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Determinants of Sleep Quality Among Parents of Children With Disabilities
*Corresponding author: Salmah Alghamdi, Department of Nursing, King Abdulaziz University, Jeddah, Saudi Arabia. saalghamdi6@kau.edu.sa
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Received: ,
Accepted: ,
How to cite this article: Alghamdi S, Asiri A, Frhat E, Almasabi M, Alabdulaziz H. Determinants of Sleep Quality Among Parents of Children With Disabilities. J Health Allied Sci NU. doi: 10.25259/JHASNU_294_2025
Abstract
Objectives
This study aimed to assess the sleep quality and its determinants, including anxiety and demographic variables, among parents of children with disabilities compared to parents of typically developing children.
Material and Methods
This cross-sectional quantitative study utilised the Pittsburgh Sleep Quality Index (PSQI) to assess sleep quality and the Generalised Anxiety Disorder Scale (GAD-7) to measure anxiety levels. A convenience sample of 368 was recruited online through social media platforms.
Results
The prevalence of poor sleep quality was significantly higher among parents of children with disability than those of typically developing children (72.7% vs 56.5%, p = 0.024). Anxiety levels were also significantly higher in this group, with a mean score of 10.24 ± 5.39 vs. 7.15 ± 5.75, p <0.001. Logistic regression analysis revealed that anxiety was a significant predictor of poor sleep quality (OR = 1.25, 95% CI: 1.18–1.33, p <0.001), even after adjusting for demographic variables.
Conclusion
The study highlights the need for integrated interventions that address both anxiety and sleep quality. Accessible resources are essential to improve parental well-being.
Keywords
Anxiety
Children
Disabilities
Parents
Sleep quality
INTRODUCTION
Parents of children with disabilities experience several challenges in meeting their children’s basic needs. The demands of caregiving often disrupt parental daily routines, limit personal time, and reduce opportunities for self-care. These responsibilities can also negatively affect physical health, particularly when the child requires assistance with mobility or daily activities. Moreover, the need for continuous attention and assistance creates parental psychological burden. This heightened caregiving burden, among parents of children with disabilities, could lead to anxiety and restricted time for rest and sleep.[1,2] Complex daily tasks and ongoing medical needs further contribute to poor sleep quality, and this burden is strongly associated with psychological disorders such as anxiety.[2]
Sleep is a fundamental component of overall health and well-being, essential for meeting daily physiological needs. Frequent interruptions in sleep can prevent individuals from completing critical stages of the sleep cycle, thereby impairing its restorative function.[3] For adults, the recommended duration of sleep is 7-8 h/ night.[4] Adequate sleep is particularly vital for parents, as it supports optimal health and enables them to effectively care for their children, especially those with disabilities, who often require greater attention and support.[5] The parents of children with disabilities always have various responsibilities that require frequent overnight awakenings and short sleep durations, which consequently lead to poor sleep quality. A study conducted in West Virginia, involving 97 parents of children with disabilities and 75 parents of typically developing children, utilised the Pittsburgh Sleep Quality Index (PSQI) and found that parents of children with disabilities reported significantly poorer sleep quality compared to their counterparts.[6]
Anxiety can be identified by factors such as worry and fear that are uncontrollable.[7] According to a systematic review conducted by Jones and Reilly,[8] who found that, the lower quality of life and lower scores on adaptive behaviour domains are linked to parental anxiety symptoms. Parents may also worry about their ability to meet future caregiving demands or about finding fulfilling alternative care arrangements when they are unable to provide the necessary care.[9] In addition, another recent study conducted in Kerala with a sample of 50 parents of children with disabilities reported a high level of anxiety and concern about the care of children with disabilities, and the need to increase parental awareness and training.[10]
Several studies have shown a link between poor sleep quality and anxiety, which may negatively impact daily functioning.[11-14] Evidence further indicated that parents face challenges related to parenting and child-rearing, which can impact parental sleep quality.[11] Studies consistently show a high prevalence of sleep disturbances in children with autism spectrum disorder (ASD), which is directly linked to increased parental sleep disturbance.[12] This results in significantly poor sleep quality among caregivers: one study classified 78% of these parents as poor sleepers,[13,14] and other studies reported even higher rates, with 91.8% of parents of children with ASD and special educational needs (SEN) experiencing poor sleep.[15,16] These findings emphasise the critical need for targeted research to address sleep problems among parents of children with disabilities, as these issues have profound implications for their mental health and caregiving capacity.
