{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T04:37:48Z","timestamp":1787027868488,"version":"build-2736575974"},"reference-count":87,"publisher":"MDPI AG","issue":"2","license":[{"start":{"date-parts":[[2026,4,30]],"date-time":"2026-04-30T00:00:00Z","timestamp":1777507200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Clocks &amp; Sleep"],"abstract":"<jats:p>Sleep disturbances are common in multiple sclerosis (MS) and contribute to increased symptom burden. Behavioral sleep hygiene practices are potentially modifiable factors influencing sleep and related symptoms, yet their role in MS remains insufficiently explored. This cross-sectional study comprised 175 MS patients. Sleep hygiene was assessed using a behavioral checklist covering a regular sleep schedule, avoidance of daytime naps, limitation of evening caffeine intake, reduced evening screen exposure, and optimization of the sleep environment. The instruments included the Fatigue Severity Scale (FSS), the Modified Fatigue Impact Scale (MFIS), the Athens Insomnia Scale (AIS), the Epworth Sleepiness Scale (ESS), and the Hospital Anxiety and Depression Scale (HADS). Higher sleep hygiene adherence was associated with lower daytime sleepiness (ESS: r = \u22120.18, p = 0.020), anxiety (HADS-A: r = \u22120.16, p = 0.034), and depression (HADS-D: r = \u22120.15, p = 0.047). Patients with higher adherence (score \u2265 3) demonstrated significantly lower MFIS, AIS, ESS, and HADS-D scores compared with those with lower adherence (all p &lt; 0.05). Multivariate regression showed that sleep hygiene adherence was independently associated with lower MFIS (\u03b2 = \u22123.24, 95% CI: \u22126.06 to \u22120.41, p = 0.025), ESS (\u03b2 = \u22120.85, 95% CI: \u22126.06 to \u22120.41, p = 0.016), HADS-A (\u03b2 = \u22120.67, 95% CI: \u22121.23 to \u22120.11, p = 0.019), and HADS-D scores (\u03b2 = \u22120.62, 95% CI: \u22121.17; \u22120.08, p = 0.026). Better adherence to sleep hygiene practices may be associated with a lower symptom burden in MS.<\/jats:p>","DOI":"10.3390\/clockssleep8020024","type":"journal-article","created":{"date-parts":[[2026,4,30]],"date-time":"2026-04-30T13:32:21Z","timestamp":1777555941000},"page":"24","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Sleep Hygiene and Symptom Burden in Multiple Sclerosis: A Cross-Sectional Study"],"prefix":"10.3390","volume":"8","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-4582-3954","authenticated-orcid":false,"given":"Michalina","family":"Rzepka","sequence":"first","affiliation":[{"name":"Department of Neurology, Faculty of Medical Sciences in Katowice, Medical University of Silesia, 40-752 Katowice, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0008-7534-7830","authenticated-orcid":false,"given":"Aleksandra","family":"Buczek","sequence":"additional","affiliation":[{"name":"Students\u2019 Scientific Society, Department of Neurology, Faculty of Medical Sciences in Katowice, Medical University of Silesia, 40-752 Katowice, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6022-7731","authenticated-orcid":false,"given":"Tomasz","family":"Chmiela","sequence":"additional","affiliation":[{"name":"Department of Neurology, Faculty of Medical Sciences in Katowice, Medical University of Silesia, 40-752 Katowice, Poland"},{"name":"Department of Neurology, Mayo Clinic, Jacksonville, FL 32224, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6618-7013","authenticated-orcid":false,"given":"Weronika","family":"Galus","sequence":"additional","affiliation":[{"name":"Department of Neurology, Faculty of Medical Sciences in Katowice, Medical University of Silesia, 40-752 