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Quality of Life and Mental Health in Caregivers of Children with Down Syndrome and Sleep Problems

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Title: Quality of Life and Mental Health in Caregivers of Children with Down Syndrome and Sleep Problems
Language: English
Authors: Kasey Fullwood, Andrew Collaro, Lachlan Power, Jasneek Chawla
Source: Journal of Applied Research in Intellectual Disabilities. 2025 38(4).
Availability: Wiley. Available from: John Wiley & Sons, Inc. 111 River Street, Hoboken, NJ 07030. Tel: 800-835-6770; e-mail: cs-journals@wiley.com; Web site: https://www.wiley.com/en-us
Peer Reviewed: Y
Page Count: 8
Publication Date: 2025
Document Type: Journal Articles
Reports - Research
Descriptors: Down Syndrome, Children, Sleep, Quality of Life, Mental Health, Caregivers, Stress Variables, Depression (Psychology), Physical Health, Family Needs, Foreign Countries, Anxiety
Geographic Terms: Australia
Assessment and Survey Identifiers: Depression Anxiety and Stress Scales
DOI: 10.1111/jar.70103
ISSN: 1360-2322
1468-3148
Abstract: Introduction: Children with Down Syndrome are more likely to experience sleep issues throughout their life compared to typically developing children. Sleep difficulties also affect caregivers, who are at increased risk of sleep disturbances, mood disturbances and poorer wellbeing. However, the impact of poor sleep in this cohort of children on their caregivers is not widely understood. Method: This study assessed the quality of life and mental health in 26 caregivers of children with Down Syndrome and sleep problems through two self-reporting questionnaires. Results: Results showed caregivers had significantly lower quality of life (QoL) and higher stress scores compared to population norms. A decrease in psychological and physical health scores was associated with higher odds of depression. Similarly, a reduced physical and social health increased the odds of experiencing stress by 50%. Conclusion: These findings suggest this cohort of families may benefit from increased psychosocial support when addressing sleep problems.
Abstractor: As Provided
Entry Date: 2025
Accession Number: EJ1481463
Database: ERIC
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  Value: <anid>AN0187526547;e0301jul.25;2025Aug28.05:02;v2.2.500</anid> <title id="AN0187526547-1">Quality of Life and Mental Health in Caregivers of Children With Down Syndrome and Sleep Problems </title> <p>Introduction: Children with Down Syndrome are more likely to experience sleep issues throughout their life compared to typically developing children. Sleep difficulties also affect caregivers, who are at increased risk of sleep disturbances, mood disturbances and poorer wellbeing. However, the impact of poor sleep in this cohort of children on their caregivers is not widely understood. Method: This study assessed the quality of life and mental health in 26 caregivers of children with Down Syndrome and sleep problems through two self‐reporting questionnaires. Results: Results showed caregivers had significantly lower quality of life (QoL) and higher stress scores compared to population norms. A decrease in psychological and physical health scores was associated with higher odds of depression. Similarly, a reduced physical and social health increased the odds of experiencing stress by 50%. Conclusion: These findings suggest this cohort of families may benefit from increased psychosocial support when addressing sleep problems.</p> <p>Keywords: caregiver mental health; down syndrome; paediatric; sleep</p> <p></p> <ulist> <item> Abbreviations</item> <p></p> <item> CPAP continuous positive airway pressure</item> <p></p> <item> DASS the Depression, Anxiety and Stress Scale</item> <p></p> <item> OSA Obstructive sleep apnoea</item> <p></p> <item> QoL Quality of Life</item> <p></p> <item> SDB sleep disordered breathing</item> <p></p> <item> WHOQOLBREF World Health Organisation Quality of Life Abbreviated Scale</item> <p></p> <item> Caregivers of children with Down Syndrome with sleep issues have poorer QoL and mental health compared to the general population. This is relevant in clinical care given to children with Down Syndrome presenting with sleep issues and the wellbeing of their families.</item> <p></p> <item> Sleep issues affect more than just the child not sleeping, and these effects can be detrimental to caregiver QoL and mental health.</item> <p></p> <item> This study is one of the first to measure QoL and mental health in caregivers of children with Down Syndrome and sleep issues.</item> <p></p> <item> Larger scale studies inclusive of all caregivers are needed to build upon our findings.</item> </ulist> <p>Summary</p> <hd id="AN0187526547-2">Introduction</hd> <p>Down Syndrome is the most common chromosomal disorder in humans, with a prevalence of approximately one in every 675 births worldwide (Hendrix et al. [<reflink idref="bib18" id="ref1">18</reflink>]). Compared to typically developing children, those with Down Syndrome are recognised to have a higher prevalence of sleep difficulties, encompassing both respiratory and non‐respiratory sleep problems (Churchill et al. [<reflink idref="bib9" id="ref2">9</reflink>]). Respiratory sleep problems encompass any abnormal respiration during sleep. Sleep disordered breathing encompasses both central and obstructive sleep apnoea. Whilst both may occur in children with Down Syndrome, obstructive sleep apnoea (OSA) is particularly prevalent in children with Down Syndrome (estimates range from 29% to 79%, compared to 1% to 5% in general paediatric population) (Marcus et al. [<reflink idref="bib26" id="ref3">26</reflink>]). OSA consists of complete and partial sleep apnoea and hypopnoea events which result in associated arterial oxygen desaturation and/or repeated arousals during sleep (Isaiah and Mitchell [<reflink idref="bib21" id="ref4">21</reflink>]). A combination of predisposing risk factors such as macroglossia, midfacial and mandibular hypoplasia, adenotonsillar hypertrophy, and hypotonia, coupled with other co‐morbid conditions such as obesity, increases their risk of OSA (Churchill et al. [<reflink idref="bib9" id="ref5">9</reflink>]; Maris et al. [<reflink idref="bib27" id="ref6">27</reflink>]). Behavioural sleep disorders such as bedtime resistance, sleep anxiety, night waking, and parasomnias have also been shown to commonly affect children with Down Syndrome (Hoffmire et al. [<reflink idref="bib19" id="ref7">19</reflink>]; Carter et al. [<reflink idref="bib4" id="ref8">4</reflink>]).