While the previous literature often highlights the relationship between stress and depression on parental sleep,[11,13,15] there is a crucial lack of studies specifically assessing the relationship between anxiety and sleep quality among parents of children with disabilities. Examining anxiety provides a greater understanding of factors interfering with the initiation and maintenance of sleep.[10,14] Therefore, this study aims to assess the quality of sleep among parents of children with disabilities and its determinants, including demographic variables and anxiety level, compared to parents of typically developing children.
MATERIAL and METHODS
Study design, settings, and sampling
This study was conducted using a quantitative, cross-sectional research design to assess the association between quality of sleep and anxiety level among parents. The cross-sectional design offers a comprehensive analysis of the interrelationships between these variables at one time.
The participants were recruited online with an invitation link through social media (X, WhatsApp, Facebook) from different regions in the Kingdom of Saudi Arabia.
Convenience sampling was used in this study. Inclusion criteria required that participants be Arabic-speaking parents with at least one child aged <18 years, and the child must be either typically developing or diagnosed with a physical, mental, intellectual, or sensory disability. The term “typically developing children” in this study refers to normal children who have no diagnosed physical, mental, intellectual, or sensory disabilities and who meet age-appropriate developmental milestones. Sample size was calculated using Raosoft, Inc. Software,[17] with inputs of a margin of error of 5%, and the confidence level of 95%. The population size is expected to be 20000, which is a conservative estimate that statistically approximates the population. The recommended sample size is ∼377.
Data collection methods
Instrumentations: First, demographic characteristics for parents and their children include variables related to age, education, and sex. The type and severity of the child’s disability were reported by the parents based on their child’s formal diagnosis. Second, the PSQI assesses sleep quality in parents of children with disabilities.[2,18] The third scale is the Generalised Anxiety Disorders Scale (GAD-7). The PSQI and GAD-7 were translated into Arabic by two bilingual experts, followed by back-translation into English to ensure accuracy of meaning between the original and translated versions. The translated Arabic versions were then reviewed by three bilingual nursing professors with content expertise to ensure the accuracy and clarity of the meaning.
The PSQI has been developed for a global measure of the complex and multidimensional nature of sleep quality.[2,18] It has subscales for sleep quality, sleep latency, sleep duration, habitual sleep efficiency, sleep disturbances, use of sleeping medication, and daytime dysfunction in the previous month. It is made up of seven components and a total of 24 items. Each component is scored from 0 (no difficulty) to 3 (severe difficulty). The global PSQI score is calculated by summing the seven component scores, yielding a range of 0-21, where higher scores indicate poorer sleep quality. A global score >5 indicates poor sleep quality.[18] Previous studies reported strong internal consistency for the PSQI, with overall Cronbach’s alpha values ranging from 0.83-0.85 and subscale reliability between 0.65-0.84.[18,19] In this study, the PSQI scale revealed acceptable internal consistency with a Cronbach’s alpha (α) value of 0.67.
