Signs of Central Hypersensitivity, Stress, and Anxiety following Treatment for Breast Cancer: A Case Control Study

Background. With treatment for breast cancer, women treated may present significant sensory abnormalities in the upper extremity. However, there are no conclusive studies that have evaluated pressure pain thresholds (PPT) in the shoulder of postoperated women for breast cancer. The aim of this study was to compare PPT in the shoulder, stress, anxiety, depression symptoms, and quality of sleep among postoperated women for breast cancer (PO group) and asymptomatic women of shoulder pain (control group). Methods. 40 women participated ( n = 20 , PO group, age: average ± standard deviation , 49.2 ± 8.3 years; body mass index (BMI): 27.5 ± 3.0 kg/cm2; surgery time: 22.2 ± 34.4 months; n = 20 , control group, 46.9 ± 8.1 years; BMI: 26.8 ± 3.5 kg/cm2). The PPT was evaluated with a digital algometer at 32 points in the shoulder region and one control point in the tibialis anterior. Stress, anxiety, and depression were evaluated with the Depression, Anxiety and Stress Scale 21 (DASS-21) and the quality of sleep by the Pittsburgh Sleep Quality Index. Results. Significant differences were observed over 1.5 kgf/cm2 in 33 points evaluated ( p < 0.01 ) with a small to high effect size (Cliff’s delta range = 0.16 ; 0.92) and higher levels of anxiety and stress in the PO group (anxiety: median [first; third quartile], 5[3; 12.5]; stress: 9.7 ± 4.7 (7.8; 11.8)) in comparison with the control group (anxiety: 2.5[1; 4.8]; stress: 6.7 ± 3.31 (5.2; 8.3), ( p < 0.05 )). No significant differences were found between the groups in depression and sleep quality ( p > 0.05 ). Conclusion. Postoperated women for breast cancer present hyperalgesia in the shoulder anterior and posterior region, low PPT in the tibialis anterior, and higher levels of stress and anxiety compared to the control group.

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696 Quality of sleep is the only predictor of suicide during Covid-19 lockdown in University students?

SLEEP ◽

10.1093/sleep/zsab072.694 ◽

2021 ◽

Vol 44 (Supplement_2) ◽

pp. A272-A272

Author(s):

Alessandra Castelnuovo ◽

Samantha Mombelli ◽

Daniela Bottoni ◽

Antonella Somma ◽

Andrea Fossati ◽

...

Keyword(s):

Medical Students ◽

Suicidal Ideation ◽

Sleep Quality ◽

Sleep Disorders ◽

Social Stress ◽

Depression Symptoms ◽

Daily Routine ◽

Quality Of Sleep ◽

Suicidal Thoughts

Abstract Introduction COVID-19 epidemic led to great psychological and social stress, related to anxiety, depression, sleep disorders, suicidal risk and behavior, and changes in daily routine. The aim of this study was to assess the psychological impact of COVID-19 lockdown in Italian students. We focused on perceived sleep quality, anxiety and depression symptoms, and mostly on risk of suicide. Methods A total of 307 students (mean age 22.84±2.68) completed Pittsburgh Sleep Quality Index (PSQI), Insomnia Severity Index (ISI), Beck Anxiety Inventory (BAI), and Beck Depression Inventory-II (BDI-II). In our study, we focused on item 9 of BDI-II, that is related to suicide. We divided our sample on presence or absence of suicidal ideation based on this item. Results We found that 30.1% showed depressive, while 38.2% anxious symptoms. Concerning item 9 of BDI-II (suicidal thoughts or wishes), 84.7% answered that they do not have any thoughts of killing themselves, while 15.3% answered that they have some suicidal ideation. Concerning sleep variables, we found that 58% of our sample showed a PSQI total score higher than 5 (poor quality of sleep), and a global worsening in sleep quality and increase of insomnia both in student with and without suicidal ideation. Conclusion Our results on risk of suicide are in line with literature. Recent reviews focused on suicidal ideation in medical students found that depressive symptoms and suicidal ideation are common among medical students, finding a prevalence of suicidal ideation of 11%. Several studies suggest that sleep disorders are a risk factor for suicidal thoughts and behaviours. Our findings show that sleep cannot considered a predictive factor of risk of suicide during health emergency, because the risk is polyfactorial. Support (if any) None

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Pilates and dance to patients with breast cancer undergoing treatment: study protocol for a randomized clinical trial – MoveMama study

Trials ◽

10.1186/s13063-019-3874-6 ◽

2020 ◽

Vol 21 (1) ◽

Cited By ~ 1

Author(s):

Leonessa Boing ◽

Tatiana do Bem Fretta ◽

Melissa de Carvalho Souza Vieira ◽

Gustavo Soares Pereira ◽

Jéssica Moratelli ◽

...