</p> <p>Treatments, including adenotonsillectomy and continuous positive airway pressure (CPAP) are commonly used to treat SDB in children with Down Syndrome; however, treatment tolerance and overall success vary significantly (Shete et al. [<reflink idref="bib32" id="ref9">32</reflink>]; Rosen [<reflink idref="bib31" id="ref10">31</reflink>]). Non‐respiratory sleep disorders can be even more challenging to manage. Pharmacological supplementation with melatonin has been shown to improve sleep onset in typically developing children; however, studies involving children with Down Syndrome are scarce and less conclusive (Braam et al. [<reflink idref="bib2" id="ref11">2</reflink>]; Ward et al. [<reflink idref="bib35" id="ref12">35</reflink>]). Behavioural interventions such as parental education and addressing sleep hygiene are also under‐researched for children with Down Syndrome.</p> <p>Sleep disruption resulting from SDB or non‐respiratory sleep disorders have unique significance within this population due to associations with long‐term morbidity including cardiovascular disease and systemic inflammation, and the increased susceptibility of children with Down Syndrome to cardiovascular disease and metabolic disorders (Hanna et al. [<reflink idref="bib16" id="ref13">16</reflink>]; Gozal [<reflink idref="bib15" id="ref14">15</reflink>]; Nehme et al. [<reflink idref="bib30" id="ref15">30</reflink>]). Furthermore, sleep disorders contribute to a range of negative functional and cognitive outcomes in children with Down Syndrome. Children with Down Syndrome and recognised sleeping issues show poorer executive function, attention, language fluency and expression, and behavioural patterns than those without sleeping difficulties (Breslin et al. [<reflink idref="bib3" id="ref16">3</reflink>]; Chen et al. [<reflink idref="bib6" id="ref17">6</reflink>]; Edgin et al. [<reflink idref="bib13" id="ref18">13</reflink>]; Esbensen et al. [<reflink idref="bib14" id="ref19">14</reflink>]; Kelmanson [<reflink idref="bib22" id="ref20">22</reflink>]). These deficits may exacerbate pre‐existing intellectual disabilities that occur in this population and can lead to poorer overall outcomes (Churchill et al. [<reflink idref="bib9" id="ref21">9</reflink>]).</p> <p>Families of children with Down Syndrome are also heavily affected by poor sleeping patterns and the follow‐on effects during waking hours. Carers of children with sleep issues are more likely to have sleeping difficulties of their own and associated mood disturbances (Varma et al. [<reflink idref="bib34" id="ref22">34</reflink>]). Our group recently published the first qualitative study to explore the impact that poor sleep in children with Down Syndrome can have on their caregivers and families, reporting largely negative experiences. Findings from this study suggest that caregivers of children with Down Syndrome understand that sleep disruption has adverse effects on their wellbeing and family dynamics; however, they are likely to normalise this poor sleep and the flow‐on effects (Chawla et al. [<reflink idref="bib5" id="ref23">5</reflink>]). This normalisation of sleep disorders in children with Down Syndrome can be exacerbated by inadequate or insensitive practices by healthcare professionals when addressing sleep‐related concerns in children with Down Syndrome (Chawla et al. [<reflink idref="bib5" id="ref24">5</reflink>]). These findings highlight considerable implications for the wellbeing and quality of life of those affected by sleep problems and represent the need for greater support from healthcare professionals. In this study, we report on psychosocial data from the caregivers who participated in the initial qualitative study. Our study aims were to evaluate the potential impact of their child's poor sleep on caregiver mental health and quality of life (QoL) by (i) comparing this cohort of caregivers' QoL and depression, anxiety, and stress scores against normative data and (ii) measuring the impact of caregiver mental health scores on their overall QoL.</p> <hd id="AN0187526547-3">Study Impact</hd> <p>Little is known about the impact of sleep disorders in children with Down syndrome on caregivers. This study provides preliminary data on the potential negative impact of sleep problems on caregivers' mental health and quality of life, highlighting this as an area that needs to be addressed in clinical practice as a priority by (i) ensuring sleep problems in children with Down syndrome are treated early, and (ii) with the provision of psychosocial supports for families.</p> <hd id="AN0187526547-4">Methods</hd> <p></p> <hd id="AN0187526547-5">Study Design</hd> <p>This study was undertaken as part of a larger mixed‐method study entitled <emph>Sleep Difficulties in Children with Down Syndrome: An Evaluation of Parent/Carer and Family Quality of Life</emph>. <emph>The quantitative component, reported here, focused on caregiver mental health and quality of life using validated questionnaires. The qualitative component involved in‐depth interviews exploring parental experiences, perceived impacts of sleep difficulties, and support needs and has been reported separately</emph> (Chawla et al. [<reflink idref="bib5" id="ref25">5</reflink>]; Cooke, Smith, et al. [<reflink idref="bib11" id="ref26">11</reflink>]; Cooke, Coles, et al. [<reflink idref="bib10" id="ref27">10</reflink>]). The study received ethical approval from the Children's Health Queensland HREC Committee. Approval Number: HREC/20/QCHQ/65571.</p> <hd id="AN0187526547-6">Participants</hd> <p>Twenty‐six caregivers of children under the care of the Sleep Unit at the Queensland Children's Hospital for a sleep problem who were enrolled in a concurrent qualitative study were included. Caregivers who participated in this concurrent qualitative study (Chawla et al. [<reflink idref="bib5" id="ref28">5</reflink>]) were asked to complete two questionnaires as part of the current study: the Depression, Anxiety and Stress Scale (DASS) and the World Health Organisation Quality of Life Abbreviated Scale (WHOQOLBREF) (Lovibond and Lovibond [<reflink idref="bib24" id="ref29">24</reflink>]; Hawthorne et al. [<reflink idref="bib17" id="ref30">17</reflink>]). Caregivers were defined as those who care for children with Down Syndrome who had a diagnosed sleep disorder. Sleep disorders included respiratory and non‐respiratory sleep disorders, diagnosed by a respiratory and sleep specialist, based on clinical assessment, medical chart reviews, and sleep study findings (where appropriate). Once an interview date for the qualitative component of the study was scheduled, questionnaires were sent by mail to enrolled participants. Caregivers were reminded to complete the questionnaires when interviewed, and further prompts were provided by the research coordinator as needed for the following 3 months. Demographic and medical history data were collected using electronic medical records and a clinical history questionnaire.