title: "Diagnosis by behavioral observation" home-videosomnography - a rigorous ethnographic approach to sleep of children with neurodevelopmental conditions.
abstract: BACKGROUND
  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.
  
  
  CONCLUSIONS
  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.
authors: 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.
authors: Osman S
authors: OS
authors: Ipsiroglu
authors: Sleep/Wake Behavior Clinic and Research Laboratory, Department of Pediatrics, Faculty of Medicine, University of British Columbia , Vancouver, BC , Canada.
authors: Yi-Hsuan Amy
authors: YH
authors: Hung
authors: Sleep/Wake Behavior Clinic and Research Laboratory, Department of Pediatrics, Faculty of Medicine, University of British Columbia , Vancouver, BC , Canada.
authors: Forson
authors: F
authors: Chan
authors: Sleep/Wake Behavior Clinic and Research Laboratory, Department of Pediatrics, Faculty of Medicine, University of British Columbia , Vancouver, BC , Canada.
authors: Michelle L
authors: ML
authors: Ross
authors: Sleep/Wake Behavior Clinic and Research Laboratory, Department of Pediatrics, Faculty of Medicine, University of British Columbia , Vancouver, BC , Canada.
authors: Dorothee
authors: D
authors: Veer
authors: Sleep/Wake Behavior Clinic and Research Laboratory, Department of Pediatrics, Faculty of Medicine, University of British Columbia , Vancouver, BC , Canada.
authors: Sonja
authors: S
authors: Soo
authors: Sleep/Wake Behavior Clinic and Research Laboratory, Department of Pediatrics, Faculty of Medicine, University of British Columbia , Vancouver, BC , Canada.
authors: Gloria
authors: G
authors: Ho
authors: Sleep/Wake Behavior Clinic and Research Laboratory, Department of Pediatrics, Faculty of Medicine, University of British Columbia , Vancouver, BC , Canada.
authors: Mai
authors: M
authors: Berger
authors: Sleep/Wake Behavior Clinic and Research Laboratory, Department of Pediatrics, Faculty of Medicine, University of British Columbia , Vancouver, BC , Canada.
authors: Graham
authors: G
authors: McAllister
authors: Austrian Institute of Technology , Vienna , Austria ; Technical University of Vienna , Vienna , Austria.
authors: Heinrich
authors: H
authors: Garn
authors: Department of Neurology, Medical University of Vienna , Vienna , Austria.
authors: Gerhard
authors: G
authors: Kloesch
authors: Department of Electronics, Federal University of Minas Gerais , Belo Horizonte , Brazil.
authors: Adriano Vilela
authors: AV
authors: Barbosa
authors: Treatable Intellectual Disability Endeavour , Vancouver, BC , Canada ; Division of Biochemical Diseases, Department of Pediatrics, Faculty of Medicine, University of British Columbia , Vancouver, BC , Canada.
authors: Sylvia
authors: S
authors: Stockler
authors: Treatable Intellectual Disability Endeavour , Vancouver, BC , Canada ; Department of Anthropology, Faculty of Arts, University of British Columbia , Vancouver, BC , Canada.
authors: William
authors: W
authors: McKellin
authors: Department of Linguistics, University of British Columbia , Vancouver, BC , Canada.
authors: Eric
authors: E
authors: Vatikiotis-Bateson
keywords: Willis Ekbom disease; behavioral observation; ethnography; neurodevelopmental conditions; pediatric; restless legs syndrome; sleep; videosomnography