{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,24]],"date-time":"2026-09-24T16:24:39Z","timestamp":1790267079635,"version":"4.1.0"},"reference-count":37,"publisher":"Wiley","issue":"6","license":[{"start":{"date-parts":[[2025,9,2]],"date-time":"2025-09-02T00:00:00Z","timestamp":1756771200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100008352","name":"Stiftelsen Samariten","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100008352","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Clinical Endocrinology"],"published-print":{"date-parts":[[2025,12]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>Standard glucocorticoid (GC) replacement therapy in autoimmune Addison\u2032s disease (AAD) fails to replicate natural cortisol rhythms. Despite adherence, patients report persistent fatigue, reduced vitality, and impaired wellbeing, ultimately lowering health\u2010related quality of life (HRQoL). Cortisol is essential for sleep regulation, yet the impact of cortisol imbalance on sleep and HRQoL in AAD remains poorly understood. This study investigates self\u2010reported sleep impairments and their associations with fatigue and HRQoL in young adults with AAD.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Patients and Methods<\/jats:title>\n                    <jats:p>Sixty\u2010four patients with AAD and 128 healthy controls completed validated questionnaires assessing sleep (Karolinska Sleep Questionnaire), fatigue (Multidimensional Fatigue Inventory), and HRQoL (Short Form\u201036).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Patients reported significantly more non\u2010restorative sleep (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.015) than controls. While overall rates of clinically relevant sleep impairments were similar, patients more frequently experienced awakening difficulties (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.011) and struggling to stay awake (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.036). Patients also reported poorer physical health (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001) and greater general fatigue (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.007), with female patients experiencing more mental fatigue (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.013). Poor sleep and fatigue were associated with reduced HRQoL across the cohort, with patients showing a more pronounced decline in physical health in relation to these factors. Mental health scores remained similar between groups.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Non\u2010restorative sleep emerged as a distinct feature of AAD. While the prevalence and severity of sleep impairments were similar to controls, the association with poorer physical health was stronger in patients. Mental health remained similar despite sleep disturbances. These findings highlight the importance of addressing even modest sleep disturbances, which may worsen fatigue and reduce physical wellbeing in AAD.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/cen.70028","type":"journal-article","created":{"date-parts":[[2025,9,2]],"date-time":"2025-09-02T13:05:22Z","timestamp":1756818322000},"page":"795-804","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["The Relationship Between Sleep, Fatigue and Quality of Life in Young Adults With Autoimmune Addison\u2032s Disease"],"prefix":"10.1111","volume":"103","author":[{"ORCID":"https:\/\/orcid.org\/0009-0002-9744-3643","authenticated-orcid":false,"given":"Sara","family":"Fletcher\u2010Sandersj\u00f6\u00f6","sequence":"first","affiliation":[{"name":"Department of Molecular Medicine and Surgery, Karolinska Institutet and Department of Endocrinology Karolinska University Hospital Stockholm Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Annelies van\u2032t","family":"Westeinde","sequence":"additional","affiliation":[{"name":"Department of Women\u2032s and Children\u2032s Health, Karolinska Institutet, Pediatric Endocrinology Unit Karolinska University Hospital Stockholm Sweden"},{"name":"Department of Clinical Sciences, Sahlgrenska Academy University of Gothenburg, Pediatric Endocrinology Unit, Sahlgrenska University Hospital Gothenburg Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tim","family":"Spelman","sequence":"additional","affiliation":[{"name":"Department of Clinical Neuroscience Karolinska Institutet Stockholm Sweden"},{"name":"Adelaide Medical School University of Adelaide Adelaide South Australia Australia"},{"name":"Centre for Health Services Research Peter MacCallum Cancer Centre Melbourne