scholarly journals Self-Reported Sleep Relates to Microstructural Hippocampal Decline in β-Amyloid Positive Adults Beyond Genetic Risk

SLEEP ◽  
2021 ◽  
Author(s):  
Håkon Grydeland ◽  
Donatas Sederevičius ◽  
Yunpeng Wang ◽  
David Bartrés-Faz ◽  
Lars Bertram ◽  
...  
Keyword(s):  
Sleep Quality ◽  
Genetic Risk ◽  
Critical Role ◽  
Sleep Efficiency ◽  
Poor Sleep ◽  
Time In Bed ◽  
Polygenic Scores ◽  
Memory Decay ◽  
Β Amyloid ◽  
With Memory

Abstract Study Objectives A critical role linking sleep with memory decay and β-amyloid (Aβ) accumulation, two markers of Alzheimer’s disease (AD) pathology, may be played by hippocampal integrity. We tested the hypotheses that worse self-reported sleep relates to decline in memory and intra-hippocampal microstructure, including in the presence of Aβ. Methods Two-hundred and forty-three cognitively healthy participants, aged 19-81 years, completed the Pittsburgh Sleep Quality Index once, and 2 diffusion tensor imaging sessions, on average 3 years apart, allowing measures of decline in intra-hippocampal microstructure as indexed by increased mean diffusivity. We measured memory decay at each imaging session using verbal delayed recall. One session of positron emission tomography, in 108 participants above 44 years of age, yielded 23 Aβ positive. Genotyping enabled control for APOE ε4 status, and polygenic scores for sleep and AD, respectively. Results Worse global sleep quality and sleep efficiency related to more rapid reduction of hippocampal microstructure over time. Focusing on efficiency (the percentage of time in bed at night spent asleep), the relation was stronger in presence of Aβ accumulation, and hippocampal integrity decline mediated the relation with memory decay. The results were not explained by genetic risk for sleep efficiency or AD. Conclusions Worse sleep efficiency related to decline in hippocampal microstructure, especially in the presence of Aβ accumulation, and Aβ might link poor sleep and memory decay. As genetic risk did not account for the associations, poor sleep efficiency might constitute a risk marker for AD, although the driving causal mechanisms remain unknown.

scholarly journals Self-Reported Sleep Relates to Microstructural Hippocampal Decline in β-Amyloid Positive Adults Beyond Genetic Risk

2020 ◽  
Author(s):  
Håkon Grydeland ◽  
Donatas Sederevičius ◽  
Yunpeng Wang ◽  
David Bartrés-Faz ◽  
Lars Bertram ◽  
...  
Keyword(s):  
Sleep Quality ◽  
Genetic Risk ◽  
Diffusion Tensor ◽  
Verbal Learning ◽  
Sleep Efficiency ◽  
Poor Sleep ◽  
Polygenic Scores ◽  
Memory Decay ◽  
Β Amyloid ◽  
Microstructural Integrity

AbstractBackgroundTo test the hypothesis that worse self-reported sleep relates to memory decay and reduced hippocampal integrity as indexed by increased intra-hippocampal water diffusion, and that the relations are stronger in the presence of β-amyloid (Aβ) accumulation, a marker of Alzheimer’s disease (AD) pathology.MethodsTwo-hundred and forty-three cognitively healthy participants, aged 19-81 years, completed the Pittsburgh Sleep Quality Index, and 2 diffusion tensor imaging sessions, on average 3 years apart, allowing measures of decline in hippocampal microstructural integrity as indexed by increased mean diffusivity. We measured memory decay using delayed recall from the California Verbal Learning Test. 18F-Flutemetamol positron emission tomography, in 108 participants above 44 years of age, yielded 23 Aβ positive. Genotyping enabled controlling for APOE ε4 status, and polygenic scores for sleep efficiency and AD.ResultsWorse global sleep quality and sleep efficiency related to more rapid reduction in hippocampal microstructural integrity over time. Focusing on sleep efficiency, the relation was stronger in presence of Aβ accumulation. Sleep efficiency related to memory decay indirectly via hippocampal integrity decline. The results were not explained by genetic risk for sleep efficiency and AD.ConclusionsPoor self-reported sleep efficiency related to decline in hippocampal integrity, especially in the presence of Aβ accumulation. Poor sleep and hippocampal microstructural decline may partly explain memory decline in older adults with Aβ pathology. The relationships were not explained by genetic risk. Poor self-reported sleep efficiency might constitute a risk factor for AD, although the causal mechanisms driving the of observed associations remain unknown.

