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Kubek LA, Claus B, Zernikow B, Wager J. Comparison of actigraphy with a sleep protocol maintained by professional caregivers and questionnaire-based parental judgment in children and adolescents with life-limiting conditions. BMC Palliat Care 2024; 23:52. [PMID: 38395866 PMCID: PMC10885472 DOI: 10.1186/s12904-024-01394-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Accepted: 02/19/2024] [Indexed: 02/25/2024] Open
Abstract
BACKGROUND Actigraphy offers a promising way to objectively assess pediatric sleep. Aim of the study was investigating the extent to which actigraphy used in children and adolescents with life-limiting conditions is consistent with two other measures of sleep diagnostics. METHODS In this monocentric prospective study N = 26 children and adolescents with life-limiting conditions treated on a pediatric palliative care unit were assessed. For three consecutive nights they wore an actigraph; the 24-hours sleep protocol documented by nurses and the Sleep Screening for Children and Adolescents with Complex Chronic Conditions (SCAC) answered by parents were analyzed. Patient characteristics and the parameters sleep onset, sleep offset, wake after sleep onset (WASO), number of wake phases, total sleep time (TST) and sleep efficiency (SE) were descriptively examined. Percentage bend correlations evaluated the three measures' concordance. RESULTS Descriptively, and except for the number of waking episodes, the different measures' estimations were comparable. Significant correlations existed between actigraphy and the sleep protocol for sleep onset (r = 0.83, p = < 0.001) and sleep offset (r = 0.89, p = < 0.001), between actigraphy and SCAC for SE (r = 0.59, p = 0.02). CONCLUSION Agreement of actigraphy with the focused sleep measures seems to be basically given but to varying degrees depending on the considered parameters.
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Affiliation(s)
- Larissa Alice Kubek
- PedScience Research Institute, Datteln, Germany.
- Department of Children's Pain Therapy and Paediatric Palliative Care, Witten/Herdecke University,Faculty of Health, School of Medicine, Witten, Germany.
| | - Benedikt Claus
- PedScience Research Institute, Datteln, Germany
- Department of Children's Pain Therapy and Paediatric Palliative Care, Witten/Herdecke University,Faculty of Health, School of Medicine, Witten, Germany
| | - Boris Zernikow
- PedScience Research Institute, Datteln, Germany
- Department of Children's Pain Therapy and Paediatric Palliative Care, Witten/Herdecke University,Faculty of Health, School of Medicine, Witten, Germany
- Paediatric Palliative Care Centre, Children's and Adolescents' Hospital, Datteln, Germany
| | - Julia Wager
- PedScience Research Institute, Datteln, Germany
- Department of Children's Pain Therapy and Paediatric Palliative Care, Witten/Herdecke University,Faculty of Health, School of Medicine, Witten, Germany
- Paediatric Palliative Care Centre, Children's and Adolescents' Hospital, Datteln, Germany
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Kubek LA, Angenendt N, Hasan C, Zernikow B, Wager J. Relevance of Potential Contributing Factors for the Development and Maintenance of Irritability of Unknown Origin in Pediatric Palliative Care. Children (Basel) 2023; 10:1726. [PMID: 38002817 PMCID: PMC10670487 DOI: 10.3390/children10111726] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Revised: 10/19/2023] [Accepted: 10/23/2023] [Indexed: 11/26/2023]
Abstract
Potential contributing factors (PCFs) for irritability of an unknown origin (IUO) in children with neurological conditions are identifiable through structured diagnostics. Uncertainty exists regarding the actual relevance of identified PCFs to IUO. Assessments from parents as well as nursing, psycho-social, and medical professionals were used to determine the contribution of different PCFs in the development and maintenance of IUO. For this, individual PCFs of N = 22 inpatient children with IUO were presented to four raters. Descriptive statistics, Kruskal-Wallis tests, and Krippendorff's alpha were used to determine which PCFs were most relevant to explain IUO and rater agreement. Psycho-social aspects (44.7%), hyperarousal (47.2%), pain (24.6%), and dystonia (18.1%) were identified as the most relevant PCFs for IUO. Descriptively, physicians' relevance rating regarding psycho-social aspects, hyperarousal, and dystonia deviated the most from the overall group rating. All professional raters considered psycho-social aspects to be more relevant than did parents. Parents rated pain as more relevant than the other raters. Kruskal-Wallis tests showed no significant differences between relevance ratings (H = 7.42, p = 0.059) or the four parties' deviations (H = 3.32, p = 0.344). A direct comparison of the six two-party constellations showed that across all factors, agreement was weak to moderate. The highest agreement was between physicians and nurses (α = 0.70), and the lowest was between nurses and psycho-social experts (α = 0.61). Understanding which psycho-social and various biological PCFs are significant for IUO can facilitate more targeted and individualized pediatric palliative care for affected patients.