The GAD-7 is a widely used self-report measure for assessing the severity of generalised anxiety disorder symptoms experienced over the past 2 weeks. It assesses both key anxiety symptoms, including faultiness, apprehension, and inability to relax, and physical signs, including agitation or problems focusing. The GAD-7 contains seven items rated on a 4-point Likert scale ranging from 0 = not at all to 3 = nearly every day. Higher ratings indicate increased anxiety; total scores range from 0-21. Anxiety severity scale: 0-4 minimal, 5-9 mild, 10-14 moderate, 15-21 severe. A score of 10 or higher is typically used as an indicator for high anxiety level.[20] In the current study, the GAD-7 demonstrated an excellent internal consistency with a Cronbach’s alpha of 0.93 and strong validity, correlating well with other established anxiety measures such as the Beck Anxiety Inventory.[20] A study in China found high reliability (Cronbach’s α = 0.931) of the (GAD-7) when assessing a larger sample (n = 496) of primary caregivers for children with disabilities. GAD-7 was used previously to assess anxiety among parents of children with disabilities.[21]
Data collection and analysis
An online link including a self-administered questionnaire was distributed through social media (WhatsApp, X, Telegram). The data collection period was from January-March 2025. Participants were provided with informed consent before completing the survey. The questionnaire takes ∼10-15 min. Confidentiality of the participants was maintained through anonymity of the data.
Statistical analysis performed by SPSS version 28. Numerical data were presented as the mean and standard deviation (SD) and analysed using an independent t-test. Categorical data were presented as the frequency and percentage and analysed using the Chi-square test and exact test, as appropriate. Logistic regression analysis was performed to assess factors associated with poor sleep quality. Linearity of continuous predictors with the logit was assessed using the Box-Tidwell procedure. Multicollinearity was evaluated using VIF (all VIF <2). Model fit was assessed using the Hosmer-Lemeshow test. A two-tailed p <0.05 was considered statistically significant.
Ethical considerations
Ethical approval was obtained from the research ethics committee at the Faculty of Nursing with reference number 1B. 101, dated November 28th, 2024. Participants’ rights were respected and protected without causing harm. Participants were informed that their participation in this study was voluntary, anonymous, and that they had the right to withdraw from the study at any time. All data related to the study are securely stored and accessible only to the research team and supervisor.
RESULTS
Socio-demographic characteristics of the parents
A total of 368 parents (36 fathers and 332 mothers) responded to the questionnaire. Around half of the participants (47.6%) were in the age group of 26-40 years, while (45.9%) of them were older than the age of 40. The largest group (39.7%) had more than 3 children. More than two-thirds of participants (71.7%) held university degrees or postgraduate degrees. Married individuals accounted for 90.5% of the population, and 55.7% were employed. As for monthly income, 52.2% reported having between 5000-15000 SR, making this the largest group. Fifty-five parents (14.9%) had ≤18-year-old children with disabilities. Detailed demographic characteristics have been presented in Table 1.
| Item | N | % |
|---|---|---|
| Age (years) | ||
| ≤25 | 24 | 6.5 |
| 26-40 | 175 | 47.6 |
| >40 | 169 | 45.9 |
| Sex | ||
| Male | 36 | 9.8 |
| Female | 332 | 90.2 |
| Number of children | ||
| 1 | 67 | 18.2 |
| 2 | 66 | 17.9 |
| 3 | 89 | 24.2 |
| >3 | 146 | 39.7 |
| Educational level | ||
| High school or below | 104 | 28.3 |
| University or postgraduate | 264 | 71.7 |
| Marital status | ||
| Married | 333 | 90.5 |
| Divorced | 21 | 5.7 |
| Widowed | 14 | 3.8 |
| Job | ||
| Unemployed | 163 | 44.3 |
| Employed | 205 | 55.7 |
| Monthly income (SR) | ||
| <5000 | 97 | 26.3 |
| 5000-15000 | 192 | 52.2 |
| >15000 | 79 | 21.5 |
| Having ≤18-year-old children with disabilities | ||
| No | 313 | 85.1 |
| Yes | 55 | 14.9 |
Socio-demographic characteristics of the children
According to the parents’ responses, 313 (85.1%) of their children were healthy, and the remaining 55 (14.9%) had disabilities. In terms of the healthy children, the majority (61.3%) were males, and 39.9% were within the age range (11-18) years, with 65.5% receiving governmental education. Among children with disabilities, a slight male predominance was observed, representing 58.2%, and the 11-18-year-old group accounted for 63.6%. Children receiving governmental and private education, respectively, comprised 29.1% and 34.5%. Further, 20% of parents had other children with disabilities. The level of their disability was moderate for 30 children (54.5%). The socio-demographic characteristics of the children have been presented in Table 2.
