{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,13]],"date-time":"2026-10-13T18:53:30Z","timestamp":1791917610667,"version":"4.3.4"},"reference-count":50,"publisher":"Oxford University Press (OUP)","issue":"1","funder":[{"name":"VA Rehabilitation Research and Development Service","award":["RX002116"],"award-info":[{"award-number":["RX002116"]}]},{"name":"VA HSR&D Service Research Career Scientist Award","award":["RCS\u00a020-191"],"award-info":[{"award-number":["RCS\u00a020-191"]}]},{"name":"VA HSR&D Service Research Career Scientist Award","award":["NIH\/NHLBI K24 HL143055"],"award-info":[{"award-number":["NIH\/NHLBI K24 HL143055"]}]},{"name":"VA Greater Los Angeles Healthcare System (VAGLAHS) Geriatric Research, Education and Clinical Center"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2022,1,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Study Objectives<\/jats:title>\n                    <jats:p>Multiple sclerosis (MS) is an autoimmune disease impacting the central nervous system. A hallmark symptom of MS is fatigue, which impairs daytime function and quality of life (QOL). Sleep disorders and disturbances are common in persons with MS and exacerbate fatigue. We evaluated relationships between sleep-disordered breathing (SDB), insomnia symptoms, sleep quality, and daytime functioning in veterans with MS participating in a larger study.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Twenty-five veterans with clinically diagnosed MS were included (average age = 57 \u00b1 11, 80% male). One had a co-occurring thoracic spinal cord injury. Twenty-four participants completed in-laboratory polysomnography (PSG) to measure apnea-hypopnea index (AHI) and sleep efficiency (PSG-SE). Insomnia Severity Index (ISI) and Pittsburg Sleep Quality Index (PSQI) were used to measure sleep subjectively. The Flinders Fatigue Scale (FFS), Epworth Sleepiness Scale (ESS), PHQ-9 depression scale, and GAD-7 anxiety scale assessed daytime symptoms. The World Health Organization Quality of Life (WHOQOL) was used to assess quality of life. Relationships between sleep (AHI, PSG-SE, ISI, PSQI), daytime symptoms (ESS, FFS, PHQ-9, and GAD-7), and quality of life (WHOQOL) were evaluated with bivariate correlations.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Higher ISI (r = 0.78, 95% CI = [0.54, 0.90], p &amp;lt; .001), higher PSQI (r = 0.51, 95% CI = [0.10, 0.77], p = .017), and lower PSG-SE (r = \u22120.45, 95% CI = [\u22120.74, \u22120.02], p = .041) were associated with worse fatigue (FFS). Higher ISI was also associated with worse WHOQOL (Physical Domain; r = \u22120.64, 95% CI = [\u22120.82, \u22120.32], p = .001). There were no other significant relationships.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>In veterans with MS, more severe insomnia and worse sleep quality may be associated with more fatigue and lower quality of life. Recognition and management of insomnia should be considered in future studies of sleep in MS.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/sleepadvances\/zpac012","type":"journal-article","created":{"date-parts":[[2022,5,6]],"date-time":"2022-05-06T17:15:37Z","timestamp":1651857337000},"source":"Crossref","is-referenced-by-count":8,"title":["Sleep disorders, daytime symptoms, and quality of life in veterans with multiple sclerosis: preliminary findings"],"prefix":"10.1093","volume":"3","author":[{"given":"Nawar A","family":"Aljundi","sequence":"first","affiliation":[{"name":"Department of Internal Medicine, Wayne State University School of Medicine , Detroit, MI , USA"},{"name":"John D. Dingell Veterans Affairs Medical Center , Detroit, MI , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Monica","family":"Kelly","sequence":"additional","affiliation":[{"name":"Geriatric Research Education and Clinical Center, VA Greater Los Angeles Healthcare System , Los Angeles, CA , USA"},{"name":"Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles , Los Angeles, CA , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Salam","family":"Zeineddine","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Wayne State University School of Medicine , Detroit, MI , USA"},{"name":"John D. Dingell Veterans Affairs Medical Center , Detroit, MI , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anan","family":"Salloum","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Wayne State University School of Medicine , Detroit, MI , USA"},{"name":"John D. Dingell