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Affiliation(s)
- Larissa Alice Kubek
- PedScience Research Institute, 45711 Datteln, Germany; (B.Z.); (J.W.)
- Department of Children’s Pain Therapy and Paediatric Palliative Care, Faculty of Health, School of Medicine, Witten/Herdecke University, 58448 Witten, Germany; (N.A.); (C.H.)
| | - Nina Angenendt
- Department of Children’s Pain Therapy and Paediatric Palliative Care, Faculty of Health, School of Medicine, Witten/Herdecke University, 58448 Witten, Germany; (N.A.); (C.H.)
- Paediatric Palliative Care Centre, Children’s and Adolescents’ Hospital, 45711 Datteln, Germany
| | - Carola Hasan
- Department of Children’s Pain Therapy and Paediatric Palliative Care, Faculty of Health, School of Medicine, Witten/Herdecke University, 58448 Witten, Germany; (N.A.); (C.H.)
- Paediatric Palliative Care Centre, Children’s and Adolescents’ Hospital, 45711 Datteln, Germany
| | - Boris Zernikow
- PedScience Research Institute, 45711 Datteln, Germany; (B.Z.); (J.W.)
- Department of Children’s Pain Therapy and Paediatric Palliative Care, Faculty of Health, School of Medicine, Witten/Herdecke University, 58448 Witten, Germany; (N.A.); (C.H.)
- Paediatric Palliative Care Centre, Children’s and Adolescents’ Hospital, 45711 Datteln, Germany
| | - Julia Wager
- PedScience Research Institute, 45711 Datteln, Germany; (B.Z.); (J.W.)
- Department of Children’s Pain Therapy and Paediatric Palliative Care, Faculty of Health, School of Medicine, Witten/Herdecke University, 58448 Witten, Germany; (N.A.); (C.H.)
- Paediatric Palliative Care Centre, Children’s and Adolescents’ Hospital, 45711 Datteln, Germany
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Kubek LA, Claus B, Rostasy K, Bertolini A, Schimmel M, Frühwald MC, Classen G, Zernikow B, Wager J. Development and preliminary validation of the Sleep Screening for Children and Adolescents with Complex Chronic Conditions (SCAC). J Sleep Res 2023:e13881. [PMID: 36929532 DOI: 10.1111/jsr.13881] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2022] [Revised: 03/01/2023] [Accepted: 03/02/2023] [Indexed: 03/18/2023]
Abstract
Children and adolescents with complex chronic conditions, including those with life-threatening or life-limiting conditions, are a heterogeneous population. Many individuals exhibit sleep abnormalities that are measurable by proxy questionnaires. No suitable instrument to assess the wide range of different complex chronic conditions is currently available. The aim of the present study was to develop a screening tool-the Sleep Screening for Children and Adolescents with Complex Chronic Conditions-to effectively obtain sleep behaviour information in this population. Following a mixed-method design, potential items for the Sleep Screening for Children and Adolescents with Complex Chronic Conditions questionnaire were defined through literature research and expert meetings. In a pre-test with N = 60 family and professional caregivers, the items' relevance and comprehensibility as well as the instrument's overall design were assessed. For the main test, N = 315 participants were recruited in three tertiary paediatric hospitals. A principal components analysis detected the questionnaire's scales. Item analysis focused on mean values, range, difficulty and discriminatory power. Convergent validation of the Sleep Screening for Children and Adolescents with Complex Chronic Conditions was assessed via correlations between scale items. Most patients had neurological or neuromuscular diseases. Four scales ("Falling and staying asleep", "Sleep-associated respiration and arousal", "Daytime sleepiness" and "Sleep-associated movements") emerged. The item analysis showed satisfactory discriminative power. In the preliminary validation, all scales correlated positively with a child's care level and with various sleep circumstances items. Three scales additionally correlated with the number of complex chronic condition diagnoses. This newly developed questionnaire can provide clinicians with first indications of possible sleep problems in a growing paediatric population.