Keyword(s):

Breast Cancer ◽

Quality Of Life ◽

Physical Activity ◽

Body Image ◽

Side Effects ◽

Sleep Quality ◽

Control Group ◽

Belly Dance ◽

Belly Dancing

Abstract Background Breast cancer is a global public health issue. The side effects of the clinical treatment can decrease the quality of life of these women. Therefore, a healthy lifestyle is essential to minimize the physical and psychological side effects of treatment. Physical activity has several benefits for women with breast cancer, and Pilates solo and belly dancing can be an enjoyable type of physical activity for women with breast cancer undergoing clinical treatment. The purpose of this study is to provide a Pilates solo and a belly dance protocol (three times per week/16 weeks) for women undergoing breast cancer treatment and compare its effectiveness with that in the control group. Methods The participants will be allocated to either the intervention arm (Pilates solo or belly dance classes three times per week for 16 weeks) or a control group (receipt of a booklet on physical activity for patients with breast cancer and maintenance of habitual physical activity routine). The Pilates solo and belly dance classes will be divided into three stages: warmup and stretching, the main stage, and relaxation. Measurements of the study outcomes will take place at baseline; postintervention; and 6, 12, and 24 months after the end of the intervention (maintenance period). The data collection for both groups will occur with a paper questionnaire and tests covering general and clinical information. The primary outcome will be quality of life (EORT QLQ-C30 and EORT QLQ-BR23), and secondary outcomes will be physical aspects such as cardiorespiratory fitness (6-min walk test and cycle ergometer), lymphedema (sum of arm circumference), physical activity (IPAQ short version), disabilities of the arm (DASH), range of motion (goniometer test), muscular strength (dynamometer test) and flexibility (sit and reach test), and psychological aspects such as depressive symptoms (Beck Depression Inventory), body image (Body Image After Breast Cancer Questionnaire), self-esteem (Rosenberg), fatigue (FACT-F), pain (VAS), sexual function (FSFI), and sleep quality (Pittsburgh Sleep Quality Index). Discussion In view of the high prevalence of breast cancer among women, the implementation of a specific protocol of Pilates solo and belly dancing for patients with breast cancer is important, considering the necessity to improve their physical and psychological quality of life. Pilates solo and belly dancing are two types of physical activity that involve mental and physical concentration, music, upper limb movements, femininity, and social involvement. An intervention with these two physical activities could offer options of supportive care to women with breast cancer undergoing treatment, with the aim being to improve physical and psychological quality of life. Trial registration ClinicalTrials.gov, NCT03194997. Registration date 12 August 2017. Universal Trial Number (World Health Organization), U1111-1195-1623.

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Quality of sleep in pregnant woman with low back pain

Fisioterapia em Movimento ◽

10.1590/0103-5150.028.002.ao12 ◽

2015 ◽

Vol 28 (2) ◽

pp. 319-326 ◽

Cited By ~ 3

Author(s):

Vanessa Patrícia Soares de Sousa ◽

Silvia Oliveira Ribeiro ◽

Carla Monique Ribeiro de Aquino ◽

Elizabel de Souza Ramalho Viana

Keyword(s):