Katowice, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0340-660X","authenticated-orcid":false,"given":"Joanna","family":"Siuda","sequence":"additional","affiliation":[{"name":"Department of Neurology, Faculty of Medical Sciences in Katowice, Medical University of Silesia, 40-752 Katowice, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4441-3088","authenticated-orcid":false,"given":"Ewa","family":"Krzystanek","sequence":"additional","affiliation":[{"name":"Department of Neurology, Faculty of Health Sciences in Katowice, Medical University of Silesia, 40-635 Katowice, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,4,30]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"zsae186","DOI":"10.1093\/sleep\/zsae186","article-title":"Insufficient Sleep: Another Risk Factor for Multiple Sclerosis","volume":"47","author":"Aoun","year":"2024","journal-title":"Sleep"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"101842","DOI":"10.1016\/j.smrv.2023.101842","article-title":"The Prevalence of Insomnia in Multiple Sclerosis: A Meta-Analysis","volume":"72","author":"Zeng","year":"2023","journal-title":"Sleep Med. Rev."},{"key":"ref_3","doi-asserted-by":"crossref","unstructured":"Li, P., Liu, J., Yang, J., He, J., and Jiang, J. (2024). The Prevalence of Obstructive Sleep Apnea\u2013Hypopnea Syndrome in Patients with Multiple Sclerosis: A Systematic Review and Meta-Analysis. Front. Neurol., 15.","DOI":"10.3389\/fneur.2024.1444470"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"5","DOI":"10.1016\/j.sleep.2013.08.791","article-title":"Sleep Disorders in Multiple Sclerosis and Their Relationship to Fatigue","volume":"15","author":"Veauthier","year":"2014","journal-title":"Sleep Med."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"50","DOI":"10.1007\/s11910-016-0649-2","article-title":"Sleep Disorders in Multiple Sclerosis","volume":"16","author":"Braley","year":"2016","journal-title":"Curr. Neurol. Neurosci. Rep."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"7","DOI":"10.1016\/j.jns.2010.12.008","article-title":"Sleep Disorders and Fatigue in Multiple Sclerosis: Evidence for Association and Interaction","volume":"302","author":"Kaminska","year":"2011","journal-title":"J. Neurol. Sci."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"106639","DOI":"10.1016\/j.msard.2025.106639","article-title":"Research Progress in Sleep Disorders Associated with Multiple Sclerosis","volume":"103","author":"Zhang","year":"2025","journal-title":"Mult. Scler. Relat. Disord."},{"key":"ref_8","first-page":"67","article-title":"Exploring the Relationship between Sleep Quality and Fatigue, Quality of Life, Daytime Sleepiness, and Anxiety\u2013Depression Levels in Patients with Multiple Sclerosis","volume":"4","author":"Ozdogar","year":"2024","journal-title":"J. Mult. Scler. Res."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"563","DOI":"10.1007\/s11136-024-03836-4","article-title":"Impact of Sleep Quality on Health-Related Quality of Life Domains and the Mediating Effects of Symptoms in People with Multiple Sclerosis","volume":"34","author":"Dagnew","year":"2025","journal-title":"Qual. Life Res."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"403","DOI":"10.5603\/pjnns.105052","article-title":"Improving Quality of Life in Polish Patients with Multiple Sclerosis: A Multicentre Analysis","volume":"59","author":"Tarasiuk","year":"2025","journal-title":"Neurol. Neurochir. Pol."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"105908","DOI":"10.1016\/j.msard.2024.105908","article-title":"Cognitive Behavioral Therapy for Fatigue in Patients with Multiple Sclerosis: A Systematic Review and Meta-Analysis","volume":"91","author":"Vo","year":"2024","journal-title":"Mult. Scler. Relat. Disord."