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Affiliation(s)
- Larissa Alice Kubek
- PedScience Research Institute, Datteln, Germany.,Department of Children's Pain Therapy and Paediatric Palliative Care, Faculty of Health, School of Medicine, Witten/Herdecke University, Witten, Germany
| | - Benedikt Claus
- PedScience Research Institute, Datteln, Germany.,Paediatric Palliative Care Centre, Children's and Adolescents' Hospital, Datteln, Germany
| | - Kevin Rostasy
- Department of Pediatric Neurology, Children's and Adolescents' Hospital Datteln, Witten/Herdecke University, Witten, Germany
| | - Annikki Bertolini
- Department of Pediatric Neurology, Children's and Adolescents' Hospital Datteln, Witten/Herdecke University, Witten, Germany
| | - Mareike Schimmel
- Pediatric Neurology, University Medical Center Augsburg, Augsburg, Germany
| | - Michael C Frühwald
- Pediatrics and Adolescent Medicine, University Medical Center Augsburg, Augsburg, Germany
| | - Georg Classen
- Department of Pediatric Neurology, Bethel Evangelical Hospital, Bielefeld, Germany
| | - Boris Zernikow
- PedScience Research Institute, Datteln, Germany.,Department of Children's Pain Therapy and Paediatric Palliative Care, Faculty of Health, School of Medicine, Witten/Herdecke University, Witten, Germany.,Paediatric Palliative Care Centre, Children's and Adolescents' Hospital, Datteln, Germany
| | - Julia Wager
- PedScience Research Institute, Datteln, Germany.,Department of Children's Pain Therapy and Paediatric Palliative Care, Faculty of Health, School of Medicine, Witten/Herdecke University, Witten, Germany.,Paediatric Palliative Care Centre, Children's and Adolescents' Hospital, Datteln, Germany
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Kubek LA, Kutz P, Roll C, Zernikow B, Wager J. Applicability of Actigraphy for Assessing Sleep Behaviour in Children with Palliative Care Needs Benchmarked against the Gold Standard Polysomnography. J Clin Med 2022; 11:jcm11237107. [PMID: 36498681 PMCID: PMC9739292 DOI: 10.3390/jcm11237107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Revised: 11/18/2022] [Accepted: 11/29/2022] [Indexed: 12/02/2022] Open
Abstract
In children with life-limiting conditions and severe neurological impairment receiving pediatric palliative care (PPC), the degree to which actigraphy generates meaningful sleep data is uncertain. Benchmarked against the gold standard polysomnography (PSG), the applicability of actigraphy in this complex population was to be assessed. An actigraph was placed on N = 8 PPC patients during one-night polysomnography measurement in a pediatric tertiary care hospital's sleep laboratory. Patient characteristics, sleep phase data, and respiratory abnormalities are presented descriptively. Bland-Altman plots evaluated actigraphy's validity regarding sleep onset, sleep offset, wake after sleep onset (WASO), number of wake phases, total sleep time (TST) and sleep efficiency compared to PSG. PSG revealed that children spent most of their time in sleep stage 2 (46.6%) and most frequently showed central apnea (28.7%) and irregular hypopnea (14.5%). Bland-Altman plots showed that actigraphy and PSG gave similar findings for sleep onset, sleep offset, wake after sleep onset (WASO), total sleep time (TST) and sleep efficiency. Actigraphy slightly overestimated TST and sleep efficiency while underestimating all other parameters. Generally, the Actiwatch 2 low and medium sensitivity levels showed the best approximation to the PSG values. Actigraphy seems to be a promising method for detecting sleep problems in severely ill children.