Low Back Pain ◽

Back Pain ◽

Sleep Quality ◽

Pearson Correlation ◽

Control Group ◽

Low Back ◽

Quality Of Sleep ◽

Pressure Algometer ◽

The Relationship

Introduction Pregnancy is characterized by several changes in her body. These changes contribute to the emergence of low back pain, which may influence the quality of sleep during pregnancy. Objective To compare the quality of sleep among pregnant women with and without low back pain during pregnancy, examining the relationship between two variables. Materials methods Thirty volunteers aged between 19 and 36 years, divided into control group (CG – n = 16) and Study Group (SG – n = 14), residents in the cities of Natal, were evaluated in the second trimester of pregnancy. To sleep evaluation were used to index the Pittsburgh Sleep Quality and the Epworth Sleepiness Scale. Low back pain was evaluated using the pressure algometer, Visual Analogue Scale (VAS) and Oswestry Disability Index. Statistical analysis used the Shapiro Wilk test, Student’s T test for independent samples and Pearson correlation test. Results The mean gestational and chronological ages were 28.2 ± 3.4 years and 19.9 ± 3.7 weeks, respectively. Sleep quality was lower in SG (8.21 ± 4.8) when compared to CG (5.94 ± 1.7) and was statistically significant (P = 0.021). Analyzing the relationship between sleep quality and pain intensity, it was observed that the variables have a positive correlation between them (r = 0.372, P = 0.043). Conclusion Our findings indicate that sleep quality is decreased in women with low back pain compared to those without pain.

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Examining relationships between sleep posture, waking spinal symptoms and quality of sleep: A cross sectional study

PLoS ONE ◽

10.1371/journal.pone.0260582 ◽

2021 ◽

Vol 16 (11) ◽

pp. e0260582

Author(s):

Doug Cary ◽

Angela Jacques ◽

Kathy Briffa

Keyword(s):

Sleep Quality ◽

Online Survey ◽

General Information ◽

Control Group ◽

Quality Of Sleep ◽

Cross Sectional ◽

Obstructive Sleep ◽

Patient Reported ◽

Sleep Posture

Introduction Research with a focus on sleep posture has been conducted in association with sleep pathologies such as insomnia and positional obstructive sleep apnoea. Research examining the potential role sleep posture may have on waking spinal symptoms and quality of sleep is however limited. The aims of this research were to compare sleep posture and sleep quality in participants with and without waking spinal symptoms. Methods Fifty-three participants (36 female) were, based on symptoms, allocated to one of three groups; Control (n = 20, 16 female), Cervical (n = 13, 10 female) and Lumbar (n = 20, 10 female). Participants completed an online survey to collect general information and patient reported outcomes and were videoed over two consecutive nights to determine sleep posture using a validated classification system including intermediate sleep postures. Results Participants in the symptomatic groups also reported a lower sleep quality than the Control group. Compared to Control group participants, those in the Cervical group had more frequent posture changes (mean (SD); 18.3(6.5) versus 23.6(6.6)), spent more time in undesirable/provocative sleep postures (median IQR; 83.8(16.4,105.2) versus 185.1(118.0,251.8)) minutes and had more long periods of immobility in a provocative posture, (median IQR: 0.5(0.0,1.5) versus 2.0 (1.5,4.0)). There were no significant differences between the Control and Lumbar groups in the number of posture changes (18.3(6.5) versus 22.9(9.1)) or the time spent in provocative sleep postures (0.5(0.0,1.5) versus 1.5(1.5,3.4)) minutes. Discussion This is the first study using a validated objective measure of sleep posture to compare symptomatic and Control group participants sleeping in their home environment. In general, participants with waking spinal symptoms spent more time in provocative sleep postures, and experienced poorer sleep quality.

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Quality of Sleep and Quality of Life during Pregnancy

Journal of the Korean Neurological Association ◽

10.17340/jkna.2020.3.4 ◽

2020 ◽

Vol 38 (3) ◽

pp. 188-193

Author(s):

Keun Tae Kim ◽

Hyoeun Bae ◽

Jin Gon Bae ◽

Yong Won Cho

Keyword(s):

Sleep Quality ◽

Pregnant Women ◽

Short Form ◽

Life Quality ◽

Control Group ◽

Quality Of Sleep ◽

Third Trimester ◽

Cross Sectional ◽

Sf 36

Background: The prevalence of sleep disorders increases as pregnancy progresses, which affects the health of pregnant women, fetal health, and the outcomes of pregnancy. The aim of this study is to evaluate the quality of sleep and life in pregnant women in Korea.Methods: This study is a prospective cross-sectional, case-control study of pregnant women and age-matched controls. From July to September 2019, all participants completed Korean-language versions of the sleep questionnaires including Pittsburgh sleep quality index (K-PSQI), Insomnia severity index, Epworth sleepiness scale, Back’s depression inventory-2(K-BDI), STOP (Snoring, Tiredness, Observed apneas, and high blood Pressure), and short-form 36 (K-SF-36).Results: A total of 422 participants consisted of 385 pregnant women and 137 controls. Second and third trimester were 200 and 185, respectively. K-PSQI scores were higher in pregnant women compared with the controls (7.87±3.49 and 8.50±3.55 vs. 5.79±2.76, <i>p</i><0.001). Total score of K-SF-36 was lowest in third trimester (62.07±17.72) and highest in the control group(79.41±13.36). There was no statistical difference between groups in K-BDI.Conclusions: This study demonstrated worsening of sleep quality as well as life quality during pregnancy. More attention to sleep of pregnant women is needed.