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"100977","DOI":"10.1016\/j.lanepe.2024.100977","article-title":"Multiple Sclerosis: Emerging Epidemiological Trends and Redefining the Clinical Course","volume":"44","author":"Portaccio","year":"2024","journal-title":"Lancet Reg. Health Eur."},{"key":"ref_13","first-page":"33","article-title":"Multiple Sclerosis\u2013Related Fatigue: An Updated Review of Pathophysiology and Associated Contributing Factors","volume":"5","author":"Yeni","year":"2025","journal-title":"J. Mult. Scler. Res."},{"key":"ref_14","doi-asserted-by":"crossref","unstructured":"Rzepka, M., Chmiela, T., Kaczmarczyk, A., and Krzystanek, E. (2024). Insomnia, Fatigue, Bladder Disorders and Mood Disorders among Polish Patients with Multiple Sclerosis: A Cross-Sectional Study. J. Clin. Med., 13.","DOI":"10.3390\/jcm13041043"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"26","DOI":"10.1016\/j.sleep.2007.11.004","article-title":"Prevalence of Poor Sleep among Patients with Multiple Sclerosis: An Independent Predictor of Mental and Physical Status","volume":"10","author":"Merlino","year":"2009","journal-title":"Sleep Med."},{"key":"ref_16","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 Med."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"294","DOI":"10.1177\/1756285615605698","article-title":"A Practical Approach to the Diagnosis and Management of Sleep Disorders in Patients with Multiple Sclerosis","volume":"8","author":"Braley","year":"2015","journal-title":"Ther. Adv. Neurol. Disord."},{"key":"ref_18","doi-asserted-by":"crossref","unstructured":"Frange, C. (2023). Sleep Health Promotion in an Individual with Multiple Sclerosis. Clinical Cases in Sleep Physical Therapy, Springer.","DOI":"10.1007\/978-3-031-38340-3"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"215","DOI":"10.1053\/smrv.2001.0246","article-title":"Use of Sleep Hygiene in the Treatment of Insomnia","volume":"7","author":"Stepanski","year":"2003","journal-title":"Sleep Med. Rev."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"23","DOI":"10.1016\/j.smrv.2014.10.001","article-title":"The Role of Sleep Hygiene in Promoting Public Health: A Review of Empirical Evidence","volume":"22","author":"Irish","year":"2015","journal-title":"Sleep Med. Rev."},{"key":"ref_21","first-page":"6776758","article-title":"Sleep Disorders and Fatigue among Patients with Multiple Sclerosis: The Role of Depression, Stress, and Anxiety","volume":"2024","author":"Kianimoghadam","year":"2024","journal-title":"Neurol. Res. Int."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"3","DOI":"10.1016\/j.smrv.2017.02.001","article-title":"Cognitive and Behavioral Therapies in the Treatment of Insomnia: A Meta-Analysis","volume":"38","author":"Kleiboer","year":"2018","journal-title":"Sleep Med. Rev."},{"key":"ref_23","first-page":"1109","article-title":"Cognitive Behavioral Therapy for Insomnia in People with Chronic Disease: A Systematic Review and Meta-Analysis","volume":"19","author":"Scott","year":"2025","journal-title":"JAMA Intern. Med."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"105","DOI":"10.1002\/wps.21069","article-title":"Cognitive Behavior Therapy vs. Control Conditions, Other Psychotherapies, Pharmacotherapies and Combined Treatment for Depression: A Comprehensive Meta-Analysis Including 409 Trials with 52,702 Patients","volume":"22","author":"Cuijpers","year":"2023","journal-title":"World Psychiatry"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"895","DOI":"10.1007\/s12529-023-10254-2","article-title":"Efficacy and Acceptance of Cognitive Behavioral Therapy in Adults with Chronic Fatigue Syndrome: A Meta-Analysis","volume":"31","author":"Bermpohl","year":"2024","journal-title":"Int. J. Behav. Med."