Caregivers’ experience of sleep management in Smith–Magenis syndrome: a mixed-methods study


Background: Smith–Magenis syndrome (SMS) is a rare genetic syndrome associated with a unique profile of early morning waking and daytime sleepiness. Children with SMS evidence high rates of self-injury and aggression and have a preference for adult over peer attention, with strong motivation to interact with a particular caregiver. In addition, people with SMS have lower adaptive functioning skills relative to cognitive abilities and demonstrate high levels of impulsivity. Taken together, these factors may result in individuals being awake overnight requiring vigilant caregiver supervision. Despite these complexities, no study has described the strategies caregivers take to keep their children with SMS safe overnight or considered the impact of these experiences on caregivers or the wider family. Methods: The current study used a mixed-methods approach to consider sleep management strategies and challenges for caregivers of people with SMS at different ages. Caregivers completed an international online survey about sleep management and related difficulties, use of interventions and access to services and support. Semi-structured interviews were conducted with 14 caregivers in the UK to increase understanding of caregiver experiences and priorities for change in the UK context. Interviews were transcribed verbatim and coded using thematic analysis. Results: Evidence from the online survey (n = 40) revealed wide-ranging impacts of poor sleep on the person with SMS and the wider family. Only 5% of caregivers reported that the sleep problems had no impact on their child, and 76% reported a moderately or extremely significant impact on themselves. For some individual caregivers, sleep management difficulties improved over time whereas for others no change was reported. Weekly respite emerged as the ideal provision for 49% of caregivers, although only 14% had access to this. The majority of caregivers (54%) received no respite. Thematic analysis of qualitative interviews revealed interactions between aspects of the behavioural phenotype of SMS which may contribute to complex and unusual presentations in relation to sleep management and safety. Conclusions: Caregivers’ priorities for sleep management and support were delineated, with key implications for services in terms of the use of SMS-sensitive strategies and respite provision.

Publication DOI:
Divisions: College of Health & Life Sciences > School of Psychology
College of Health & Life Sciences > Aston Institute of Health & Neurodevelopment (AIHN)
Funding Information: This study was supported by funding from Smith–Magenis Syndrome (SMS) Foundation UK and Cerebra.
Additional Information: Publisher Copyright: © 2022, The Author(s). Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit The Creative Commons Public Domain Dedication waiver ( applies to the data made available in this article, unless otherwise stated in a credit line to the data. Funding Information: This study was supported by funding from Smith–Magenis Syndrome (SMS) Foundation UK and Cerebra.
Uncontrolled Keywords: Caregivers,Parents,Smith–Magenis syndrome,Sleep,Safety,Qualitative,Disability,Genetics(clinical),Pharmacology (medical)
Publication ISSN: 1750-1172
Last Modified: 22 May 2024 07:35
Date Deposited: 24 Aug 2022 10:16
Full Text Link:
Related URLs: http://www.scop ... tnerID=8YFLogxK (Scopus URL) ... 023-021-02159-8 (Publisher URL)
PURE Output Type: Article
Published Date: 2022-02-04
Accepted Date: 2021-12-19
Authors: Agar, Georgie (ORCID Profile 0000-0001-8707-8713)
Bissell, Stacey
Wilde, Lucy
Over, Nigel
Williams, Caitlin
Richards, Caroline
Oliver, Chris



Version: Published Version

License: Creative Commons Attribution

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