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Affiliation(s)
- Larissa Alice Kubek
- PedScience Research Institute, 45711 Datteln, Germany
- Department of Children's Pain Therapy and Paediatric Palliative Care, Faculty of Health, School of Medicine, Witten/Herdecke University, 58455 Witten, Germany
| | - Patrizia Kutz
- Department of Neonatology, Pediatric Intensive Care and Sleep Medicine, Children's and Adolescents' Hospital, Witten/Herdecke University, 45711 Datteln, Germany
| | - Claudia Roll
- Department of Neonatology, Pediatric Intensive Care and Sleep Medicine, Children's and Adolescents' Hospital, Witten/Herdecke University, 45711 Datteln, Germany
| | - Boris Zernikow
- PedScience Research Institute, 45711 Datteln, Germany
- Department of Children's Pain Therapy and Paediatric Palliative Care, Faculty of Health, School of Medicine, Witten/Herdecke University, 58455 Witten, Germany
- Palliative Care Centre, Children's and Adolescents' Hospital, 45711 Datteln, Germany
| | - Julia Wager
- PedScience Research Institute, 45711 Datteln, Germany
- Department of Children's Pain Therapy and Paediatric Palliative Care, Faculty of Health, School of Medicine, Witten/Herdecke University, 58455 Witten, Germany
- Palliative Care Centre, Children's and Adolescents' Hospital, 45711 Datteln, Germany
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Wager J, Kubek LA, Brenner M, Calmanti S, Doyle C, Lövgren M, Kreicbergs U, Kremer L, Le Moine P, Robert G, Schuiling-Otten M, Schröder-Bäck P, Verhagen E, Zernikow B. Expert survey on coverage and characteristics of pediatric palliative care in Europe - a focus on home care. BMC Palliat Care 2022; 21:185. [PMID: 36244981 PMCID: PMC9575204 DOI: 10.1186/s12904-022-01078-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Accepted: 09/23/2022] [Indexed: 11/10/2022] Open
Abstract
Background For children with life-limiting conditions home care is a key component of pediatric palliative care. However, poor information is available on service coverage and in particular on country-specific pediatric palliative home care characteristics. The aim of the study was therefore to describe the association between pediatric palliative care coverage and national activities and obtain detailed information on the pediatric palliative home care structure in different European countries. Methods Online survey with in-country experts from N = 33 European countries. Results Pediatric palliative home care (65.6%) represented the most pediatric palliative care units (15.6%) and the least common services. National documents constituted the most widespread national pediatric palliative care activity (59.4%) and were associated with available services. Pediatric palliative home care could be mostly accessed as a service free of charge to families (95.2%) from the time of a child's diagnosis (85.7%). In most countries, oncological and non-oncological patients were cared for in pediatric palliative home care. Only a minority of home care teams covered home-ventilated children. Pediatric palliative home care usually comprised medical care (81.0%), care coordination (71.4%), nursing care (75.0%) and social support (57.1%). Most countries had at least two professional groups working in home care teams (81.0%), mostly physicians and nurses. In many countries, pediatric palliative home care was not available in all regions and did not offer a 24 h-outreach service. Conclusions Pediatric palliative care provision in Europe is heterogeneous. Further work on country-specific structures is needed. Supplementary Information The online version contains supplementary material available at 10.1186/s12904-022-01078-0.
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Affiliation(s)
- Julia Wager
- PedScience Research Institute, Herdieckstraße 5b, 45711, Datteln, Germany.,Paediatric Palliative Care Centre, Children's and Adolescents' Hospital, Datteln, Germany.,Department of Children's Pain Therapy and Paediatric Palliative Care, Faculty of Health, School of Medicine, Witten/Herdecke University, Witten, Germany
| | - Larissa Alice Kubek
- PedScience Research Institute, Herdieckstraße 5b, 45711, Datteln, Germany. .,Department of Children's Pain Therapy and Paediatric Palliative Care, Faculty of Health, School of Medicine, Witten/Herdecke University, Witten, Germany.
| | - Maria Brenner
- School of Nursing, Midwifery & Health Systems, University College, Dublin, Ireland
| | - Sara Calmanti
- Accompagnement Et Information (CREAI) en Faveur Des Populations Vulnérables, Centre Régional d'Etudes, Bretagne, France
| | - Carmel Doyle
- School of Nursing and Midwifery, Trinity College, Dublin, Ireland
| | | | | | - Leontien Kremer
- Princess Máxima Center for Pediatric Oncology, 3584 CS, Utrecht, The Netherlands
| | - Philippe Le Moine
- Equipe Ressource Régionale de Soins Palliatifs Pédiatriques La BRISE, Bretagne, France
| | - Guillaume Robert
- Equipe Ressource Régionale de Soins Palliatifs Pédiatriques La BRISE, Bretagne, France
| | | | - Peter Schröder-Bäck
- Department of International Health, Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, The Netherlands
| | - Eduard Verhagen
- Department of Pediatrics, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Boris Zernikow
- PedScience Research Institute, Herdieckstraße 5b, 45711, Datteln, Germany.,Paediatric Palliative Care Centre, Children's and Adolescents' Hospital, Datteln, Germany.,Department of Children's Pain Therapy and Paediatric Palliative Care, Faculty of Health, School of Medicine, Witten/Herdecke University, Witten, Germany
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