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"1271","DOI":"10.1016\/j.apmr.2020.03.009","article-title":"Practical Sleep Information for People with Multiple Sclerosis","volume":"101","author":"Siengsukon","year":"2020","journal-title":"Arch. Phys. Med. Rehabil."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"103271","DOI":"10.1016\/j.msard.2021.103271","article-title":"A Multidimensional Approach to Sleep Health in Multiple Sclerosis","volume":"56","author":"Whibley","year":"2021","journal-title":"Mult. Scler. Relat. Disord."},{"key":"ref_28","unstructured":"Jiyeon, S., Oragun, R., Dennis, S., Elen, G., Fariha, H., Sherzai, D., and Roy, A. (2026). Lifestyle and Behavioral Enhancements of Sleep: A Review. Am. J. Lifestyle Med., in press."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"29","DOI":"10.1007\/s44192-026-00377-9","article-title":"Sleep Quality, Mental Health, Lifestyle Factors, and Academic Performance among Medical Students in Three Syrian Universities: A Cross-Sectional Study","volume":"6","author":"Sleiay","year":"2026","journal-title":"Discov. Ment. Health"},{"key":"ref_30","doi-asserted-by":"crossref","unstructured":"Wei, X., Dai, W., and Xie, Y. (2025). The Impact of Healthy Community Environment and Sleep Quality on the Physical Health of Older Adults: Evidence from CGSS2021. Front. Psychol., 16.","DOI":"10.3389\/fpsyg.2025.1556043"},{"key":"ref_31","unstructured":"Xu, J. (2024). Exploring the Factors of Sleep Quality: An Integrated Analysis of Data from Questionnaires and Environmental Sensor Data. [Master\u2019s Thesis, Yale University]."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"cmaf110","DOI":"10.1093\/fampra\/cmaf110","article-title":"The Effect of Sleep Hygiene Education on Sleep Quality and Blood Pressure in Patients with Essential Hypertension in a Family Practice Center: A Randomized Controlled Trial","volume":"43","author":"Tutu","year":"2025","journal-title":"Fam. Pract."},{"key":"ref_33","doi-asserted-by":"crossref","unstructured":"Pfeiffer, A.M., Triplett, C., and Schaefers, O. (2026). Improving Sleep Health through Sleep Hygiene Education in Adults Aged 50\u201380 Years. Front. Sleep, 4.","DOI":"10.3389\/frsle.2025.1722557"},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"1162","DOI":"10.1136\/jnnp-2022-329227","article-title":"Poor Sleep and Multiple Sclerosis: Associations with Symptoms of Multiple Sclerosis and Quality of Life","volume":"93","author":"Laslett","year":"2022","journal-title":"J. Neurol. Neurosurg. Psychiatry"},{"key":"ref_35","first-page":"20552173231194352","article-title":"Sleep Disturbance and Fatigue in Multiple Sclerosis: A Systematic Review and Meta-Analysis","volume":"9","author":"Bhattarai","year":"2023","journal-title":"Mult. Scler. J. Exp. Transl. Clin."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"e70084","DOI":"10.1111\/jsr.70084","article-title":"The Efficacy of Non-Pharmacological Interventions for Sleep Disorders in People with Multiple Sclerosis: A Systematic Review and Meta-Analysis","volume":"35","author":"Ozdogar","year":"2026","journal-title":"J. Sleep Res."},{"key":"ref_37","doi-asserted-by":"crossref","unstructured":"Adamczewska-Chmiel, K., Dudzic, K., Chmiela, T., and Gorzkowska, A. (2022). Smartphones, the Epidemic of the 21st Century: A Possible Source of Addictions and Neuropsychiatric Consequences. Int. J. Environ. Res. Public Health, 19.","DOI":"10.3390\/ijerph19095152"},{"key":"ref_38","doi-asserted-by":"crossref","unstructured":"Strober, L.B. (2015). Fatigue in Multiple Sclerosis: A Look at the Role of Poor Sleep. Front. Neurol., 6.","DOI":"10.3389\/fneur.2015.00021"},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"1515","DOI":"10.1177\/0271678X241230188","article-title":"Chronic Sleep Fragmentation Impairs Brain Interstitial Clearance in Young Wildtype Mice","volume":"44","author":"Deng","year":"2024","journal-title":"J. Cereb. Blood Flow Metab."