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PENGARUH LATIHAN JALAN KAKI TERHADAP KUALITAS TIDUR PADA PASIEN KANKER PAYUDARA YANG MENJALANI KEMOTERAPI DI RSUP DR. M DJAMIL PADANG

JURNAL KESEHATAN MERCUSUAR ◽

10.36984/jkm.v3i1.80 ◽

2020 ◽

Vol 3 (1) ◽

pp. Page16-27

Author(s):

Weny Amelia ◽

Mira Andika ◽

Diana Yulanda

Keyword(s):

Breast Cancer ◽

Sleep Quality ◽

Cancer Patients ◽

Quality Index ◽

Quality Score ◽

P Value ◽

Breast Cancer Patients ◽

Quality Of Sleep ◽

Walking Exercise

Abstrak Kemoterapi merupakan salah satu modalitas pengobatan kanker untuk mengatasi stadium lokal maupun metastase. Masalah yang sering muncul pada pasien kanker payudara yang menjalani kemoterapi adalah gangguan tidur sehingga berpengaruh terhadap kualitas tidur pasien. Penurunan kualitas tidur yang dialami oleh pasien kanker payudara yang menjalani kemoterapi dapat diatasi dengan latihan jalan kaki. Latihan jalan kaki merupakan kegiatan atau aktivitas yang dilakukan dengan menggunakan kedua kaki yang diikuti dengan ayunan tangan atau bagian anggota tubuh secara sinergis. Tujuan penelitian ini adalah untuk melihat pengaruh latihan jalan kaki terhadap kualitas tidur padapasien kanker payudara yang menjalani kemoterapi. . Penelitian ini dilakukan di RSUP Dr. M.Djamil Padang. Waktu penelitian ini dimulai pada tanggal 4-9 September 2019. Penelitian ini menggunakan pre eksperimet design dengan rancangan one group pretest-posttest design. Pengumpulan data dilakukan dengan menggunakan kuesioner PSQI (Pittsburgh Quality Index) untuk mengetahui kualitas tidur pasien berupa latihan jalan kaki selama 30 menit dilakukan 3 kali dalam 3 hari. . Hasil penelitian dengan uji statistik uji paired sampel t-test didapatkan bahwa rata-rata skor kualitas tidur sebelum intervensi 12.16 dan rata-rata skor kualitas tidur setelah intervensi 7.16. Penelitian ini menemukan perbedaan bermakna peningkatan kualitas tidur sebelum dan setelah intervensi p value = 0,000 ( p< 0.05) sehingga dapat disimpulkan bahwa terdapat pengaruh latihan jalan kaki terhadap kualitas tidur pasien kanker payudara yang menjalani kemoterapi. . Disarankan kepada perawat untuk memberikan edukasi latihan jalan kaki kepada pasien kanker payudara yang menjalani kemoterapi untuk meningkatkan kualitas tidur pasien, sehingga dapat meningkatkan kondisi kesehatan pasien secara umum yang nantinya dapat memperbaiki dan meningkatkan kualitas hidup pasien kanker payudara. Kata Kunci : Latihan Jalan kaki, Kualitas Tidur, Kanker Payudara, Kemoterapi Abstract Chemotherapy is one of the modalities of cancer treatment to overcome the local stage and metastasis. The problem that often arises in breast cancer patients undergoing chemotherapy is sleep disorders that affect the patient's sleep quality. Decreased sleep quality experienced by breast cancer patients undergoing chemotherapy can be overcome by walking exercises. Walking exercises are activities or activities carried out using both legs followed by swinging hands or parts of the body synergistically. The purpose of this study was to look at the effect of walking training on sleep quality in breast cancer patients undergoing chemotherapy. . This research was conducted at the Dr. M.Djamil Padang. When this study began on September 4-9, 2019. This study used a pre-experimental design with one group pretest-posttest design. Data collection was carried out using a PSQI (Pittsburgh Quality Index) questionnaire to determine the quality of sleep of patients in the form of 30 minutes of walking exercises performed 3 times in 3 days. . The results of the study with the statistical test paired sample t-test found that the average sleep quality score before the intervention was 12.16 and the average sleep quality score after the intervention was 7.16. This study found a significant difference in the improvement of sleep quality before and after the intervention p value = 0,000 (p <0.05) so that it can be concluded that there is an effect of walking exercise on the sleep quality of breast cancer patients undergoing chemotherapy. . It is recommended to nurses to provide education on walking exercises to breast cancer patients undergoing chemotherapy to improve the quality of sleep of patients, so as to improve the general health condition of patients who can later improve and improve the quality of life for breast cancer patients. Keywords: Breast Cancer, Chemotherapy, Sleep Quality, Walking Exercise