Actigraphy measured sleep disruption as a predictor of survival in advanced breast cancer.

2013 ◽  
Vol 31 (15_suppl) ◽  
pp. 9532-9532 ◽  
Author(s):  
Oxana Palesh ◽  
Arianna Aldridge Gerry ◽  
Jamie M. Zeitzer ◽  
Cheryl Koopman ◽  
Booil Jo ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Metastatic Breast Cancer ◽  
Sleep Quality ◽  
Disease Progression ◽  
Cancer Patients ◽  
Metastatic Breast ◽  
Sleep Efficiency ◽  
Sleep Disruption ◽  
Poor Sleep ◽  
Time In Bed

9532 Background: Sleep disruption, prevalent in cancer patients and survivors, is associated with disrupted hormonal circadian rhythms and poor quality of life. Previous studies in cancer patients and survivors have pointed out the association between poor sleep and faster disease progression. However, until now these studies have been limited by their retrospective or correlational design, providing little resolution of the question of whether sleep disruption accelerates disease progression or whether disease progression dysregulates sleep, or whether a third factor might underlie the association between sleep dysregulation and disease progression. This study aimed to clarify this relationship by using a longitudinal research design to examine whether sleep disruption assessed at baseline predicts survival in women with metastatic breast cancer. Methods: We examined sleep quality and duration in 97 women diagnosed with metastatic breast cancer (mean age=54.6, SD=9.8) via wrist-worn actigraphy for 3 days and sleep diaries. Sleep quality was operationalized as poor sleep efficiency (the ratio of total asleep time to total time in bed * 100%). Results: As hypothesized, poor sleep efficiency was found to predict shorter survival (Hazard Ratio (HR), 0.96, 95% CI, 0.93 to 0.98, p<0.001) over 6 years. This relationship remained significant (HR, 0.94, CI, 0.91 to 0.97, p<.001) even after controlling for other known prognostic factors (age, ER status, cancer treatment, metastatic spread, cortisol levels, and depression). Conclusions: Our findings show that sleep dysregulation is a clear and significant independent prognostic factor for disease progression in metastatic breast cancer. Further research is needed to determine whether treating sleep disruption with cognitive behavioral therapy or medication can improve survival in metastatic breast cancer. Funded by P01AG018784, R01CA118867, K07CA132916.

scholarly journals Sleep lifestyle correlate of dizziness among teachers

2020 ◽  
Author(s):  
Daiane Soares de Almeida Ciquinato ◽  
Paula Carolina Dias Gibrin ◽  
Carla Juliana Lotti Félix ◽  
Jessica Aparecida Bazoni ◽  
Luciana Lozza de Moraes Marchiori
Keyword(s):  
Young Adults ◽  
Sleep Quality ◽  
Sleep Time ◽  
Cross Sectional Study ◽  
Sleep Efficiency ◽  
Poor Sleep ◽  
Moderate Correlation ◽  
Cross Sectional ◽  
Time In Bed ◽  
Significant Difference

Abstract Introduction Some studies have shown associations between sleep quality and dizziness. However, this association has not been investigated in teachers. Objective To verify a possible association between dizziness complaint and sleep quality in teachers. Methods Cross-sectional study developed with 96 school teachers (mean age of 47.8 ± 9.8 years). To assess dizziness, an audiological assessment was performed, which was the same one used in routine audiological care (Miller protocol). The dizziness handicap inventory (DHI) was applied to those individuals who reported dizziness. To evaluated sleep quality, the Pittsburgh sleep quality index was used. Results The prevalence of dizziness was 22.9% (n = 22). Of these, 77.3% (n = 17) were women, 63.6% (n = 14) demonstrated poor sleep quality, and 54.5% (n = 12) were young adults (27–48 years). In the comparison between the dizziness and the control groups, no statistically significant differences were found (p> 0.05). The analysis adjusted for the confounding variables showed a difference for men in the sleep efficiency variable (p = 0.043); young adults showed a statistically significant difference in the total score (p = 0.021) and total sleep time (p = 0.029). There was a moderate correlation between DHI and total time in bed (p = 0.036, r = 0.497) and DHI and sleep efficiency (p = 0.014; r = -0.582). Conclusion Dizziness influences the quality of sleep in teachers, especially that of the youngest and male patients. There was a moderate correlation between total time in bed, sleep efficiency, and DHI, demonstrating that sleep quality should be considered an important factor in the assessment and rehabilitation process of dizziness.