},{"key":"ref_40","doi-asserted-by":"crossref","unstructured":"De la Herr\u00e1n-Arita, A.K. (2025). When Sleep Fails, Brain Clearance Suffers: The Role of Glymphatic Impairment in Clinical Neurology. Acta Neurol. Belg., in press.","DOI":"10.1007\/s13760-025-02959-w"},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"420","DOI":"10.1055\/a-2559-7565","article-title":"Neuroimmunology and Sleep","volume":"45","author":"Dredla","year":"2025","journal-title":"Semin. Neurol."},{"key":"ref_42","doi-asserted-by":"crossref","unstructured":"Ren, Z., Mao, X., Zhang, Z., and Wang, W. (2025). The Impact of Sleep Deprivation on Cognitive Function in Healthy Adults: Insights from Auditory P300 and Reaction Time Analysis. Front. Neurosci., 19.","DOI":"10.3389\/fnins.2025.1559969"},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"37","DOI":"10.1097\/JNN.0000000000000409","article-title":"The Relationship among Multiple Sclerosis-Related Symptoms, Sleep Quality, and Sleep Hygiene Behaviors","volume":"51","author":"Newland","year":"2019","journal-title":"J. Neurosci. Nurs."},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"41","DOI":"10.1038\/s41392-022-00899-y","article-title":"Molecular Regulations of Circadian Rhythm and Implications for Physiology and Diseases","volume":"7","author":"Fagiani","year":"2022","journal-title":"Signal Transduct. Target. Ther."},{"key":"ref_45","first-page":"20552173231159560","article-title":"Disease Associations of Excessive Daytime Sleepiness in Multiple Sclerosis: A Prospective Study","volume":"9","author":"Sguigna","year":"2023","journal-title":"Mult. Scler. J. Exp. Transl. Clin."},{"key":"ref_46","doi-asserted-by":"crossref","unstructured":"Hyndych, A., Koval, K., Dzeruzhynska, N., and Mader, E.C. (2025). Sleep and Psychiatric Disorders: Bidirectional Interactions and Shared Neurobiological Mechanisms. PLoS Ment. Health, 2.","DOI":"10.1371\/journal.pmen.0000531"},{"key":"ref_47","doi-asserted-by":"crossref","unstructured":"Cao, D., Geng, X., Yi, S., Zhang, H., and Fu, Y. (2026). Dynamic Effects of Sleep Deprivation on Emotional Behavior, Circadian Rhythm Genes, and Inflammatory Infiltration in the Medial Prefrontal Cortex. Front. Behav. Neurosci., 19.","DOI":"10.3389\/fnbeh.2025.1742898"},{"key":"ref_48","doi-asserted-by":"crossref","unstructured":"Fasokun, M., Akinyemi, O., Ogunyankin, F., Ndebele-Ngwenya, P., Gordon, K., Ikugbayigbe, S., Nwosu, U., Michael, M., Hughes, K., and Ogundare, T. (2026). Associations between Sleep Duration and Depression, Mental Health, Physical Health, and General Health in U.S. Adults: A Population-Based Study. PLoS ONE, 21.","DOI":"10.1371\/journal.pone.0321347"},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"331","DOI":"10.1016\/j.jns.2016.11.067","article-title":"Prevalence of Depression and Anxiety in Multiple Sclerosis: A Systematic Review and Meta-Analysis","volume":"372","author":"Boeschoten","year":"2017","journal-title":"J. Neurol. Sci."},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"zsz067.947","DOI":"10.1093\/sleep\/zsz067.947","article-title":"The Relationships between Circadian Rhythm, Sleep Quality, Fatigue, and Depressive Symptoms among Adults with Multiple Sclerosis","volume":"42","author":"Lorenz","year":"2019","journal-title":"Sleep"},{"key":"ref_51","first-page":"1217","article-title":"Sleep, Neuroendocrine Disorders, and the Bidirectional Relationship between the Hypothalamic\u2013Pituitary\u2013Adrenal Axis: A Mini-Review","volume":"29","author":"Udi","year":"2025","journal-title":"J. Appl. Sci. Environ. Manag."