</p> <hd id="AN0187526547-7">Materials</hd> <p></p> <hd id="AN0187526547-8">Depression and Anxiety Stress Scale</hd> <p>The DASS‐42 is a set of three self‐report scales designed to measure the negative emotional states of depression, anxiety, and stress (Lovibond and Lovibond [<reflink idref="bib25" id="ref31">25</reflink>]). It is a validated measure of mental health in adults and consists of 42 questions. Normative data for this assessment were developed from a sample of 1044 males and 1870 females aged between 17 and 69 years of varying social backgrounds. Scales for surveyed family members were compared to normative means and 95% confidence intervals (95% CIs). Higher scores on the DASS‐42 represent higher rated depression, anxiety, and stress. Scores are represented on a scale of Normal to Severe.</p> <hd id="AN0187526547-9">World Health Organisation Quality of Life Abbreviated Scale</hd> <p>The WHOQOL‐100 assessment was developed by the WHOQOL group with 15 international field centres to develop a QoL assessment that would be applicable cross‐culturally and has been previously used in studies involving families of children with Down Syndrome. The WHOQOLBREF is an abbreviated version of this questionnaire which is based on a four‐domain structure (physical health, psychological, social relationships, and environment). It is a self‐administered, validated questionnaire that consists of 26 questions. The questionnaire produces a QoL profile which includes four domain scores, which denote an individual's perception of QoL in each domain, as well as two individual questions that ask about an individual's overall perception of QoL (Q1) and an individual's overall perception of health (Q2). Raw domain scores are transformed to a scale of 0–100, and scores for surveyed family members were compared to all‐age mean values and 95% CIs (WHOQOL [<reflink idref="bib36" id="ref32">36</reflink>]). Higher scores in each domain represent better quality of life in those health domains.</p> <hd id="AN0187526547-10">Data Analysis</hd> <p>Descriptive statistics including means and standard deviations (SDs) were presented for all four domains of the WHOQOLBREF and the DASS. Participant scores were compared to normative data using <emph>T</emph>‐tests for each WHOQOLBREF domain. Participant age was not recorded; participant scores were compared to all‐age values. <emph>T</emph>‐tests were done on Depression, Anxiety, and Stress scores against normative data (Lovibond and Lovibond [<reflink idref="bib24" id="ref33">24</reflink>]). Pearson's correlation matrix was used to capture correlations between QoL and DASS scores, along with intercorrelations between demographic variables. Univariable logistic regression was used to determine whether QoL scores could predict mild, moderate, or severe depression, anxiety, and stress.</p> <hd id="AN0187526547-11">Demographic Data</hd> <p>Twenty‐six of the 34 caregivers (76.5%) who participated in the concurrent qualitative study returned completed DASS and WHOQOLBREF questionnaires. Demographic characteristics of study participants are summarised in Table 1.</p> <p>1 TABLE Demographic information for 26 participants.</p> <p> <ephtml> <table><thead valign="bottom"><tr><th align="left" /><th align="center">Sub‐category</th><th align="center">Number of participants (<italic>n</italic> = 26, including 24 females)</th></tr></thead><tbody valign="top"><tr><td align="left">Family structure</td><td align="center">Nuclear (two caregiver household)</td><td align="center">19 (73%)</td></tr><tr><td align="center">Separated with dual custody</td><td align="center">4 (15%)</td></tr><tr><td align="center">Single caregiver</td><td align="center">3 (12%)</td></tr><tr><td align="left">Siblings in the family</td><td align="center">Yes</td><td align="center">12 (46%)</td></tr><tr><td align="center">No</td><td align="center">14 (54%)</td></tr><tr><td align="left">Primary caregiver education level</td><td align="center">Tertiary</td><td align="center">19 (73%)</td></tr><tr><td align="center">Up to year 11/12 (secondary education)</td><td align="center">7 (27%)</td></tr><tr><td align="center">Less than year 11/12 (secondary education)</td><td align="center">0</td></tr><tr><td align="left">Primary earner occupation type</td><td align="center">Skilled/professional</td><td align="center">15 (58%)</td></tr><tr><td align="center">Semi‐skilled</td><td align="center">9 (35%)</td></tr><tr><td align="center">Unskilled</td><td align="center">2 (8%)</td></tr><tr><td align="left">Employment status if primary earner</td><td align="center">Full‐time</td><td align="center">11 (42%)</td></tr><tr><td align="center">Part‐time</td><td align="center">12 (46%)</td></tr><tr><td align="center">Unemployed/pension</td><td align="center">3 (12%)</td></tr></tbody></table> </ephtml> </p> <hd id="AN0187526547-12">Results</hd> <p>Environment health scores were the highest of the four QoL domains among carers with children with Down Syndrome, with Social health the lowest (Table 2). On average, caregivers' Stress scores were highest on the DASS scale, followed by Depression and Anxiety (Table 3). Mean depression and anxiety scores were within the normal range, with stress mild in participants. Further analysis showed 50% of stress scores, 42.3% of depression scores, and 26.2% of anxiety scores in the mild–extreme ranges. Of these, 11.5% of participants rated their depression as severe, whilst 38% showed severe stress scores (Figure 1).</p> <p>2 TABLE Mean scores, mean difference to normative data, t ‐scores and significance levels of quality of life scores.</p> <p> <ephtml> <table><thead valign="bottom"><tr><th align="left" /><th align="center">Mean (SD)</th><th align="center">Mean difference</th><th align="center"><italic>t</italic>‐score</th><th align="center"><italic>p</italic>‐value</th></tr></thead><tbody valign="top"><tr><td align="left">Physical health</td><td align="center">58.34 (14.54)</td><td align="center">15.15</td><td align="center">−4.24</td><td align="center">< 0.001</td></tr><tr><td align="left">Psychological health</td><td align="center">56.5 (14.99)</td><td align="center">14.1</td><td align="center">−5.05</td><td align="center">< 0.001</td></tr><tr><td align="left">Social health</td><td align="center">49.03 (24.21)</td><td align="center">22.46</td><td align="center">−6.13</td><td align="center">< 0.001</td></tr><tr><td align="left">Environment health</td><td align="center">67.96 (15.56)</td><td align="center">7.14</td><td align="center">−2.74</td><td align="center">0.006</td></tr></tbody></table> </ephtml> </p> <p>3 TABLE Mean scores, mean differences, t ‐scores and significance levels of participant Depression, Anxiety and Stress Scale scores compared to normative values (Lovibond and Lovibond 1995a).