Investigation of the Sleep Quality of Children Ages 4 to 6 Yr With Cerebral Palsy and Cerebral Visual Impairment and Their Caregivers' Sleep Quality and Levels of Depression and Anxiety.
Cemali M, Alataş D, et al. • The American journal of occupational therapy : official publication of the American Occupational Therapy Association • 2026
CVI in children with CP has been associated with poorer sleep in both children and caregivers, as well as higher psychological burden in caregivers, and children's sleep quality emerged as the main predictor of maternal anxiety and depression.
Key Findings
Results
Children with cerebral palsy and comorbid cerebral visual impairment had significantly poorer sleep quality than children with cerebral palsy without CVI.
Sleep quality was assessed using the Child Sleep Habits Questionnaire (CSHQ)
Children with CVI had significantly higher CSHQ scores (p < .05), indicating worse sleep
Sample included 42 children with CP and CVI compared to 42 children with CP without CVI
Children were ages 4 to 6 years, studied between November 2023 and April 2024 at a special education and rehabilitation center
Results
Mothers of children with CP and CVI reported significantly worse sleep quality compared to mothers of children with CP without CVI.
Maternal sleep was assessed using the Pittsburgh Sleep Quality Index (PSQI)
Mothers of children with CVI had significantly higher PSQI scores (p < .05), indicating poorer sleep quality
Each group of mothers corresponded to their respective child group (42 mothers per group)
Mothers served as primary caregivers for their children
Results
Mothers of children with CP and CVI exhibited significantly higher levels of anxiety and depression than mothers of children with CP without CVI.
Maternal anxiety was assessed with the Beck Anxiety Inventory (BAI) and depression with the Beck Depression Inventory (BDI)
Mothers of children with CVI had significantly higher BAI and BDI scores (p < .05)
Both anxiety and depression levels were elevated in the CVI caregiver group
These findings indicate a higher psychological burden among caregivers of children with CVI
Results
Visual Function Classification System (VFCS) score correlated with all child and maternal outcome measures.
VFCS was used to assess visual functioning in children with CP
VFCS score was correlated with children's sleep quality (CSHQ scores)
VFCS score was also correlated with maternal sleep quality (PSQI), anxiety (BAI), and depression (BDI)
This suggests that the degree of visual impairment in children is associated with broader well-being outcomes for both child and caregiver
Results
Children's sleep quality was the main predictor of maternal anxiety and depression.
Regression or predictor analyses identified children's sleep quality as the primary factor influencing maternal mental health outcomes
This association was statistically significant (p < .05)
Maternal anxiety (BAI) and depression (BDI) were both predicted by child sleep quality
This finding underscores the interdependence between child sleep disturbances and caregiver psychological health
Methods
The study design was a cross-sectional comparative study including 84 children with CP and their caregiver mothers.
42 children had CP with CVI and 42 had CP without CVI, ages 4 to 6 years
Primary caregiver mothers were included as the caregiver sample
Study was conducted between November 2023 and April 2024 at a special education and rehabilitation center
Instruments used included CSHQ, VFCS, PSQI, BAI, and BDI
What This Means
This research suggests that when children with cerebral palsy (CP) also have cerebral visual impairment (CVI) — a brain-based condition affecting how visual information is processed — they tend to sleep worse than children with CP alone. The study compared 42 children ages 4–6 with both CP and CVI to 42 children with CP but without CVI, along with their mothers. Children with CVI had higher scores on a standardized sleep problems questionnaire, indicating more disrupted sleep. The worse a child's visual functioning was, the worse their sleep problems tended to be.
This research also suggests that the effects of CVI extend beyond the child and significantly impact caregiving mothers. Mothers of children with CVI reported poorer sleep quality, higher anxiety, and higher depression levels compared to mothers of children without CVI. Importantly, the child's sleep quality was identified as the strongest predictor of the mother's mental health — meaning that when children slept poorly, their mothers were more likely to experience anxiety and depression.
These findings matter because they highlight that visual impairment and sleep problems in children with CP should not be treated in isolation. Rehabilitation professionals, including occupational therapists, may benefit from addressing both visual and sleep issues together, and from screening caregivers for psychological distress. The study calls for further research to turn these findings into concrete clinical practice guidelines.
Cemali M, Alataş D, Öztürk D, Sarı M, Karaduman A. (2026). Investigation of the Sleep Quality of Children Ages 4 to 6 Yr With Cerebral Palsy and Cerebral Visual Impairment and Their Caregivers' Sleep Quality and Levels of Depression and Anxiety.. The American journal of occupational therapy : official publication of the American Occupational Therapy Association. https://doi.org/10.5014/ajot.2026.051400