},{"key":"ref_52","doi-asserted-by":"crossref","first-page":"12","DOI":"10.1007\/s10802-025-01406-x","article-title":"Prospective Pathways among Rumination, Depression, and Insomnia in Youth","volume":"54","author":"Bailey","year":"2026","journal-title":"Res. Child. Adolesc. Psychopathol."},{"key":"ref_53","first-page":"e36221","article-title":"Sleep Hygiene Practices and Its Impact on Mental Health and Functional Performance among Adults in Tabuk City: A Cross-Sectional Study","volume":"15","author":"Alanazi","year":"2023","journal-title":"Cureus"},{"key":"ref_54","doi-asserted-by":"crossref","unstructured":"Novak, A., and Lev-Ari, S. (2023). Resilience, Stress, Well-Being, and Sleep Quality in Multiple Sclerosis. J. Clin. Med., 12.","DOI":"10.3390\/jcm12020716"},{"key":"ref_55","doi-asserted-by":"crossref","first-page":"204","DOI":"10.1016\/S1836-9553(10)70030-8","article-title":"The Depression Anxiety Stress Scale (DASS)","volume":"56","author":"Parkitny","year":"2010","journal-title":"J. Physiother."},{"key":"ref_56","doi-asserted-by":"crossref","first-page":"108","DOI":"10.1007\/s10072-025-08623-8","article-title":"Sex and Gender-Related Differences in Neurological Diseases: Current Challenges and Recommendations for Clinical Practice","volume":"47","author":"Cicero","year":"2026","journal-title":"Neurol. Sci."},{"key":"ref_57","doi-asserted-by":"crossref","unstructured":"Barbuti, E., Piervincenzi, C., Ruggieri, S., and Petracca, M. (2025). Sex-Related Differences in Lifestyle Factors Affecting Multiple Sclerosis Susceptibility and Disease Progression. Brain Sci., 15.","DOI":"10.3390\/brainsci15101097"},{"key":"ref_58","doi-asserted-by":"crossref","first-page":"101958","DOI":"10.1016\/j.msard.2020.101958","article-title":"Feasibility and Treatment Effect of Cognitive Behavioral Therapy for Insomnia in Individuals with Multiple Sclerosis: A Pilot Randomized Controlled Trial","volume":"40","author":"Siengsukon","year":"2020","journal-title":"Mult. Scler. Relat. Disord."},{"key":"ref_59","first-page":"1","article-title":"The Effectiveness of Mindfulness-Integrated Cognitive-Behavioral Therapy on Sleep Quality, Anxiety, and Fatigue in Patients with Multiple Sclerosis: A Randomized Clinical Trial","volume":"4","author":"Pouyanfard","year":"2019","journal-title":"Avicenna J. Clin. Med."},{"key":"ref_60","doi-asserted-by":"crossref","first-page":"610","DOI":"10.1177\/1352458518761187","article-title":"Online Meditation Training for People with Multiple Sclerosis: A Randomized Controlled Trial","volume":"25","author":"Cavalera","year":"2019","journal-title":"Mult. Scler. J."},{"key":"ref_61","doi-asserted-by":"crossref","first-page":"833","DOI":"10.1177\/13524585251329820","article-title":"Hypnosis and Mindfulness Audio Recordings for Reducing Fatigue in Individuals with Multiple Sclerosis: A Randomized Controlled Study","volume":"31","author":"Jensen","year":"2025","journal-title":"Mult. Scler. J."},{"key":"ref_62","doi-asserted-by":"crossref","first-page":"594","DOI":"10.1177\/1352458513503391","article-title":"Randomized Controlled Trial of a Behavioral Intervention Targeting Symptoms and Physical Activity in Multiple Sclerosis","volume":"20","author":"Pilutti","year":"2014","journal-title":"Mult. Scler. J."},{"key":"ref_63","doi-asserted-by":"crossref","first-page":"373","DOI":"10.1016\/j.sleep.2024.05.005","article-title":"ACTIVE-FIT Program: Assessment of Sleep Quality and Its Relationship with Physical Activity in Patients with Relapsing\u2013Remitting Multiple Sclerosis","volume":"119","author":"Gonzalez","year":"2024","journal-title":"Sleep Med."