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THE DIFFERENCE IN ADDITION OF BACK MASSAGE COMBINATION IN PREGNANCY EXERCISE IN IMPROVING QUALITY OF SLEEP IN THIRD TRIMESTER PREGNANT WOMEN

Majalah Ilmiah Fisioterapi Indonesia ◽

10.24843/mifi.2018.v06.i02.p03 ◽

2018 ◽

Vol 6 (2) ◽

pp. 16

Author(s):

Mezzi Wulandari Arenza ◽

Ni Wayan Tianing ◽

I Putu Adiartha Griadhi

Keyword(s):

Sleep Quality ◽

Pregnant Women ◽

Control Group ◽

Quality Of Sleep ◽

Third Trimester ◽

The Third ◽

The Difference ◽

In Pregnancy ◽

Back Massage

ABSTRACTSleep disturbance in the third trimester pregnant women is caused by discomfort, an increasingly largeabdominal condition, back pain, frequent urination, fetal movement, heartburn, cramps in the legs, tiredness, difficultygetting started, and physiological changes. Sleep disorders result in decreased quality of sleep. Pregnant women whohave poor sleep quality are at risk of longer labor, cesarean delivery, premature birth, and even infant mortality. The aimof this research is to know the difference of pregnant exercise combination and back massage in improving the sleepquality of third trimester pregnant women. This research use experiment method with quasi experiment approach andresearch design is pre and post test with control design. Sample are 18 people, divided into 2 groups, 9 people intreatment groups given pregnancy exercise and back massage and 9 people in control group is given only pregnantexercise. Intervention is given 8 times. Pittsburgh Sleep Quality Index (PSQI) questionnaire used for measured of sleepquality. The result of different test of unpaired group, in the treatment group got difference of average 4,556 and controlgroup got difference mean 2,333 with p=0,004 (p<0,05). These results showed that there was a significant differencebetween the treatment group and the control group in improving the sleep quality of the third trimester pregnant women.In conclusion, there are differences in the addition of back massage combination in pregnancy exercise intervention inimproving sleep quality of third trimester pregnant women.Keyword : Pregnancy Exercise, Back Massage, Sleep Quality, Third Trimester.

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Soaking Feet Hydrotherapy Using Warm Water to Improve Quality of Sleeping Among Pregnant Women

Jurnal Kebidanan dan Kesehatan Tradisional ◽

10.37341/jkkt.v0i0.232 ◽

2021 ◽

pp. 16-23

Author(s):

Ayu Wulandari ◽

Gita Kostania

Keyword(s):

Sleep Quality ◽

Pregnant Women ◽

Sampling Technique ◽

Warm Water ◽

Control Group ◽

Quality Of Sleep ◽

Control Group Design ◽

Before And After ◽

The Difference

Sleep is a basic need that must be fulfilled by humans. Sleep disorders often occur in pregnant women which has an impact on the quality of sleep. This study aims to identify the effect of soaking feet with warm water on the quality of sleep for pregnant women. This study used a quasi-experiment design with a nonequivalent control group design approach. The sampling technique used total sampling with 40 respondents who were in accordance with the eligible criteria. Interventions are given for 7 consecutive days. Measurement of sleep quality score using the Pittsburgh Sleep Quality Index questionnaire. The difference in sleep quality scores was analyzed by Mann Whitney test, and scores of each component were analyzed by using Wilcoxon test.The results of this study indicate the influence of soaking feet with warm water on sleep quality of respondents before and after the intervention (p = 0.007; α = 5%). From these results, it can be said that there was an increase in quality of sleep after soaking the feet with warm water. Hydrotherapy by soaking feet with warm water can be applied by pregnant women to improve sleep quality.