| Item | Typically developing children (n = 313) (%) |
Children with disabilities (n = 55) (%) |
|---|---|---|
| Sex | ||
| Male | 192 (61.3) | 32 (58.2) |
| Female | 121 (38.7) | 23 (41.8) |
| Age (years) | ||
| 1-5 | 82 (26.2) | 8 (14.5) |
| 6-10 | 106 (33.9) | 12 (21.8) |
| 11-18 | 125 (39.9) | 35 (63.6) |
| Education | ||
| None | 46 (14.7) | 20 (36.4) |
| Governmental | 205 (65.5) | 16 (29.1) |
| Private | 62 (19.8) | 19 (34.5) |
| Having other children with disability | ||
| No | 44 (80) | |
| Yes | 11 (20) | |
| Severity of disability | ||
| Mild | 12 (21.8) | |
| Moderate | 30 (54.5) | |
| Severe | 13 (23.6) | |
Sleep quality for parents
The poor sleep quality of parents is demonstrated through seven main components of PSQI, as descriptively represented in Table 3. The first component, subjective sleep quality, of parents, 38.9% showed very good subjective sleep quality, and 44.3% showed fairly good sleep quality. For the second component, sleep latency, 35.6% of parents gave a 1-2 score for sleep latency, and 31.8% gave a 3-4 score. For the third component, sleep duration, 38.9% of parents reported having >7 h of sleep, and 25.8% used to have 6-7 h of sleep. For the fourth component, sleep efficiency was >85% for most parents (60.6%). For the fifth component, sleep disturbance, 53.5% and 39.7% of parents, respectively, had sleep disturbance scores of 1-9 and 10-18. For the sixth component, the majority (83.2%) reported not using sleep medications for the past month. For the seventh component, the daytime dysfunction score was zero among 34.5% of parents, while it was 1-2 among 43.2%. The mean overall score was 7.04 ± 3.65, as 59% of parents were deemed to have poor sleep quality and 41% showed good sleep quality. The mean difference in PSQI score was 1.38 (95%CI: 0.34, 2.42), with Cohen’s d effect size of 0.38.
| Item |
All parents (n = 368) (%) |
Parents of typically developing children (n = 313) (%) | Parents of children with disabilities (n = 55) (%) | p value |
|---|---|---|---|---|
| Subjective sleep quality | ||||
| Very good | 143 (38.9) | 129 (41.2) | 14 (25.5) | 0.031 |
| Fairly good | 163 (44.3) | 138 (44.1) | 25 (45.5) | |
| Fairly bad | 14 (3.8) | 10 (3.2) | 4 (7.3) | |
| Very bad | 48 (13) | 36 (11.5) | 12 (21.8) | |
| Sleep latency | ||||
| 0 | 37 (10.1) | 31 (9.9) | 6 (10.9) | 0.645 |
| 1-2 | 131 (35.6) | 115 (36.7) | 16 (29.1) | |
| 3-4 | 117 (31.8) | 96 (30.7) | 21 (38.2) | |
| 5-6 | 83 (22.6) | 71 (22.7) | 12 (21.8) | |
| Sleep duration | ||||
| >7 h | 143 (38.9) | 128 (40.9) | 15 (27.3) | 0.105 |
| 6-7 h | 95 (25.8) | 77 (24.6) | 18 (32.7) | |
| 5-6 h | 88 (23.9) | 76 (24.3) | 12 (21.8) | |
| <5 h | 42 (11.4) | 32 (10.2) | 10 (18.2) | |
| Sleep efficiency | ||||
| >85% | 223 (60.6) | 190 (60.7) | 33 (60) | 0.662 |
| 75-84% | 55 (14.9) | 49 (15.7) | 6 (10.9) | |
| 65-74% | 51 (13.9) | 41 (13.1) | 10 (18.2) | |
| <65% | 39 (10.6) | 33 (10.5) | 6 (10.9) | |
| Sleep disturbance | ||||
| 0 | 16 (4.3) | 14 (4.5) | 2 (3.6) | 0.244 |
| 1-9 | 197 (53.5) | 174 (55.6) | 23 (41.8) | |
| 10-18 | 146 (39.7) | 118 (37.7) | 28 (50.9) | |
