns in a community sample. The second aim was to assess the feasibility and acceptance of, and compliance with, the electronic diary and the paper diary. Ninety parents reported infant sleep behavior in a paper diary in their home environments for a total of 6 days, 95 in an electronic diary, within two consecutive weeks while actigraphic data were obtained simultaneously. We found moderate to good agreement between electronic diaries and actigraphy (r = 0.41-0.65, P < 0.01), and paper diaries and actigraphy (r = 0.47-0.70, P < 0.01). In addition, this study also found good agreement between both diaries and also between both diaries and actigraphy for sleep percentage over 24 h (electronic diaries and actigraphy: 54.1 ± 0.7%, 52.5 ± 0.7%, P < 0.05; paper diaries and actigraphy: 55.1 ± 0.5%, 52.2 ± 0.6%, P < 0.01) and for daytime (electronic diaries and actigraphy: 27.3 ± 0.9%, 23.5 ± 1.2%, P < 0.01; paper diaries and actigraphy: 27.3 ± 0.8%, 23.2 ± 1.0%, P < 0.01), with the exception that less daytime sleep was recorded on actigraphy than on either diary. In conclusion, the electronic diary and the paper diary are valid and well-accepted methods for the assessment of infant sleep. Parents preferred the electronic diary but, conversely, they were less compliant in completing it.