Veterans Affairs Medical Center , Detroit, MI , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nishtha","family":"Pandya","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Wayne State University School of Medicine , Detroit, MI , USA"},{"name":"John D. Dingell Veterans Affairs Medical Center , Detroit, MI , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Q Afifa","family":"Shamim-Uzzaman","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, University of Michigan Medical School , Ann Arbor, MI , USA"},{"name":"Department of Neurology, University of Michigan Medical School , Ann Arbor, MI , USA"},{"name":"Sleep Disorders Center, VA Ann Arbor Healthcare System , Ann Arbor, MI , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Amira N","family":"Badr","sequence":"additional","affiliation":[{"name":"Eugene Applebaum College of Pharmacy and Health Sciences, Wayne State University , Detroit, MI , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael N","family":"Mitchell","sequence":"additional","affiliation":[{"name":"Geriatric Research Education and Clinical Center, VA Greater Los Angeles Healthcare System , Los Angeles, CA , USA"},{"name":"Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles , Los Angeles, CA , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Abdulghani","family":"Sankari","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Wayne State University School of Medicine , Detroit, MI , USA"},{"name":"John D. Dingell Veterans Affairs Medical Center , Detroit, MI , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"M Safwan","family":"Badr","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Wayne State University School of Medicine , Detroit, MI , USA"},{"name":"John D. Dingell Veterans Affairs Medical Center , Detroit, MI , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0849-3391","authenticated-orcid":false,"given":"Jennifer L","family":"Martin","sequence":"additional","affiliation":[{"name":"Geriatric Research Education and Clinical Center, VA Greater Los Angeles Healthcare System , Los Angeles, CA , USA"},{"name":"Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles , Los Angeles, CA , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2022,5,6]]},"reference":[{"issue":"1","key":"2023041115355408000_","first-page":"1","article-title":"Multiple sclerosis: pathogenesis, symptoms, diagnoses and cell-based therapy","volume":"19","author":"Ghasemi","year":"2017","journal-title":"Cell 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Neurol."},{"issue":"5","key":"2023041115355408000_","doi-asserted-by":"crossref","first-page":"613","DOI":"10.1177\/1352458510393772","article-title":"Fatigue in multiple sclerosis is closely related to sleep disorders: a polysomnographic cross-sectional study","volume":"17","author":"Veauthier","year":"2011","journal-title":"Mult Scler."},{"issue":"2","key":"2023041115355408000_","doi-asserted-by":"crossref","first-page":"155","DOI":"10.5664\/jcsm.3442","article-title":"Obstructive sleep apnea and fatigue in patients with multiple sclerosis","volume":"10","author":"Braley","year":"2014","journal-title":"J Clin Sleep Med."},{"issue":"9","key":"2023041115355408000_","doi-asserted-by":"crossref","first-page":"1025","DOI":"10.5664\/jcsm.4044","article-title":"The underdiagnosis of sleep disorders in patients with multiple sclerosis","volume":"10","author":"Brass","year":"2014","journal-title":"J Clin Sleep 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Dermatol."},{"issue":"7","key":"2023041115355408000_","doi-asserted-by":"crossref","first-page":"722","DOI":"10.5664\/jcsm.27030","article-title":"The Flinders Fatigue Scale: preliminary psychometric properties and clinical sensitivity of a new scale for measuring daytime fatigue associated with insomnia","volume":"3","author":"Gradisar","year":"2007","journal-title":"J Clin Sleep Med."},{"issue":"6","key":"2023041115355408000_","doi-asserted-by":"crossref","first-page":"540","DOI":"10.1093\/sleep\/14.6.540","article-title":"New method for measuring daytime sleepiness: the Epworth Sleepiness Scale","volume":"14","author":"Johns","year":"1991","journal-title":"Sleep"},{"key":"2023041115355408000_","doi-asserted-by":"crossref","first-page":"l1476","DOI":"10.1136\/bmj.l1476","article-title":"Accuracy of Patient Health Questionnaire-9 (PHQ-9) for screening to detect major depression: individual participant data 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