scholarly journals Differential Effects of DHA- and EPA-Rich Oils on Sleep in Healthy Young Adults: A Randomized Controlled Trial

Nutrients ◽  
2021 ◽  
Vol 13 (1) ◽  
pp. 248
Author(s):  
Michael J. Patan ◽  
David O. Kennedy ◽  
Cathrine Husberg ◽  
Svein Olaf Hustvedt ◽  
Philip C. Calder ◽  
...  
Keyword(s):  
Sleep Quality ◽  
Controlled Trial ◽  
Sleep Time ◽  
Sleep Efficiency ◽  
Omega 3 ◽  
Double Blind ◽  
Differential Effects ◽  
Positive Effects ◽  
Time In Bed ◽  
Oily Fish

Emerging evidence suggests that adequate intake of omega-3 polyunsaturated fatty acids (n-3 PUFAs), which include docosahexaenoic acid (DHA) and eicosapentaenoic acid (EPA), might be associated with better sleep quality. N-3 PUFAs, which must be acquired from dietary sources, are typically consumed at suboptimal levels in Western diets. Therefore, the current placebo-controlled, double-blind, randomized trial, investigated the effects of an oil rich in either DHA or EPA on sleep quality in healthy adults who habitually consumed low amounts of oily fish. Eighty-four participants aged 25–49 years completed the 26-week intervention trial. Compared to placebo, improvements in actigraphy sleep efficiency (p = 0.030) and latency (p = 0.026) were observed following the DHA-rich oil. However, these participants also reported feeling less energetic compared to the placebo (p = 0.041), and less rested (p = 0.017), and there was a trend towards feeling less ready to perform (p = 0.075) than those given EPA-rich oil. A trend towards improved sleep efficiency was identified in the EPA-rich group compared to placebo (p = 0.087), along with a significant decrease in both total time in bed (p = 0.032) and total sleep time (p = 0.019) compared to the DHA-rich oil. No significant effects of either treatment were identified for urinary excretion of the major melatonin metabolite 6-sulfatoxymelatonin. This study was the first to demonstrate some positive effects of dietary supplementation with n-3 PUFAs in healthy adult normal sleepers, and provides novel evidence showing the differential effects of n-3 PUFA supplements rich in either DHA or EPA. Further investigation into the mechanisms underpinning these observations including the effects of n-3 PUFAs on sleep architecture are required.

601 Comparison of Sleep Parameters in Children with Achondroplasia and Trisomy 21

SLEEP ◽  
2021 ◽  
Vol 44 (Supplement_2) ◽  
pp. A236-A237
Author(s):  
Jodi Gustave ◽  
Kaelyn Gaza ◽  
Jennifer Marriner ◽  
Seema Rani ◽  
Abigail Strang ◽  
...  
Keyword(s):  
Sleep Quality ◽  
Rem Sleep ◽  
Trisomy 21 ◽  
Sleep Disturbances ◽  
Sleep Latency ◽  
Sleep Efficiency ◽  
Sleep Architecture ◽  
Poor Sleep ◽  
Arousal Index ◽  
Sleep Parameters