</p> <p> <ephtml> <table><thead valign="bottom"><tr><th align="left" /><th align="center">Mean (SD)</th><th align="center">Mean difference</th><th align="center"><italic>t</italic>‐score</th><th align="center"><italic>p</italic>‐value</th></tr></thead><tbody valign="top"><tr><td align="left">Depression</td><td align="center">8.46 (7.46)</td><td align="center">2.12</td><td align="center">1.543</td><td align="center">0.123</td></tr><tr><td align="left">Anxiety</td><td align="center">5.77 (6.83)</td><td align="center">1.07</td><td align="center">1.101</td><td align="center">0.271</td></tr><tr><td align="left">Stress</td><td align="center">14.77 (7.47)</td><td align="center">4.66</td><td align="center">2.9921</td><td align="center">0.003</td></tr></tbody></table> </ephtml> </p> <p> <img src="https://imageserver.ebscohost.com/img/embimages/rdk/E03/01jul25/jar70103-fig-0001.jpg?ephost1=dGJyMNHX8kSepq84v%2bvlOLCmsE6epq5Srqa4SK6WxWXS" alt="jar70103-fig-0001.jpg" title="1 Histograms of Depression, Anxiety and Stress scores for 26 study participants." /> </p> <p></p> <hd id="AN0187526547-14">Comparison to Normative Data</hd> <p>When comparing participant QoL scores for each domain against normative data, all domains of health were significantly lower than the normative data (WHOQOL [<reflink idref="bib36" id="ref34">36</reflink>]) (Table 2).</p> <p>When compared to DASS normative data (Lovibond and Lovibond [<reflink idref="bib24" id="ref35">24</reflink>]), participants had a higher mean stress score, whilst depression and anxiety scores of participants were not significantly different from normal values (Table 3).</p> <hd id="AN0187526547-15">Correlations</hd> <p>Pearson's correlation values outline relationships between all variables (Table 4). Depression was negatively correlated to all QoL variables. Further, depression showed a significant positive correlation to anxiety and stress, where anxiety and stress scores increased as depression scores increased. Psychological health was significantly positively correlated with social relationships and environment. Further, physical health was significantly negatively correlated with stress. All other variables showed non‐significant correlations. No significant differences were found between demographic variables.</p> <p>4 TABLE Correlation values for four quality of life domains and Depression, Anxiety and Stress Scale scores.</p> <p> <ephtml> <table><thead valign="bottom"><tr><th align="left" /><th align="center">Physical</th><th align="center">Psychological</th><th align="center">Social relationships</th><th align="center">Environment</th><th align="center">Depression</th><th align="center">Anxiety</th><th align="center">Stress</th></tr></thead><tbody valign="top"><tr><td align="left">Physical health</td><td align="center">—</td><td align="center" /><td align="center" /><td align="center" /><td align="center" /><td align="center" /><td align="center" /></tr><tr><td align="left">Psychological</td><td align="center">0.31</td><td align="center">—</td><td align="center" /><td align="center" /><td align="center" /><td align="center" /><td align="center" /></tr><tr><td align="left">Social relationships</td><td align="center">0.03</td><td align="center">0.43*</td><td align="center">—</td><td align="center" /><td align="center" /><td align="center" /><td align="center" /></tr><tr><td align="left">Environment</td><td align="center">0.07</td><td align="center">0.56**</td><td align="center">0.55**</td><td align="center">—</td><td align="center" /><td align="center" /><td align="center" /></tr><tr><td align="left">Depression</td><td align="center">−0.58**</td><td align="center">−0.63***</td><td align="center">−0.45*</td><td align="center">−0.49*</td><td align="center">—</td><td align="center" /><td align="center" /></tr><tr><td align="left">Anxiety</td><td align="center">−0.34</td><td align="center">−0.10</td><td align="center">−0.35</td><td align="center">−0.32</td><td align="center">0.56**</td><td align="center">—</td><td align="center" /></tr><tr><td align="left">Stress</td><td align="center">−0.46*</td><td align="center">−0.23</td><td align="center">−0.51</td><td align="center">−0.33</td><td align="center">0.58**</td><td align="center">0.67**</td><td align="center">—</td></tr></tbody></table> </ephtml> </p> <p>1 <emph>Note:</emph> *<emph>p</emph> < 0.05; **<emph>p</emph> < 0.01; ***<emph>p</emph> < 0.001.</p> <hd id="AN0187526547-16">Logistic Regression</hd> <p></p> <hd id="AN0187526547-17">Depression</hd> <p>Each single point reduction in QoL for physical health (odds ratio [OR] = 0.88, 95% CI 0.78–0.98, <emph>p</emph> = 0.016) and psychological health (OR = 0.84, 95% CI 0.74–0.96, <emph>p</emph> = 0.011) was associated with higher odds of reporting mild, moderate, or severe depression (Figure 2). Therefore, participants with decreased physical and psychological health were more likely to report symptoms consistent with mild–severe rated depression. There was no statistical significance for social relationship health (OR = 0.97, 95% CI 0.93–1.00, <emph>p</emph> = 0.084) and environment health (OR = 0.88, 95% CI 0.69–1.00, <emph>p</emph> = 0.063).</p> <p> <img src="https://imageserver.ebscohost.com/img/embimages/rdk/E03/01jul25/jar70103-fig-0002.jpg?ephost1=dGJyMNHX8kSepq84v%2bvlOLCmsE6epq5Srqa4SK6WxWXS" alt="jar70103-fig-0002.jpg" title="2 Scatter plots of depression scale scores against World Health Organisation Quality of Life Abbreviated Scale scores. Shading indicates level of depression as determined by Depression, Anxiety, and Stress Scale." /> </p> <p></p> <hd id="AN0187526547-19">Anxiety</hd> <p>There was no statistical significance for all four domains on anxiety, with QoL scores not associated with anxiety scores.</p> <hd id="AN0187526547-20">Stress</hd> <p>Each single point reduction in QoL for physical health (OR = 0.92, 95% CI 0.85–0.99, <emph>p</emph> = 0.033) and social relationship health (OR = 0.96, 95% CI 0.92–0.99, <emph>p</emph> = 0.043) was associated with increased odds of reporting mild/moderate/severe stress by 50% (1.5) (Figure 3). Therefore, participants with lower physical and social health were more likely to report mild–severe levels of stress. No statistical significance was found for psychological (OR = 0.94, 95% CI 0.89–1.00, <emph>p</emph> = 0.067) and environment health (OR = 0.98, 95% CI 0.93–1.03, <emph>p</emph> = 0.515).