},{"key":"ref_64","doi-asserted-by":"crossref","first-page":"1369","DOI":"10.2147\/NDT.S249277","article-title":"The Effectiveness of Occupational Therapy-Based Sleep Interventions on Quality of Life and Fatigue in Patients with Multiple Sclerosis: A Pilot Randomized Clinical Trial Study","volume":"16","author":"Akbarfahimi","year":"2020","journal-title":"Neuropsychiatr. Dis. Treat."},{"key":"ref_65","doi-asserted-by":"crossref","first-page":"zpab008","DOI":"10.1093\/sleepadvances\/zpab008","article-title":"Physiological Correlates of the Epworth Sleepiness Scale Reveal Different Dimensions of Daytime Sleepiness","volume":"2","author":"Lok","year":"2021","journal-title":"Sleep Adv."},{"key":"ref_66","doi-asserted-by":"crossref","first-page":"117","DOI":"10.1093\/sleep\/26.2.117","article-title":"The Cumulative Cost of Additional Wakefulness: Dose-Response Effects on Neurobehavioral Functions and Sleep Physiology from Chronic Sleep Restriction and Total Sleep Deprivation","volume":"26","author":"Maislin","year":"2003","journal-title":"Sleep"},{"key":"ref_67","doi-asserted-by":"crossref","first-page":"52","DOI":"10.1016\/j.smrv.2015.01.009","article-title":"The Pittsburgh Sleep Quality Index as a Screening Tool for Sleep Dysfunction in Clinical and Non-Clinical Samples: A Systematic Review and Meta-Analysis","volume":"25","author":"Mollayeva","year":"2016","journal-title":"Sleep Med. Rev."},{"key":"ref_68","doi-asserted-by":"crossref","first-page":"1444","DOI":"10.1212\/WNL.33.11.1444","article-title":"Rating Neurologic Impairment in Multiple Sclerosis: An Expanded Disability Status Scale (EDSS)","volume":"33","author":"Kurtzke","year":"1983","journal-title":"Neurology"},{"key":"ref_69","doi-asserted-by":"crossref","unstructured":"Dubinina, E., Korostovtseva, L., Rotar, O., Amelina, V., Boyarinova, M., Bochkarev, M., Shashkova, T., Baranova, E., Libis, R., and Duplyakov, D. (2021). Physical Activity Is Associated with Sleep Quality: Results of the ESSE-RF Epidemiological Study. Front. Psychol., 12.","DOI":"10.3389\/fpsyg.2021.705212"},{"key":"ref_70","first-page":"e43595","article-title":"The Effect of Physical Activity on Sleep Quality and Sleep Disorder: A Systematic Review","volume":"15","author":"Alnawwar","year":"2023","journal-title":"Cureus"},{"key":"ref_71","doi-asserted-by":"crossref","first-page":"744","DOI":"10.1037\/a0021504","article-title":"Assessing the Impact of Common Method Variance on Higher Order Multidimensional Constructs","volume":"96","author":"Johnson","year":"2011","journal-title":"J. Appl. Psychol."},{"key":"ref_72","doi-asserted-by":"crossref","first-page":"415","DOI":"10.5664\/jcsm.9586","article-title":"Discrepancies between Self-Reported and Device-Measured Sleep Parameters in Adults with Multiple Sclerosis","volume":"18","author":"Cederberg","year":"2022","journal-title":"J. Clin. Sleep Med."},{"key":"ref_73","doi-asserted-by":"crossref","first-page":"52","DOI":"10.1016\/j.jpsychores.2016.03.017","article-title":"Biological and Psychological Correlates of Self-Reported and Objective Sleep Measures","volume":"84","author":"Jackowska","year":"2016","journal-title":"J. Psychosom. Res."},{"key":"ref_74","doi-asserted-by":"crossref","first-page":"292","DOI":"10.1002\/ana.22366","article-title":"Diagnostic Criteria for Multiple Sclerosis: 2010 Revisions to the McDonald Criteria","volume":"69","author":"Polman","year":"2011","journal-title":"Ann. Neurol."},{"key":"ref_75","doi-asserted-by":"crossref","first-page":"162","DOI":"10.1016\/S1474-4422(17)30470-2","article-title":"Diagnosis of Multiple Sclerosis: 2017 Revisions of the McDonald Criteria","volume":"17","author":"Thompson","year":"2018","journal-title":"Lancet Neurol."