Abstract Introduction Children with achondroplasia and Trisomy 21 (T21) have increased incidence of sleep disturbances including sleep disordered breathing. Abnormal sleep architecture has been documented in children with T21. It is important to continue to analyze sleep parameters in both groups since poor sleep quality is associated with neurocognitive impairment. Methods Following IRB approval, we performed a retrospective chart review of patients at Nemours/A.I. duPont Hospital for Children in Wilmington, DE with achondroplasia and T21 who underwent an initial polysomnogram (PSG) between 2015 and 2020. We compared sleep architecture parameters between the groups including sleep efficiency, total sleep time (TST), sleep latency, arousal index and concentration of N3 and REM sleep. Results In patients with achondroplasia (n=49, mean age 5.8 months and 63.3% male), 12% reported restless sleep. PSG data revealed TST of 392 minutes, mean sleep efficiency of 82%, mean sleep latency of 9.4 min, mean arousal index of 40, 22% REM sleep and 32% N3 sleep. In the patients with T21 (n=32, mean age 17.8 months and 50% male), 59% reported restless sleep. PSG data revealed TST of 393 minutes, mean sleep efficiency of 82%, mean sleep latency of 14 minutes, arousal index of 35, 15% REM sleep and 40% N3 sleep. The differences in REM and N3 sleep between the two groups were statistically significant (p-values of 0.001 and 0.04, respectively), but the differences in arousal index, TST and sleep efficiency were not. Conclusion Our study showed that children with T21 subjectively noted more restless sleep compared to patients with achondroplasia although TST and sleep efficiency were similar. Patients with achondroplasia had a higher arousal index that was not statistically significant. Children with achondroplasia had a shorter sleep latency and more robust REM concentration, likely due to their younger age. There was a higher concentration of N3 sleep in patients with T21. This is likely due to the decrease in REM concentration. In conclusion, it is important to establish expected sleep parameters in patients with achondroplasia and T21 to maximize sleep quality and mitigate negative neurocognitive effects of poor sleep. Support (if any):

scholarly journals 0127 Relationship Between Sleep Metrics with Free-Living Glucose Concentrations and Glycemic Variability in Non-Diabetic Adults

SLEEP ◽  
2020 ◽  
Vol 43 (Supplement_1) ◽  
pp. A50-A50
Author(s):  
J R Sparks ◽  
E E Kishman ◽  
X Wang
Keyword(s):  
South Carolina ◽  
Glucose Metabolism ◽  
Sleep Onset ◽  
Glycemic Variability ◽  
Sleep Efficiency ◽  
Sleep Diary ◽  
Poor Sleep ◽  
Free Living ◽  
Experimental Conditions ◽  
Time In Bed

Abstract Introduction Insufficient sleep and poor sleep quality have been associated with impaired glucose metabolism at fasting and under experimental conditions. Continuous glucose monitoring (CGM) measures glucose concentrations over an extended, free-living period that can be used to assess glycemic health. Relationships between CGM-assessed glucose concentrations and glycemic variability, an emerging glycemic health marker, with sleep metrics have yet to be elucidated. The purpose of this study was to examine the relationships between sleep metrics with glucose concentrations and glycemic variability in non-diabetic adults. Methods Twenty-four non-diabetic adults (age=46.0±5.8 years; BMI=32.2±5.7 kg/m2) completed actigraphy, sleep diary, and CGM over 7 consecutive days. Time-in-bed (TIB), total sleep time (TST), wake duration after sleep onset, and sleep efficiency [(TST÷TIB)×100%] were determined using actigraphy assisted with sleep diary input. Nightly variability of each sleep metric was calculated as standard deviation (SD) across all nights. Glucose concentrations at waking in the morning, and 1, 2, and 3 hours prior to waking, and diurnal, nocturnal, and 24-hour means were determined. Intra-day glycemic variability, including mean amplitude of glycemic excursions and continuous overlapping of net glycemic action of 1, 2, and 4 hours, and inter-day glycemic variability, mean of daily differences, were calculated. Pearson product correlations between sleep metrics with glucose concentrations and glycemic variability were performed. Results Average TIB and TST were 462.6±61.7 minutes and 403.3±59.7 minutes, respectively. TIB negatively correlated with glucose concentrations at 2 and 3 hours prior to waking (r=-0.42, p=0.04 and r=-0.42, p=0.04, respectively). Nightly variability in sleep efficiency positively correlated with waking, and 1, 2, and 3 hours prior to waking glucose concentrations (0.44≤r≤0.48, p≤0.03 for all). No sleep metrics correlated with glycemic variability measures (p≥0.10 for all). Conclusion Findings suggest a longer amount of sleep opportunity and more consistent sleep efficiency relate to better glucose metabolism in non-diabetic adults. Support American Heart Association 14BGIA20380706 and University of South Carolina Support to Promote Advancement of Research and Creativity Grant #11530-17-43917.

scholarly journals 1134 Light Exposure At Daytime On Sleep Quality In Stroke Patient During Rehabilitation