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COMBINATION OF PRENATAL GENTLE YOGA EXERCISES AND LAVENDER AROMATERAPY INHALATION TO IMPROVING SLEEP QUALITY IN TRIMESTER III PREGNANT WOMEN

Journal of Midwifery ◽

10.25077/jom.5.1.42-49.2020 ◽

2021 ◽

Vol 5 (1) ◽

pp. 42

Author(s):

Shinta Wurdiana Rhomadona ◽

Dianita Primihastuti

Keyword(s):

Sleep Quality ◽

Pregnant Women ◽

Sleep Disturbances ◽

Control Group ◽

Mild Stress ◽

Quality Of Sleep ◽

A Value ◽

Increased Risk ◽

Significant Difference

As gestational age increases, the quality of sleep can decrease. It was reported that about 60% of late trimester pregnant women experience fatigue and> 75% experience sleep disturbances. However, these complaints are often ignored, even though it can lead to an increased risk of gestational hypertension, diabetes, prematurity, and postpartum depression. Sleep disturbances can also cause depression and stress that affects the fetus. Mild stress causes an increase in fetal heart rate which, if left untreated, will make the baby hyperactive. Meanwhile, the consequences are depression and babies who are born have less time to sleep deeply. Efforts to overcome this sleep disorder are yoga and lavender aromatherapy inhalation. Purpose: Therefore, the researchers estimated that the application of a combination of prenatal gentle yoga and lavender aromatherapy would be more effective in affecting the quality of sleep in pregnant women, so it is hoped that it can reduce sleep disturbances in third trimester pregnant women. Results: There is a significant effect of the combination of prenatal gentle yoga and inhalation of lavender aromatherapy in improving sleep quality in the treatment group with a value of α = 0.011 or α <0.05. There was a significant difference in the quality of sleep in the group compared to the control group with a value of α = 0.004 or α <0.05. Conclusion: By practicing prenatal gentle yoga and regular inhalation of lavender aromatherapy, it will be able to improve sleep patterns without using sleeping pills which wil

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Sleep Quality and Fatigue among Breast Cancer Patients Undergoing Chemotherapy

International Journal of Hematology-Oncology and Stem Cell Research ◽

10.18502/ijhoscr.v13i4.1894 ◽

2019 ◽

Author(s):

Mahrokh Imanian ◽

Mahsa Imanian ◽

Mahdi Karimyar

Keyword(s):

Breast Cancer ◽

Sleep Quality ◽

Sleep Disorders ◽

Cancer Patients ◽

Breast Cancer Survivors ◽

Breast Cancer Patients ◽

Quality Of Sleep ◽

The Mean ◽

Cutting Point

Background: Breast cancer survivors make up a growing population facing treatment that poses long – standing adverse effects including chemotherapy- related sleep disorders and fatigue. There is limited knowledge of patients' lived experiences of chemotherapy- induced sleep disorders and fatigue. The aim of this study was to explore sleep quality and fatigue among breast cancer patients undergoing chemotherapy. Materials and Methods: One hundred fifteen patients were included in this census-based cross-sectional study. Data were collected through the Pittsburgh Sleep Quality Index and Brief Fatigue Inventory four days after the chemotherapy session. Statistical analysis was carried out using SPSS software version 13 and P<0.05 was considered statistically significant in all tests. Results: The mean hours of sleep were 5.6±1.83 in the range of 2 to 10 hours. The mean score of fatigue of participants was 5.59±1.67. Based on the cutting point, 57.4%, 20.9%, and 21.7% of participants had a moderate (4-6.9), mild (0.1-3.9), and severe (7-9.9) level of fatigue, respectively. The mean score of sleep quality among the participants was equal to 14.06±3.06, with a maximum and minimum of 7 and 21. The results of Spearman correlation coefficient showed that there is a significant relationship between fatigue and quality of sleep )0.210). Conclusion: Although the study findings revealed that patients with breast cancer undergoing chemotherapy experience different degrees of sleep disorders and fatigue, there is a need for more detailed studies to improve the quality of sleep and reduce fatigue in these patients due to the little attention paid to this issue in the medical field.

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