},{"key":"ref_76","first-page":"32","article-title":"Expanded Disability Status Scale (EDSS) according to Kurtzke","volume":"13","author":"Walczak","year":"2017","journal-title":"Pol. Przegl. Neurol."},{"key":"ref_77","doi-asserted-by":"crossref","first-page":"2115","DOI":"10.5664\/jcsm.9476","article-title":"Sleep Is Essential to Health: An American Academy of Sleep Medicine Position Statement","volume":"17","author":"Ramar","year":"2021","journal-title":"J. Clin. Sleep Med."},{"key":"ref_78","doi-asserted-by":"crossref","first-page":"233","DOI":"10.1016\/j.sleh.2015.10.004","article-title":"National Sleep Foundation\u2019s Updated Sleep Duration Recommendations: Final report","volume":"1","author":"Hirshkowitz","year":"2015","journal-title":"Sleep Health"},{"key":"ref_79","doi-asserted-by":"crossref","first-page":"1121","DOI":"10.1001\/archneur.1989.00520460115022","article-title":"The Fatigue Severity Scale: Application to Patients with Multiple Sclerosis and Systemic Lupus Erythematosus","volume":"46","author":"Krupp","year":"1989","journal-title":"Arch. Neurol."},{"key":"ref_80","doi-asserted-by":"crossref","first-page":"15","DOI":"10.7224\/1537-2073.2012-019","article-title":"Psychometric Properties of the Modified Fatigue Impact Scale","volume":"15","author":"Larson","year":"2013","journal-title":"Int. J. MS Care"},{"key":"ref_81","first-page":"148","article-title":"Validation Analysis of the Polish Version of the Modified Fatigue Impact Scale","volume":"43","author":"Gruszczak","year":"2009","journal-title":"Neurol. Neurochir. Pol."},{"key":"ref_82","first-page":"211","article-title":"Validation of the Polish Version of the Athens Insomnia Scale","volume":"45","author":"Szelenberger","year":"2011","journal-title":"Psychiatr. Pol."},{"key":"ref_83","doi-asserted-by":"crossref","first-page":"555","DOI":"10.1016\/S0022-3999(00)00095-7","article-title":"Athens Insomnia Scale: Validation of an Instrument Based on ICD-10 Criteria","volume":"48","author":"Soldatos","year":"2000","journal-title":"J. Psychosom. Res."},{"key":"ref_84","doi-asserted-by":"crossref","first-page":"540","DOI":"10.1093\/sleep\/14.6.540","article-title":"A New Method for Measuring Daytime Sleepiness: The Epworth Sleepiness Scale","volume":"14","author":"Johns","year":"1991","journal-title":"Sleep"},{"key":"ref_85","doi-asserted-by":"crossref","first-page":"361","DOI":"10.1111\/j.1600-0447.1983.tb09716.x","article-title":"The Hospital Anxiety and Depression Scale","volume":"67","author":"Zigmond","year":"1983","journal-title":"Acta Psychiatr. Scand."},{"key":"ref_86","first-page":"653","article-title":"Use of the Hospital Anxiety and Depression Scale in Psychosomatic Disorders","volume":"30","author":"Grzywa","year":"1996","journal-title":"Psychiatr. Pol."},{"key":"ref_87","doi-asserted-by":"crossref","first-page":"1518","DOI":"10.1177\/1352458509347150","article-title":"Validation of the Hospital Anxiety and Depression Scale for Use with Multiple Sclerosis Patients","volume":"15","author":"Honarmand","year":"2009","journal-title":"Mult. Scler. J."}],"container-title":["Clocks &amp; Sleep"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2624-5175\/8\/2\/24\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,5,14]],"date-time":"2026-05-14T04:18:09Z","timestamp":1778732289000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2624-5175\/8\/2\/24"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,4,30]]},"references-count":87,"journal-issue":{"issue":"2","published-online":{"date-parts":[[2026,6]]}},"alternative-id":["clockssleep8020024"],"URL":"https:\/\/doi.org\/10.3390\/clockssleep8020024","relation":{},"ISSN":["2624-5175"],"issn-type":[{"value":"2624-5175","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,4,30]]}}}