SLEEP ◽  
2020 ◽  
Vol 43 (Supplement_1) ◽  
pp. A432-A432
Author(s):  
W Liao ◽  
S Lin ◽  
N Meng ◽  
H Tin ◽  
S Tsai ◽  
...  
Keyword(s):  
Sleep Quality ◽  
Stroke Patient ◽  
Light Exposure ◽  
Sleep Onset ◽  
Bright Light ◽  
Sleep Efficiency ◽  
Poor Sleep ◽  
Cross Sectional ◽  
Melatonin Concentration ◽  
Improve Sleep Quality

Abstract Introduction Lights maintain the day and night rhythm to set patients’ “wake-up cycle” and to stabilize their physiological functions, which may be expected to improve sleep. This study was aimed to investigate the relations between sleep quality and daytime light exposure in stroke patient during rehabilitation. Methods A cross-sectional study design was adopted and 120 stroke patients were recruited from rehabilitation wards of two medical centers and 116 patients completed this study. Research instruments including the Pittsburgh Sleep Quality Index, Epworth Sleepiness Scale, Sleep Log, and Somnowatch (Germany) for actigaphy sleep and light were used to collect data and urinary melatonin concentration were measured. Results 47.4% of the patients had poor sleep quality (PSQI&gt;5), 74.1% had actigraphic sleep efficiency less than 85%, and 90.5% waked more than 30 minutes after sleep onset. The average exposure time at lower level light (≤149 lux) were 288.8 minutes, accounting for 48% of the day (8:00-18:00). Compared to lower light exposure group (less than 319.5 min at &gt;150 lux), those who exposed to higher level light (more than 319.5 min at &gt;150 lux) had increased 52.1 minutes in actigraphic total sleep time (TST, t=-2.134, p=0.035), increased 8% in actigraphic sleep efficiency (SE, t=-2.053, p=0.042), and decreased 41.1 minutes in actigraphic wake-after-sleep-onset (WASO, t=2.209, p=0.029). Urinary melatonin concentration increased 52.7 pg/ml, but not statistically significant (t=-1.277, p=0.205). Result of multiple regression analysis showed that after controlling for age, gender, post-stroke complications, and environmental interference, time of bright light exposure significantly affected subjective sleep satisfaction (p=0.014), TST (p=0.04), SE (p=0.041), and WASO (p=0.026). Conclusion Increasing time of bright illumination (≥150 lux) during daytime may improve sleep quality. Results of this study provide empirical references for non-drug intervention to improve sleep quality in patients with stroke. Support This study was supported by the Ministry of Science and Technology, MOST 105-2628-B-040 -005 -MY2.

scholarly journals POOR SLEEP QUALITY IS RELATED TO DECREASED WHITE MATTER INTEGRITY IN BRAIN NOCICEPTIVE PATHWAYS IN OLDER ADULTS

2019 ◽  
Vol 3 (Supplement_1) ◽  
pp. S367-S368
Author(s):  
Anna R Egbert ◽  
Ryan S Falck ◽  
John R Best ◽  
Linda Li ◽  
Lynne Feehan ◽  
...  
Keyword(s):  
Older Adults ◽  
White Matter ◽  
Sleep Quality ◽  
Sleep Efficiency ◽  
Sensor Data ◽  
White Matter Integrity ◽  
Poor Sleep ◽  
Accelerometer Data ◽  
Poor Sleep Quality ◽  
Brain White Matter

Abstract Poor sleep quality, decreased physical activity (PA) and increased sedentary behavior (SB) are common characteristics of older adults. Notably, these factors play an important role in brain health. We examined the relationship between sleep quality, PA, SB and brain white matter integrity (WM) in older adults with osteoarthritis (OA). We retained data on 16 participants (mean age 60, SD=7.7) from a larger Monitor-OA cohort recruited from Metro Vancouver, BC, Canada. Sleep efficiency and duration, amount of time spent on PA and SB daily over a period of one week was acquired with an objective measure – the multi-sensor monitor SenseWear Mini which integrates tri-axial accelerometer data, physiological sensor data and personal demographic information. Brain WM tractography was calculated from fractional anisotropy data obtained with diffusion weighted magnetic resonance imaging. Voxelwise group-level statistics examined the effects of our variables of interest on the integrity of brain WM tracts while controlling for participants age. We found that lower sleep efficiency was related to decreased integrity in WM tracts of frontal, temporal lobes, precuneus and thalamus (Bonferroni corrected p&lt;0.05). Shorter sleep was related to lower WM integrity in frontal regions, posterior cingulate and insula radiations (Bonferroni corrected p&lt;0.05). No significant effects were noted for PA or SB. The identified brain regions are involved in sleep processes but further overlap with the nociceptive brain network. Our findings suggest that neural mechanisms related to sleep disturbance may also involve pain-related processing in older adults.