</p> <p> <img src="https://imageserver.ebscohost.com/img/embimages/rdk/E03/01jul25/jar70103-fig-0003.jpg?ephost1=dGJyMNHX8kSepq84v%2bvlOLCmsE6epq5Srqa4SK6WxWXS" alt="jar70103-fig-0003.jpg" title="3 Scatter plots of stress scale scores against World Health Organisation Quality of Life Abbreviated Scale scores. Shading indicates level of stress as determined by Depression, Anxiety, and Stress Scale." /> </p> <p></p> <hd id="AN0187526547-22">Discussion</hd> <p>In this study of 26 caregivers of children with Down Syndrome who had recognised sleep issues, we found lower QoL scores across multiple health domains when compared to the general population, along with higher stress scores. Further, we found low QoL predicted the occurrence of increased depression and stress scores. These results begin to outline the impact of sleep issues on caregivers with children with Down Syndrome. Existing literature outlines the profound negative effect sleep has on parental mental health and quality of life in typically developing children and other developmental disorders (Varma et al. [<reflink idref="bib34" id="ref36">34</reflink>]; Merrill and Slavik [<reflink idref="bib29" id="ref37">29</reflink>]; Abdullah et al. [<reflink idref="bib1" id="ref38">1</reflink>]; Martin et al. [<reflink idref="bib28" id="ref39">28</reflink>]; Liu et al. [<reflink idref="bib23" id="ref40">23</reflink>]); however, to our knowledge, this is one of only two studies to show these effects in caregivers of children with Down Syndrome. In their study of QoL in a Korean group of caregivers of children with Down Syndrome, Choi et al. found that sleep issues in children with Down Syndrome had a negative impact on participants (Choi et al. [<reflink idref="bib8" id="ref41">8</reflink>]). However, sleep was not the primary focus of this study, and it did not specifically examine a cohort of children with Down Syndrome who had confirmed sleep disorders. A systematic review and meta‐analysis on the QoL of family caregivers of children and young adults with Down Syndrome highlighted lower QoL when compared to population norms (Cheok et al. [<reflink idref="bib7" id="ref42">7</reflink>]). Authors reported various contributing factors to reduced QoL, including poor sleep quality in the child, outlining a consistent pattern within the literature of poor sleep impacting QoL in caregivers. More recently, a study evaluating patient and carer priorities of children with Down Syndrome found carers identified sleep quality as one of the most important research and clinical care priorities (Taylor et al. [<reflink idref="bib33" id="ref43">33</reflink>]). These studies add to the growing body of literature on the perceived importance of child sleep from caregivers and how poor sleep in the child can have flow‐over effects to caregivers, especially within the Down Syndrome population.</p> <p>In this study we found that within QoL, lower physical, psychological, and social relationship health was observed in caregivers compared to reference norms, suggesting that caring for a child with Down Syndrome who is experiencing sleep problems may contribute to lower QoL. Caregivers stress was found to be higher than the general population, suggesting that the presence of a child with Down Syndrome who is experiencing sleep issues may contribute to a more stressful household. Other mental health scores of depression and anxiety did not differ from population norms. This could be attributed to the mental health measures having lower sensitivity to smaller sample sizes, failing to capture population differences. These findings highlight an important issue for clinicians, demonstrating the importance of addressing caregiver sleep and mental health alongside the child with Down Syndrome's sleep difficulties. A lack of sleep can have flow‐on effects to many aspects of a caregiver's life, from experiencing their own diminished sleep to caring for tired and frustrated children. Holistic evaluation of a family's sleep may in fact be vital to achieve success in treating the child with Down Syndrome's sleep—unless the caregiver is supported, the implementation of strategies to improve sleep in the child is unlikely to be successful. We have recently demonstrated the impact on siblings of children with Down Syndrome who sleep poorly, further emphasising the need to address the needs of entire families when managing sleep in a child with Down Syndrome (Cooke, Smith, et al. [<reflink idref="bib11" id="ref44">11</reflink>]).</p> <p>As other studies have shown (Hohls et al. [<reflink idref="bib20" id="ref45">20</reflink>]; de Freitas et al. [<reflink idref="bib12" id="ref46">12</reflink>]), there is some correlation between quality of life and depression. For example, caregivers who reported low mood and had high depression scores were found to have poorer QoL. Similarly, lower QoL in specific health domains correlated with clinically significant levels of depression and stress. The previously published qualitative data from the same cohort by our group supports that poor sleep in the child with Down Syndrome may contribute to negative impact on psychosocial wellbeing in these caregivers and highlights again, that providing psychological support for caregivers when they present with a child with sleep disruption is an important part of management to consider (Chawla et al. [<reflink idref="bib5" id="ref47">5</reflink>]). Unlike these other studies, we did not observe any significant correlation between QoL and anxiety (Hohls et al. [<reflink idref="bib20" id="ref48">20</reflink>]; de Freitas et al. [<reflink idref="bib12" id="ref49">12</reflink>]), which could be attributed to our smaller sample size.</p> <p>There were some limitations to this study. Whilst participants were caregivers of children with Down Syndrome who had sleep issues, we did not correlate the severity of sleep problems in the child with Down Syndrome with carer mental health and QoL scores. Therefore, we cannot definitively conclude there is an association between poor sleep and worse parental outcomes. The small number of participants in this study does considerably limit our ability to draw definitive conclusions regarding the relationship between poor sleep in a child with Down Syndrome and caregiver mental health and QoL. Our smaller sample size may also increase Type II errors, leading to results not reaching statistical significance. Most caregivers in this study were female and therefore we cannot comment on whether findings would be similar in male caregivers. Similarly, as is often the case in research, our study attracted a particular demographic of participants, and our sample consisted largely of nuclear families reflecting a two‐caregiver household. As such, this may not accurately represent all caregivers' mental health and QoL. We hypothesise that caregivers from single‐parent households may in fact have worse outcomes due to being the sole caregiver responsible for their child with Down Syndrome. Further, we did not have a control group of children with Down Syndrome who did not have sleep problems. This was overcome by undertaking comparison to reference values and we recognise this is a less robust method than recruiting a control group from within the same community. Finally, it is also important to acknowledge the potential for bidirectional relationships, whereby poor quality of life may contribute to psychological distress, and conversely, symptoms of depression or stress may negatively influence perceptions of quality of life. However, our recently published concurrent qualitative study supports a negative association between sleep disruption in a child with Down Syndrome and parental outcomes and describes in more detail the negative experiences of individual caregivers (Chawla et al. [<reflink idref="bib5" id="ref50">5</reflink>]).