| 19-27 | 9 (2.4) | 7 (2.2) | 2 (3.6) | |
| Use of sleep medication | ||||
| Not during the past month | 306 (83.2) | 266 (85) | 40 (72.7) | 0.012 |
| Less than once a week | 30 (8.2) | 21 (6.7) | 9 (16.4) | |
| Once or twice a week | 11 (3) | 11 (3.5) | 0 (0) | |
| Three or more times a week | 21 (5.7) | 15 (4.8) | 6 (10.9) | |
| Daytime dysfunction | ||||
| 0 | 127 (34.5) | 112 (35.8) | 15 (27.3) | 0.312 |
| 1-2 | 159 (43.2) | 135 (43.1) | 24 (43.6) | |
| 3-4 | 64 (17.4) | 53 (16.9) | 11 (20) | |
| 5-6 | 18 (4.9) | 13 (4.2) | 5 (9.1) | |
| Global PSQI score | 7.04 ± 3.65 | 6.84 ± 3.57 | 8.22 ± 3.89 | 0.009 |
| Sleep quality | ||||
| Poor | 217 (59) | 177 (56.5) | 40 (72.7) | 0.024 |
| Good | 151 (41) | 136 (43.5) | 15 (27.3) | |
Numerical data are presented as mean ± SD, and categorical data are presented as frequency (%). Statistical significance at p <0.05, PSQI: Pittsburgh Sleep Quality Index.
The comparison between parents of typically developing children and parents of children with disabilities revealed a statistically significant difference in terms of subjective sleep quality (p = 0.031) and frequency of using sleep medications (p = 0.012). The prevalence of poor sleep quality was significantly higher among parents of children with disability than those of typically developing children (72.7% vs 56.5%, p = 0.024).
Anxiety level for parents
As regards GAD-7 anxiety scale, the frequencies of feeling nervous, anxious, or on edge, not being able to stop or control worrying, worrying too much about different things, having trouble relaxing, becoming easily annoyed or irritable, and feeling afraid, as if something awful might happen, were significantly different between the two groups of parents (p <0.05). Overall, the total GAD-7 anxiety score was significantly higher among parents of children with disabilities than parents of typically developing children (mean 10.24 ± 5.39 vs 7.15 ± 5.75, p <0.001). The mean difference in GAD score was 3.09 (95% CI: 1.45, 4.73), with Cohen’s d effect size of 0.54. The prevalence of minimal anxiety was 12.7% among parents of children with disability vs. 35.8% among parents of typically developing children, that of mild anxiety was 40% vs. 34.2%, respectively, that of moderate anxiety was 21.8% vs. 15.3% and that of severe anxiety was 25.5% vs. 14.7%, indicating significantly more severe anxiety among parents of children with disability (p = 0.005), has been presented in Table 4.
| Item |
All parents (n = 368) (%) |
Parents of typically developing children (n = 313) (%) | Parents of children with disabilities (n = 55) (%) | p value |
|---|---|---|---|---|
| Total score | 7.61 ± 5.8 | 7.15 ± 5.75 | 10.24 ± 5.39 | <0.001 |
| Minimal anxiety | 119 (32.3) | 112 (35.8) | 7 (12.7) | 0.005 |
| Mild anxiety | 129 (35.1) | 107 (34.2) | 22 (40) | |
| Moderate anxiety | 60 (16.3) | 48 (15.3) | 12 (21.8) | |
| Severe anxiety | 60 (16.3) | 46 (14.7) | 14 (25.5) |
Numerical data are presented as mean ± SD, and categorical data are presented as frequency (%). Statistical significance at p <0.05.