scholarly journals Sleep Pattern Changes in Nursing Students during the COVID-19 Lockdown

2020 ◽  
Vol 17 (14) ◽  
pp. 5222 ◽  
Author(s):  
Cristina Romero-Blanco ◽  
Julián Rodríguez-Almagro ◽  
María Dolores Onieva-Zafra ◽  
María Laura Parra-Fernández ◽  
María del Carmen Prado-Laguna ◽  
...  
Keyword(s):  
Nursing Students ◽  
Sleep Quality ◽  
Nonparametric Tests ◽  
Normal Weight ◽  
Lifestyle Changes ◽  
Poor Sleep ◽  
First Year Students ◽  
Time In Bed ◽  
The Difference ◽  
Stratified Analysis

The prevalence of poor sleep quality among students is very high and, in nursing students, has been associated with reduced performance, behavioral changes, dietary changes, and even aggressive behavior due to changes in sleep patterns. The lockdown in response to COVID-19 may have resulted in lifestyle changes that affected sleep quality. For this reason, the objective of this study is to determine the difference in nursing students’ sleep quality before and during the lockdown, put in place in response to the coronavirus (COVID-19) pandemic. To meet this objective, we conducted a longitudinal observational study on 207 nursing students, with two cut-off points (February and April). The main dependent variable was sleep quality, measured using the Pittsburgh sleep quality index (PSQI) and its seven components. Parametric and nonparametric tests were used for paired and unpaired data, as well as group-stratified analysis. The mean time students spent in bed was 7.6 h (standard deviation (SD) = 1.1 h) before lockdown and 8.5 h (SD = 1.2 h) during lockdown. The PSQI score got 0.91 points worse during lockdown (95% CI, −0.51, −1.31). Of the five components, five were statistically significantly affected (p ≤ 0.05), and of these, the most changed were sleep latency, sleep duration, and sleep efficiency. When stratified by group, we observed differences in women, first-year students, second-year students, alcohol consumers, those of normal weight, and those that live with family. The main conclusion is that although students spent more time in bed, overall sleep quality was worse during lockdown, as well as being worse in five of the seven components.

Sleep disturbance and fatigue in mild relapsing remitting multiple sclerosis patients on chronic immunomodulant therapy: an actigraphic study

2009 ◽  
Vol 16 (2) ◽  
pp. 238-247 ◽  
Author(s):  
Laura Mendozzi ◽  
Federica Tronci ◽  
Massimo Garegnani ◽  
Luigi Pugnetti
Keyword(s):  
Sleep Quality ◽  
Glatiramer Acetate ◽  
Current Treatment ◽  
Sleep Efficiency ◽  
Poor Sleep ◽  
Chronic Therapy ◽  
Relapsing Remitting ◽  
Mild Disability ◽  
Multiple Sclerosis Patients ◽  
At Home

Background: poor sleep is common in MS and it contributes to fatigue. The β interferons produce systemic effects which may not adapt and may induce fatigue. Objective: to verify whether subjective poor sleep and fatigue during chronic therapy correspond to reduced sleep efficiency obtained by actigraphy at home. Methods: 42 ambulatory relapsing remitting MS patients with mild disability were monitored for at least 7 nights. Habitual sleep quality and fatigue were assessed with the MOS sleep measure and the Fatigue Severity Scale. Sleep logs provided daily sleep quality assessments during actigraphy at home. Patients were grouped according to their current treatment: no therapy, glatiramer acetate, IFNβ 3 times a week, and IFNβ once a week. Results and Conclusion: sleep efficiency was reduced by an average of 5% in 2/3 of the nights following IFNβ injections compared to the other nights, and daily sleep ratings correlated with actigraphy. Patients on glatiramer acetate also showed a lower sleep efficiency than patients without therapy. Actigraphy data were only modestly correlated with MOSsm scores, not with fatigue. Long term adaptation of sleep effects of immunomodulant agents is incomplete and needs to be considered in treatment planning and assessment of sleep in MS.

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