</p> <p>With these limitations in mind, our results can only infer the potential impact sleep issues may have on caregivers QoL and mental health. This relationship is however supported by studies in children with other developmental disorders such as Attention Deficit and Hyperactivity Disorder (Martin et al. [<reflink idref="bib28" id="ref51">28</reflink>]) and Autism Spectrum Disorder (Abdullah et al. [<reflink idref="bib1" id="ref52">1</reflink>]; Liu et al. [<reflink idref="bib23" id="ref53">23</reflink>]), as well as in typically developing children (Varma et al. [<reflink idref="bib34" id="ref54">34</reflink>]; Merrill and Slavik [<reflink idref="bib29" id="ref55">29</reflink>]). Further research involving a larger number of participants is necessary to confirm the exact nature of the relationship between poor sleep in children with Down Syndrome and parental outcomes. Furthermore, comparing these findings to data from caregivers of children with other health care needs would provide valuable insight into whether the outcomes observed are specific to parenting a child with Down syndrome or reflect broader experiences associated with caregiving for children with complex developmental or medical conditions.</p> <p>However, based on the initial findings in this study, we recommend that clinicians consider the need to explore family wellbeing and mental health when evaluating a child with Down Syndrome who presents with sleep difficulties. Integrating screening for caregiver mental health and quality of life allows early identification of those needing additional supports. Alongside evaluating the family wellbeing, clinicians should integrate caregiver supports when treating sleep in the child. These could be in the form of clinical resources, specific sleep management programmes, such as CBT‐I, community programmes or peer support networks. Future research should focus on developing such resources and programmes to allow children with Down Syndrome management of their sleep problems. For policymakers, this study emphasises the importance of embedding caregiver supports within healthcare, through existing or new government disability schemes. This could ensure respite or financial subsidies for care are available to caregivers to avoid the escalation of caregiver burden and may help to reduce the impact on their health and wellbeing. Future studies focusing specifically on the economic burden associated with providing care for children with sleep problems would additionally assist in advocating for improved resources in caregivers.</p> <hd id="AN0187526547-23">Acknowledgements</hd> <p>The authors have nothing to report. Open access publishing facilitated by The University of Queensland, as part of the Wiley ‐ The University of Queensland agreement via the Council of Australian University Librarians.</p> <hd id="AN0187526547-24">Ethics Statement</hd> <p>The study received ethical approval from the Children's Health Queensland HREC Committee. Approval Number: HREC/20/QCHQ/65571. Participant consent was obtained in a concurrent qualitative study (Chawla et al. [<reflink idref="bib5" id="ref56">5</reflink>]).</p> <hd id="AN0187526547-25">Conflicts of Interest</hd> <p>The authors declare no conflicts of interest.</p> <hd id="AN0187526547-26">Data Availability Statement</hd> <p>The data that support the findings of this study are available on request from the corresponding author. The data are not publicly available due to privacy or ethical restrictions.</p> <ref id="AN0187526547-27"> <title> Footnotes </title> <blist> <bibl id="bib1" idref="ref38" type="bt">1</bibl> <bibtext> Funding: The authors received no specific funding for this work.</bibtext> </blist> </ref> <ref id="AN0187526547-28"> <title> References </title> <blist> <bibtext> Abdullah, M. M., R. D. Neville, J. H. Donnelly, and K. D. Lakes. 2021. " Are Parental Depressive Symptoms Related to the Sleep Quality and Physical Activity of Their Children With Developmental Disabilities? " Research in Developmental Disabilities 119 : 104091.</bibtext> </blist> <blist> <bibl id="bib2" idref="ref11" type="bt">2</bibl> <bibtext> Braam, W., R. Didden, M. Smits, and L. Curfs. 2008. " Melatonin Treatment in Individuals With Intellectual Disability and Chronic Insomnia: A Randomized Placebo‐Controlled Study." Journal of Intellectual Disability Research 52, no. 3 : 256 – 264.</bibtext> </blist> <blist> <bibl id="bib3" idref="ref16" type="bt">3</bibl> <bibtext> Breslin, J., G. Spanò, R. Bootzin, P. Anand, L. Nadel, and J. Edgin. 2014. " Obstructive Sleep Apnea Syndrome and Cognition in Down Syndrome." Developmental Medicine and Child Neurology 56, no. 7 : 657 – 664.</bibtext> </blist> <blist> <bibl id="bib4" idref="ref8" type="bt">4</bibl> <bibtext> Carter, M., E. McCaughey, D. Annaz, and C. M. Hill. 2009. " Sleep Problems in a Down Syndrome Population." Archives of Disease in Childhood 94, no. 4 : 308 – 310.</bibtext> </blist> <blist> <bibl id="bib5" idref="ref23" type="bt">5</bibl> <bibtext> Chawla, J. K., E. Cooke, M. C. Miguel, S. Burgess, and S. Staton. 2023. " Parents' Experiences of Having a Child With Down Syndrome and Sleep Difficulties." Behavioral Sleep Medicine 21, no. 5 : 570 – 584.</bibtext> </blist> <blist> <bibl id="bib6" idref="ref17" type="bt">6</bibl> <bibtext> Chen, C. C., G. Spanò, and J. O. Edgin. 2013. " The Impact of Sleep Disruption on Executive Function in Down Syndrome." Research in Developmental Disabilities 34, no. 6 : 2033 – 2039.</bibtext> </blist> <blist> <bibl id="bib7" idref="ref42" type="bt">7</bibl> <bibtext> Cheok, F. E., N. R. X. Tan, Y. Y. Chan, et al. 2024. " Quality of Life of Family Caregivers of Children and Young Adults With Down Syndrome: A Systematic Review and Meta‐Analysis." Annals of the Academy of Medicine, Singapore 53, no. 8 : 490 – 501.</bibtext> </blist> <blist> <bibl id="bib8" idref="ref41" type="bt">8</bibl> <bibtext> Choi, E. K., E. Jung, M. Van Riper, and Y. J. Lee. 2019. " Sleep Problems in Korean Children With Down Syndrome and Parental Quality of Life." Journal of Intellectual Disability Research 63, no. 11 : 1346 – 1358.</bibtext> </blist> <blist> <bibl id="bib9" idref="ref2" type="bt">9</bibl> <bibtext> Churchill, S. S., G. M. Kieckhefer, C. A. Landis, and T. M. Ward. 2012. " Sleep Measurement and Monitoring in Children With Down Syndrome: A Review of the Literature, 1960–2010." Sleep Medicine Reviews 16, no. 5 : 477 – 488.</bibtext> </blist> <blist> <bibtext> Cooke, E., L. Coles, S. Staton, K. Thorpe, and J. Chawla. 2023. " Communicating the Complex Lives of Families That Include a Child With Down Syndrome." Health Sociology Review 32, no. 1 : 19 – 41.</bibtext> </blist> <blist> <bibtext> Cooke, E., C. Smith, M. C. Miguel, et al. 2023. " Siblings' Experiences of Sleep Disruption in Families With a Child With Down Syndrome." Sleep Health 10, no. 2 : 198 – 204.