3.5. The association between parents’ sleep quality and anxiety level
In univariate logistic regression analysis, a higher anxiety score of parents according to the GAD-7 scale was significantly associated with poor sleep quality, OR = 1.25(95% CI: 1.18 to 1.32, p <0.001). Also, having children with disabilities is associated with higher odds of poor sleep, OR = 2.05 (95% CI: 1.09 to 3.86, p = 0.027).
In multiple regression analysis, the only variable associated with poor sleep is the level of anxiety. Higher anxiety score of parents according to the GAD-7 scale was significantly associated with poor sleep quality, OR = 1.25 (95% CI: 1.18 to 1.33, p <0.001). These results indicate a substantial and statistically significant positive relationship between increased anxiety and the likelihood of experiencing poor sleep quality [Table 5].
| Item | Univariate analysis | Multivariable analysis | ||||
|---|---|---|---|---|---|---|
| Unadjusted OR | Unadjusted 95% CI | Unadjusted p value | Adjusted OR | Adjusted 95% CI | Adjusted p value | |
| Parental age (years) | ||||||
| ≤25 | Ref | Ref | ||||
| 26-40 | 2.15 | 0.9-5.11 | 0.083 | 1.45 | 0.47-4.43 | 0.514 |
| >40 | 2.08 | 0.87-4.95 | 0.098 | 1.36 | 0.43-4.31 | 0.599 |
| Sex | ||||||
| Male | Ref | Ref | ||||
| Female | 1.69 | 0.85-3.38 | 0.135 | 1.12 | 0.48-2.62 | 0.789 |
| Number of children | ||||||
| 1 | Ref | Ref | ||||
| 2 | 1.25 | 0.63-2.5 | 0.526 | 0.92 | 0.39-2.19 | 0.849 |
| 3 | 0.93 | 0.49-1.77 | 0.836 | 0.68 | 0.3-1.55 | 0.359 |
| >3 | 1.19 | 0.66-2.14 | 0.558 | 1.06 | 0.48-2.33 | 0.884 |
| Educational level | ||||||
| High school or below | Ref | Ref | ||||
| University or postgraduate | 1.14 | 0.72-1.8 | 0.584 | 1.03 | 0.56-1.91 | 0.915 |
| Marital status | ||||||
| Married | Ref | Ref | ||||
| Divorced | 0.51 | 0.21-1.25 | 0.14 | 0.5 | 0.17-1.45 | 0.201 |
| Widowed | 1.7 | 0.52-5.55 | 0.376 | 1.38 | 0.34-5.65 | 0.653 |
| Job | ||||||
| Unemployed | Ref | Ref | ||||
| Employed | 0.84 | 0.55-1.27 | 0.408 | 0.97 | 0.55-1.72 | 0.918 |
| Monthly income (SR) | ||||||
| <5000 | Ref | Ref | ||||
| 5000-15000 | 1.03 | 0.63-1.68 | 0.922 | 1.29 | 0.68-2.44 | 0.431 |
| >15000 | 1.2 | 0.65-2.19 | 0.564 | 1.69 | 0.75-3.81 | 0.208 |
| Having children with disabilities | 2.05 | 1.09-3.86 | 0.027 | 1.17 | 0.53-2.58 | 0.688 |
| GAD-7 score | 1.25 | 1.18-1.32 | <.001 | 1.25 | 1.18-1.33 | <.001 |
OR: Odds ratio, CI: Confidence interval, Statistical significance at p <0.05.
DISCUSSION
The current study explored the relationship between poor sleep quality and anxiety among parents. The majority of the participants were mothers, as in the other comparable studies, which may suggest that the mothers were the primary caregivers.[22,23] The results showed consistently that parents of children with disabilities have poor sleep quality and greater anxiety compared to parents of typically developing children.