Victoria Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tatja","family":"Hirvikosi","sequence":"additional","affiliation":[{"name":"Department of Women\u2032s and Children\u2032s Health, Pediatric Neuropsychiatry Unit Center for Neurodevelopmental Disorders at Karolinska Institutet (KIND), Center for Psychiatric Research, Karolinska Institutet Stockholm Sweden"},{"name":"Habilitation &amp; Health Region Stockholm Stockholm Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4398-0948","authenticated-orcid":false,"given":"Svetlana","family":"Lajic","sequence":"additional","affiliation":[{"name":"Department of Women\u2032s and Children\u2032s Health, Karolinska Institutet, Pediatric Endocrinology Unit Karolinska University Hospital Stockholm Sweden"},{"name":"Department of Clinical Sciences, Sahlgrenska Academy University of Gothenburg, Pediatric Endocrinology Unit, Sahlgrenska University Hospital Gothenburg Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sophie","family":"Bensing","sequence":"additional","affiliation":[{"name":"Department of Molecular Medicine and Surgery, Karolinska Institutet and Department of Endocrinology Karolinska University Hospital Stockholm Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2025,9,2]]},"reference":[{"key":"e_1_2_9_2_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.cca.2020.01.029"},{"key":"e_1_2_9_3_1","doi-asserted-by":"publisher","DOI":"10.1111\/cen.13999"},{"key":"e_1_2_9_4_1","doi-asserted-by":"publisher","DOI":"10.1016\/S2213-8587(13)70182-7"},{"key":"e_1_2_9_5_1","doi-asserted-by":"publisher","DOI":"10.1210\/jc.2007-0685"},{"key":"e_1_2_9_6_1","doi-asserted-by":"publisher","DOI":"10.1530\/EJE-14-0023"},{"key":"e_1_2_9_7_1","doi-asserted-by":"publisher","DOI":"10.1111\/cen.12484"},{"key":"e_1_2_9_8_1","doi-asserted-by":"publisher","DOI":"10.1055\/s-0032-1331766"},{"key":"e_1_2_9_9_1","doi-asserted-by":"publisher","DOI":"10.1111\/cen.13059"},{"key":"e_1_2_9_10_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.psyneuen.2017.02.004"},{"key":"e_1_2_9_11_1","doi-asserted-by":"publisher","DOI":"10.1210\/jc.2004-1056"},{"key":"e_1_2_9_12_1","doi-asserted-by":"publisher","DOI":"10.1093\/sleep\/15.1.21"},{"key":"e_1_2_9_13_1","doi-asserted-by":"publisher","DOI":"10.3389\/fendo.2021.694046"},{"key":"e_1_2_9_14_1","doi-asserted-by":"publisher","DOI":"10.1073\/pnas.1714239115"},{"key":"e_1_2_9_15_1","doi-asserted-by":"publisher","DOI":"10.1210\/er.2015-1080"},{"key":"e_1_2_9_16_1","doi-asserted-by":"publisher","DOI":"10.1530\/EJE-18-0439"},{"key":"e_1_2_9_17_1","doi-asserted-by":"publisher","DOI":"10.1210\/jcem.85.11.6965"},{"key":"e_1_2_9_18_1","doi-asserted-by":"publisher","DOI":"10.1210\/jc.2013-4253"},{"key":"e_1_2_9_19_1","doi-asserted-by":"publisher","DOI":"10.1007\/s12020-020-02552-6"},{"key":"e_1_2_9_20_1","doi-asserted-by":"publisher","DOI":"10.1007\/BF03401290"},{"key":"e_1_2_9_21_1","doi-asserted-by":"publisher","DOI":"10.1530\/eje.0.1480449"},{"key":"e_1_2_9_22_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.physbeh.2015.08.011"},{"key":"e_1_2_9_23_1","doi-asserted-by":"publisher","DOI":"10.3390\/ijerph182312835"},{"key":"e_1_2_9_24_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.psyneuen.2022.105714"},{"issue":"2","key":"e_1_2_9_25_1","first-page":"379","article-title":"Clinical and Immunological Characteristics of Autoimmune Addison Disease: A Nationwide Swedish Multicenter Study","volume":"102","author":"Dalin F.","year":"2017","journal-title":"Journal of Clinical Endocrinology and Metabolism"},{"key":"e_1_2_9_26_1","doi-asserted-by":"publisher","DOI":"10.1210\/jc.2011-1926"},{"key":"e_1_2_9_27_1","doi-asserted-by":"publisher","DOI":"10.1080\/15402002.2014.974181"},{"key":"e_1_2_9_28_1","doi-asserted-by":"publisher","DOI":"10.1111\/sbr.12024"},{"key":"e_1_2_9_29_1","doi-asserted-by":"publisher","DOI":"10.1080\/02841860601009430"},{"key":"e_1_2_9_30_1","doi-asserted-by":"publisher","DOI":"10.1097\/00005650-199206000-00002"},{"key":"e_1_2_9_31_1","doi-asserted-by":"publisher","DOI":"10.1210\/jc.2009-0672"},{"key":"e_1_2_9_32_1","doi-asserted-by":"publisher","DOI":"10.1210\/jc.2002-020769"},{"key":"e_1_2_9_33_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.sleep.2010.07.012"},{"key":"e_1_2_9_34_1","doi-asserted-by":"publisher","DOI":"10.3390\/ijerph15040758"},{"key":"e_1_2_9_35_1","doi-asserted-by":"publisher","DOI":"10.3389\/fendo.2020.610904"},{"key":"e_1_2_9_36_1","doi-asserted-by":"publisher","DOI":"10.1530\/EJE-20-0642"},{"key":"e_1_2_9_37_1","doi-asserted-by":"publisher","DOI":"10.1080\/13543784.2024.2311207"},{"key":"e_1_2_9_38_1","unstructured":"Public Health Agency of Sweden. 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