</bibtext> </blist> <blist> <bibtext> de Freitas, P. H. B., A. L. Meireles, I. K. da Silva Ribeiro, M. N. S. Abreu, W. de Paula, and C. S. Cardoso. 2023. " Symptoms of Depression, Anxiety and Stress in Health Students and Impact on Quality of Life." Revista Latino‐Americana de Enfermagem 31 : e3884.</bibtext> </blist> <blist> <bibtext> Edgin, J. O., U. Tooley, B. Demara, C. Nyhuis, P. Anand, and G. Spanò. 2015. " Sleep Disturbance and Expressive Language Development in Preschool‐Age Children With Down Syndrome." Child Development 86, no. 6 : 1984 – 1998.</bibtext> </blist> <blist> <bibtext> Esbensen, A. J., E. K. Hoffman, D. W. Beebe, K. C. Byars, and J. Epstein. 2018. " Links Between Sleep and Daytime Behaviour Problems in Children With Down Syndrome." Journal of Intellectual Disability Research 62, no. 2 : 115 – 125.</bibtext> </blist> <blist> <bibtext> Gozal, D. 2009. " Sleep, Sleep Disorders and Inflammation in Children." Sleep Medicine 10, no. 1 : S12 – S16.</bibtext> </blist> <blist> <bibtext> Hanna, N., Y. Hanna, H. Blinder, J. Bokhaut, and S. L. Katz. 2022. " Predictors of Sleep Disordered Breathing in Children With Down Syndrome: A Systematic Review and Meta‐Analysis." European Respiratory Review 31, no. 164 : 220026.</bibtext> </blist> <blist> <bibtext> Hawthorne, G., H. Herrman, and B. Murphy. 2006. " Interpreting the WHOQOL‐BREF: Preliminary Population Norms and Effect Sizes." Social Indicators Research 77, no. 1 : 37 – 59.</bibtext> </blist> <blist> <bibtext> Hendrix, J. A., A. Amon, L. Abbeduto, et al. 2021. " Opportunities, Barriers, and Recommendations in Down Syndrome Research." Translational Science of Rare Diseases 5 : 99 – 129.</bibtext> </blist> <blist> <bibtext> Hoffmire, C. A., C. I. Magyar, H. V. Connolly, I. D. Fernandez, and E. van Wijngaarden. 2014. " High Prevalence of Sleep Disorders and Associated Comorbidities in a Community Sample of Children With Down Syndrome." Journal of Clinical Sleep Medicine 10, no. 4 : 411 – 419.</bibtext> </blist> <blist> <bibtext> Hohls, J. K., H. H. König, E. Quirke, and A. Hajek. 2021. " Anxiety, Depression and Quality of Life—A Systematic Review of Evidence From Longitudinal Observational Studies." International Journal of Environmental Research and Public Health 18, no. 22 : 12022.</bibtext> </blist> <blist> <bibtext> Isaiah, A., and R. B. Mitchell. 2024. Snoring and Obstructive Sleep Apnea in Children: An Evidence‐Based, Multidisciplinary Approach. 1st ed. Stacy Masucci.</bibtext> </blist> <blist> <bibtext> Kelmanson, I. A. 2017. " Sleep Disturbances, Behavioural Problems and Adaptive Skills in Children With Down's Syndrome." Early Child Development and Care 187, no. 11 : 1679 – 1693.</bibtext> </blist> <blist> <bibtext> Liu, R., H. Dong, Y. Wang, et al. 2021. " Sleep Problems of Children With Autism May Independently Affect Parental Quality of Life." Child Psychiatry & Human Development 52, no. 3 : 488 – 499.</bibtext> </blist> <blist> <bibtext> Lovibond, S. H., and P. F. Lovibond. 1995a. Manual for the Depression Anxiety Stress Scales. Psychology Foundation of Australia.</bibtext> </blist> <blist> <bibtext> Lovibond, P. F., and S. H. Lovibond. 1995b. " The Structure of Negative Emotional States: Comparison of the Depression Anxiety Stress Scales (DASS) With the Beck Depression and Anxiety Inventories." Behaviour Research and Therapy 33, no. 3 : 335 – 343.</bibtext> </blist> <blist> <bibtext> Marcus, C. L., L. J. Brooks, S. D. Ward, et al. 2012. " Diagnosis and Management of Childhood Obstructive Sleep Apnea Syndrome." Pediatrics 130, no. 3 : e714 – e755.</bibtext> </blist> <blist> <bibtext> Maris, M., S. Verhulst, M. Wojciechowski, P. van de Heyning, and A. Boudewyns. 2016. " Prevalence of Obstructive Sleep Apnea in Children With Down Syndrome." Sleep 39, no. 3 : 699 – 704.</bibtext> </blist> <blist> <bibtext> Martin, C. A., N. Papadopoulos, N. Rinehart, and E. Sciberras. 2021. " Associations Between Child Sleep Problems and Maternal Mental Health in Children With ADHD." Behavioral Sleep Medicine 19, no. 1 : 12 – 25.</bibtext> </blist> <blist> <bibtext> Merrill, R. M., and K. R. Slavik. 2023. " Relating Parental Stress With Sleep Disorders in Parents and Children." PLoS One 18, no. 1 : e0279476.</bibtext> </blist> <blist> <bibtext> Nehme, J. B. S., R. LaBerge, M. Pothos, et al. 2017. " Predicting Presence of Sleep Disordered Breathing in Children With Down Syndrome." Sleep Medicine 36 : 104 – 108.</bibtext> </blist> <blist> <bibtext> Rosen, D. 2011. " Management of Obstructive Sleep Apnea Associated With Down Syndrome and Other Craniofacial Dysmorphologies." Current Opinion in Pulmonary Medicine 17, no. 6 : 431 – 436.</bibtext> </blist> <blist> <bibtext> Shete, M. M., R. M. S. Stocks, M. E. Sebelik, and R. A. Schoumacher. 2010. " Effects of Adeno‐Tonsillectomy on Polysomnography Patterns in Down Syndrome Children With Obstructive Sleep Apnea: A Comparative Study With Children Without Down Syndrome." International Journal of Pediatric Otorhinolaryngology 74, no. 3 : 241 – 244.</bibtext> </blist> <blist> <bibtext> Taylor, E., A. Sommerfield, B. Frank, et al. 2025. " Patient and Carer Priorities for Research and Clinical Care of Children With Down Syndrome." Archives of Disease in Childhood : archdischild‐2024‐328319.</bibtext> </blist> <blist> <bibtext> Varma, P., R. Conduit, M. Junge, and M. L. Jackson. 2020. " Examining Sleep and Mood in Parents of Children With Sleep Disturbances." Nature and Science of Sleep 12 : 865 – 874.</bibtext> </blist> <blist> <bibtext> Ward, F., M. Nanjappa, S. A. J. Hinder, and M. Roy. 2015. " Use of Melatonin for Sleep Disturbance in a Large Intellectual Disability Psychiatry Service." International Journal of Developmental Disabilities 61, no. 3 : 182 – 187.</bibtext> </blist> <blist> <bibtext> WHOQOL. 1996. WHOQOL‐BREF: Introduction, Administration, Scoring and Generic Version of the Assessment: Field Trial Version, December 1996. World Health Organization.</bibtext> </blist> </ref> <aug> <p>By Kasey Fullwood; Andrew Collaro; Lachlan Power and Jasneek Chawla</p> <p>Reported by Author; Author; Author; Author</p> </aug> <nolink nlid="nl1" bibid="bib18" firstref="ref1"></nolink> <nolink nlid="nl2" bibid="bib26" firstref="ref3"></nolink> <nolink nlid="nl3" bibid="bib21" firstref="ref4"></nolink> <nolink nlid="nl4" bibid="bib27" firstref="ref6"></nolink> <nolink nlid="nl5" bibid="bib19" firstref="ref7"></nolink> <nolink nlid="nl6" bibid="bib32" firstref="ref9"></nolink> <nolink nlid="nl7" bibid="bib31" firstref="ref10"></nolink> <nolink nlid="nl8" bibid="bib35" firstref="ref12"></nolink> <nolink nlid="nl9" bibid="bib16" firstref="ref13"></nolink> <nolink nlid="nl10" bibid="bib15" firstref="ref14"></nolink> <nolink nlid="nl11" bibid="bib30" firstref="ref15"></nolink> <nolink nlid="nl12" bibid="bib13" firstref="ref18"></nolink> <nolink nlid="nl13" bibid="bib14" firstref="ref19"></nolink> <nolink nlid="nl14" bibid="bib22" firstref="ref20"></nolink> <nolink nlid="nl15" bibid="bib34" firstref="ref22"></nolink> <nolink nlid="nl16" bibid="bib11" firstref="ref26"></nolink> <nolink nlid="nl17" bibid="bib10" firstref="ref27"></nolink> <nolink nlid="nl18" bibid="bib24" firstref="ref29"></nolink> <nolink nlid="nl19" bibid="bib17" firstref="ref30"></nolink> <nolink nlid="nl20" bibid="bib25" firstref="ref31"></nolink> <nolink nlid="nl21" bibid="bib36" firstref="ref32"></nolink> <nolink nlid="nl22" bibid="bib29" firstref="ref37"></nolink> <nolink nlid="nl23" bibid="bib28" firstref="ref39"></nolink> <nolink nlid="nl24" bibid="bib23" firstref="ref40"></nolink> <nolink nlid="nl25" bibid="bib33" firstref="ref43"></nolink> <nolink nlid="nl26" bibid="bib20" firstref="ref45"></nolink> <nolink nlid="nl27" bibid="bib12" firstref="ref46"></nolink>