In line with earlier studies,[2,24] parents of children with disabilities exhibited significantly poorer sleep quality (mean PSQI score: 8.22 ± 3.89) compared to parents of typically developing children (6.84 ± 3.57; p = 0.009). Interestingly, 72.7% of parents of children with disabilities had poor sleep quality compared to 56.5% of parents of typically developing children (p = 0.024). These findings reflect a noticeably poor sleep quality that is likely attributable to the unique caregiving demands, emotional distress, and uncertainty involved in caring for children with disability.[25]
Findings also revealed significant differences between the two groups in certain PSQI components, particularly subjective sleep quality and the use of sleep medication. Parents of children with disabilities had worse subjective sleep (p = 0.031) and higher use of sleep aids (p = 0.012). This finding reinforces the hypothesis that the cumulative caregiving burden contributes not only to persistent emotional strain but also to maladaptive sleep patterns, perhaps as coping mechanisms.[26]
Beyond sleep disruption, anxiety levels measured were significantly higher among parents of children with disabilities than among parents with typically developing children (mean 10.24 ± 5.39 vs. 7.15 ± 5.75, p <0.001). Severe anxiety affected 25.5% of these parents and persisted even after adjusting for demographic factors in the logistic regression model. This may indicate that anxiety severity plays a critical role in predicting poor sleep outcomes, consistent with findings from previous research.[27]
The findings indicate a significant association between anxiety and poor sleep quality among parents. This relationship remained significant even after adjusting for demographic factors such as age, gender, employment status, and educational level. This finding aligned with the previous research findings that show how distress or anxiety can undermine sleep quality, especially in parents caring for children with disabilities.[6,28] The correlation between poor sleep quality and anxiety indicates the need for integrated caregiver assistance. Future research can focus on interventions that improve sleep quality and mental health among parents of children with disabilities.
The preliminary significant association between having children with disabilities and poor sleep quality was attenuated to non-significance in the multivariable analysis, when accounting for other sociodemographic variables and anxiety in the model. This finding may suggest that the initial observed correlation is confounded by other factors in the model. Upcoming studies should therefore move beyond simple sociodemographic controls to examine possible confounders, such as social support, that may explain the underlying associations between caring for a child with a disability and poor sleep quality.
Future research must use longitudinal study designs to clarify the causal relationships between anxiety and sleep disruption. Additionally, while this study focused on parents of children with disabilities broadly, future research may benefit from analysing subtypes of disabilities specifically, such as autism spectrum disorder and physical impairments. Family support and education programs should be created to increase knowledge and awareness of the methods to improve sleep quality and manage anxiety. The workshops typically include practical techniques for anxiety reduction, coping skills, and sleep quality. Ensuring broad access to resources that promote better sleep and reduce anxiety, particularly for parents of children with disabilities, can improve their general health and, in turn, their capacity to provide care for their children.
This study has certain limitations that warrant discussion. No causal conclusions on the relationship between the study variables can be established because this research is a cross-sectional design. In addition, the study relied on convenience sampling, which may limit the generalisability of the findings due to potential selection biases. Reliance on parent self-reports of the study’s variables and the severity of disability could lead to inaccurate information due to misunderstandings of the questions or recall bias. The generalisability of the study could be limited due to the convenience sampling and the small sample size of disability sub-groups. Furthermore, the unequal group sizes in this study may reduce the robustness of between-group comparisons. Despite adjusting for several covariates, unmeasured confounding is still a possibility, for instance, the parental medical conditions.
CONCLUSION
The findings of this study revealed that parents of children with disabilities experience significantly poorer sleep quality and higher anxiety levels compared to parents of typically developing children. Poor sleep in both groups of parents appears to be primarily associated with anxiety, even after controlling for demographic factors. These findings emphasise the need for integrated interventions that address both anxiety and sleep quality to support parents in caring for their children. Efforts by healthcare providers should focus on providing accessible resources that help in reducing anxiety and improving sleep quality.
Ethical approval
The research/study was approved by the Institutional Review Board at King Abdulaziz University, number 1B. 101, dated 28th November 2024.
Declaration of patient consent
The authors certify that they have obtained all appropriate participation consent forms. In the form, the participants have given their consent for their clinical information to be reported in the journal. The participants understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
Use of artificial intelligence (AI)-assisted technology for manuscript preparation
The authors confirm that there was no use of artificial intelligence (AI)-assisted technology for assisting in the writing or editing of the manuscript, and no images were manipulated using AI.
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