Association Between Subjective and Objective Measures of Pediatric Sleep: A Systematic Review and Meta-Analysis of Duration, Continuity, Regularity, and Quality

To evaluate the correlation between subjective and objective sleep measures in children and adolescents without neurodevelopmental disorders across four interrelated dimensions: duration, continuity, regularity, and quality. We conducted a systematic review with a comprehensive database search in MEDLINE, Embase, CINAHL, and PsycInfo (last updated August 2024). Further, we retrieved references of included studies. Studies were included if they reported at least one subjective and one objective sleep measure in participants aged 2–17 years. Seventy-four studies met inclusion criteria. Correlation estimates were synthesized using random-effects meta-analyses when ≥3 studies were available, and heterogeneity was assessed with I 2 statistics. Correlations between subjective and objective measures varied substantially both within and across sleep dimensions. The strongest correlations were observed for sleep duration. Sleep onset latency and wake after sleep onset showed weak correlations, and for sleep quality correlation estimates were inconsistent, reflecting heterogeneous definitions and assessment tools. Regarding subjective regularity, weak-to-moderate associations were found with objective midpoint of sleep. Substantial to considerable heterogeneity across analyses indicated methodological and population-level variability. Subjective and objective sleep measures reflect related but distinct aspects of children’s sleep and cannot usually replace one another. Because sleep dimensions are interrelated and not mutually exclusive, findings should be interpreted cautiously. Researchers should choose methods that align with their study goals. Future work should aim for clearer conceptual definitions, improved temporal alignment, and age-appropriate tools. • Strongest correlations were found for sleep duration • Weak correlations were found for sleep onset latency and awakenings • Sleep quality definitions vary across studies • Subjective and objective tools capture distinct aspects • Sleep tools must align with research objectives