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  Data: Quality of Life and Mental Health in Caregivers of Children with Down Syndrome and Sleep Problems
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  Data: <searchLink fieldCode="AR" term="%22Kasey+Fullwood%22">Kasey Fullwood</searchLink><br /><searchLink fieldCode="AR" term="%22Andrew+Collaro%22">Andrew Collaro</searchLink><br /><searchLink fieldCode="AR" term="%22Lachlan+Power%22">Lachlan Power</searchLink><br /><searchLink fieldCode="AR" term="%22Jasneek+Chawla%22">Jasneek Chawla</searchLink>
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  Data: <searchLink fieldCode="SO" term="%22Journal+of+Applied+Research+in+Intellectual+Disabilities%22"><i>Journal of Applied Research in Intellectual Disabilities</i></searchLink>. 2025 38(4).
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  Data: Wiley. Available from: John Wiley & Sons, Inc. 111 River Street, Hoboken, NJ 07030. Tel: 800-835-6770; e-mail: cs-journals@wiley.com; Web site: https://www.wiley.com/en-us
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  Data: 8
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  Data: Journal Articles<br />Reports - Research
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  Data: <searchLink fieldCode="DE" term="%22Down+Syndrome%22">Down Syndrome</searchLink><br /><searchLink fieldCode="DE" term="%22Children%22">Children</searchLink><br /><searchLink fieldCode="DE" term="%22Sleep%22">Sleep</searchLink><br /><searchLink fieldCode="DE" term="%22Quality+of+Life%22">Quality of Life</searchLink><br /><searchLink fieldCode="DE" term="%22Mental+Health%22">Mental Health</searchLink><br /><searchLink fieldCode="DE" term="%22Caregivers%22">Caregivers</searchLink><br /><searchLink fieldCode="DE" term="%22Stress+Variables%22">Stress Variables</searchLink><br /><searchLink fieldCode="DE" term="%22Depression+%28Psychology%29%22">Depression (Psychology)</searchLink><br /><searchLink fieldCode="DE" term="%22Physical+Health%22">Physical Health</searchLink><br /><searchLink fieldCode="DE" term="%22Family+Needs%22">Family Needs</searchLink><br /><searchLink fieldCode="DE" term="%22Foreign+Countries%22">Foreign Countries</searchLink><br /><searchLink fieldCode="DE" term="%22Anxiety%22">Anxiety</searchLink>
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  Data: <searchLink fieldCode="SU" term="%22Depression+Anxiety+and+Stress+Scales%22">Depression Anxiety and Stress Scales</searchLink>
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  Data: 10.1111/jar.70103
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  Data: 1360-2322<br />1468-3148
– Name: Abstract
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  Data: Introduction: Children with Down Syndrome are more likely to experience sleep issues throughout their life compared to typically developing children. Sleep difficulties also affect caregivers, who are at increased risk of sleep disturbances, mood disturbances and poorer wellbeing. However, the impact of poor sleep in this cohort of children on their caregivers is not widely understood. Method: This study assessed the quality of life and mental health in 26 caregivers of children with Down Syndrome and sleep problems through two self-reporting questionnaires. Results: Results showed caregivers had significantly lower quality of life (QoL) and higher stress scores compared to population norms. A decrease in psychological and physical health scores was associated with higher odds of depression. Similarly, a reduced physical and social health increased the odds of experiencing stress by 50%. Conclusion: These findings suggest this cohort of families may benefit from increased psychosocial support when addressing sleep problems.
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  Data: EJ1481463
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        Value: 10.1111/jar.70103
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      – Text: English
    PhysicalDescription:
      Pagination:
        PageCount: 8
    Subjects:
      – SubjectFull: Down Syndrome
        Type: general
      – SubjectFull: Children
        Type: general
      – SubjectFull: Sleep
        Type: general
      – SubjectFull: Quality of Life
        Type: general
      – SubjectFull: Mental Health
        Type: general
      – SubjectFull: Caregivers
        Type: general
      – SubjectFull: Stress Variables
        Type: general
      – SubjectFull: Depression (Psychology)
        Type: general
      – SubjectFull: Physical Health
        Type: general
      – SubjectFull: Family Needs
        Type: general
      – SubjectFull: Foreign Countries
        Type: general
      – SubjectFull: Anxiety
        Type: general
      – SubjectFull: Australia
        Type: general
      – SubjectFull: Depression Anxiety and Stress Scales
        Type: general
    Titles:
      – TitleFull: Quality of Life and Mental Health in Caregivers of Children with Down Syndrome and Sleep Problems
        Type: main
  BibRelationships:
    HasContributorRelationships:
      – PersonEntity:
          Name:
            NameFull: Kasey Fullwood
      – PersonEntity:
          Name:
            NameFull: Andrew Collaro
      – PersonEntity:
          Name:
            NameFull: Lachlan Power
      – PersonEntity:
          Name:
            NameFull: Jasneek Chawla
    IsPartOfRelationships:
      – BibEntity:
          Dates:
            – D: 01
              M: 07
              Type: published
              Y: 2025
          Identifiers:
            – Type: issn-print
              Value: 1360-2322
            – Type: issn-electronic
              Value: 1468-3148
          Numbering:
            – Type: volume
              Value: 38
            – Type: issue
              Value: 4
          Titles:
            – TitleFull: Journal of Applied Research in Intellectual Disabilities
              Type: main
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