{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T04:45:41Z","timestamp":1787028341454,"version":"build-2736575974"},"reference-count":71,"publisher":"MDPI AG","issue":"6","license":[{"start":{"date-parts":[[2022,3,10]],"date-time":"2022-03-10T00:00:00Z","timestamp":1646870400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100009647","name":"Ministry of Health","doi-asserted-by":"publisher","award":["SUB.E020.21.002"],"award-info":[{"award-number":["SUB.E020.21.002"]}],"id":[{"id":"10.13039\/100009647","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["IJERPH"],"abstract":"<jats:p>Sleep disturbances are pervasive in patients with multiple sclerosis (MS), with incidence about four times higher compared to the general population. The most frequent primary sleep problems include insomnia, restless leg syndrome, sleep-related movement disorders, and sleep-disordered breathing. This study aims to assess the relationships between sleeping problems and the quality of life (QoL) in MS patients. This cross-sectional study was conducted among 152 MS patients (mean age: 36.27 \u00b1 9.60) between November 2018 and February 2019 at a neurological health center in Wroclaw, Poland. The study was based on a questionnaire that included questions concerning sociodemographic and clinical data in addition to the following standardized questionnaires: Athens Insomnia Scale (AIS), Epworth Sleepiness Scale (ESS), and Multiple Sclerosis International Quality of Life (MusiQoL). The degree of physical disability was evaluated following the Expanded Disability Status Scale (EDSS). Analysis of the research material showed that 66.45% of MS patients had insomnia, and 41.45% presented with daytime sleepiness. The QoL of respondents was assessed as average (50.73). Univariate linear regression model analysis showed the effects of professional status, daytime sleepiness, insomnia, and degree of disability on the QoL of MS patients. Sleep disturbances are widespread in MS patients. The presence of sleep disturbances (insomnia and daytime sleepiness) significantly affects the QoL of MS patients.<\/jats:p>","DOI":"10.3390\/ijerph19063271","type":"journal-article","created":{"date-parts":[[2022,3,10]],"date-time":"2022-03-10T11:46:47Z","timestamp":1646912807000},"page":"3271","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":31,"title":["Sleep Disturbances, Degree of Disability and the Quality of Life in Multiple Sclerosis Patients"],"prefix":"10.3390","volume":"19","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-4377-5987","authenticated-orcid":false,"given":"Aleksandra","family":"Ko\u0142tuniuk","sequence":"first","affiliation":[{"name":"Department of Nursing and Obstetrics, Wroclaw Medical University, 51-618 Wroclaw, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3758-2975","authenticated-orcid":false,"given":"Magdalena","family":"Kazimierska-Zaj\u0105c","sequence":"additional","affiliation":[{"name":"Department of Health Humanities and Social Science, Wroclaw Medical University, 50-345 Wroclaw, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dominika","family":"Pog\u0142\u00f3dek","sequence":"additional","affiliation":[{"name":"Department of Nursing and Obstetrics, Wroclaw Medical University, 51-618 Wroclaw, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0777-4565","authenticated-orcid":false,"given":"Justyna","family":"Chojdak-\u0141ukasiewicz","sequence":"additional","affiliation":[{"name":"Department of Neurology, Wroclaw Medical University, 50-556 Wroclaw, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2022,3,10]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"212","DOI":"10.1055\/s-0038-1649502","article-title":"Multiple Sclerosis","volume":"38","author":"Yamout","year":"2018","journal-title":"Semin. Neurol."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"1123","DOI":"10.1177\/1352458517694432","article-title":"New Insights into the Burden and Costs of Multiple Sclerosis in Europe","volume":"23","author":"Kobelt","year":"2017","journal-title":"Mult. Scler. J."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"1816","DOI":"10.1177\/1352458520970841","article-title":"Rising Prevalence of Multiple Sclerosis Worldwide: Insights from the Atlas of MS, Third Edition","volume":"26","author":"Walton","year":"2020","journal-title":"Mult. Scler. J."},{"key":"ref_4","first-page":"B5212","article-title":"Gender Differences in Multiple Sclerosis Epidemiology and Treatment Response","volume":"63","author":"Magyari","year":"2016","journal-title":"Dan. Med. J."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"27","DOI":"10.1111\/ene.13819","article-title":"Multiple Sclerosis\u2014A Review","volume":"26","author":"Dobson","year":"2019","journal-title":"Eur. J. Neurol."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"40","DOI":"10.1016\/j.sleh.2014.12.010","article-title":"National Sleep Foundation\u2019s Sleep Time Duration Recommendations: Methodology and Results Summary","volume":"1","author":"Hirshkowitz","year":"2015","journal-title":"Sleep Health"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"14288","DOI":"10.1523\/JNEUROSCI.5102-12.2013","article-title":"Effects of Sleep and Wake on Oligodendrocytes and Their Precursors","volume":"33","author":"Bellesi","year":"2013","journal-title":"J. Neurosci."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"246","DOI":"10.1016\/j.sleep.2016.08.006","article-title":"Short Sleep Duration and Health Outcomes: A Systematic Review, Meta-Analysis, and Meta-Regression","volume":"32","author":"Itani","year":"2017","journal-title":"Sleep Med."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"25","DOI":"10.1016\/j.smrv.2017.06.011","article-title":"Long Sleep Duration and Health Outcomes: A Systematic Review, Meta-Analysis and Meta-Regression","volume":"39","author":"Jike","year":"2018","journal-title":"Sleep Med. Rev."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"481","DOI":"10.1191\/135248506ms1320oa","article-title":"Sleep and Fatigue in Multiple Sclerosis","volume":"12","author":"Stanton","year":"2006","journal-title":"Mult. Scler. J."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"e00553","DOI":"10.1002\/brb3.553","article-title":"Poor Sleep Quality in Patients with Multiple Sclerosis: Gender Differences","volume":"6","author":"Vitkova","year":"2016","journal-title":"Brain Behav."},{"key":"ref_12","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. J."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"131","DOI":"10.1001\/archpsyc.59.2.131","article-title":"Mortality Associated with Sleep Duration and Insomnia","volume":"59","author":"Kripke","year":"2002","journal-title":"Arch. Gen. Psychiatry"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"56","DOI":"10.1016\/j.sleep.2019.02.020","article-title":"Sleep Quality Can Influence the Outcome of Patients with Multiple Sclerosis","volume":"58","author":"Buratti","year":"2019","journal-title":"Sleep Med."},{"key":"ref_15","first-page":"553","article-title":"Sleep Deprivation: Impact on Cognitive Performance","volume":"3","author":"Alhola","year":"2007","journal-title":"Neuropsychiatr. Dis. Treat."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"72","DOI":"10.1007\/s00415-016-8318-6","article-title":"The Role of Sleep on Cognition and Functional Connectivity in Patients with Multiple Sclerosis","volume":"264","author":"Westerik","year":"2017","journal-title":"J. Neurol."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"64","DOI":"10.1055\/s-2005-867075","article-title":"Sleep Disorders in Multiple Sclerosis","volume":"25","author":"Fleming","year":"2005","journal-title":"Semin. Neurol."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"86","DOI":"10.1016\/j.jns.2011.07.015","article-title":"Sleep Disturbances in Multiple Sclerosis","volume":"309","author":"Caminero","year":"2011","journal-title":"J. Neurol. Sci."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"585","DOI":"10.1007\/s40263-017-0444-x","article-title":"Health-Related Quality of Life in Patients with Multiple Sclerosis: Impact of Disease-Modifying Drugs","volume":"31","author":"Jongen","year":"2017","journal-title":"CNS Drugs"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"519","DOI":"10.1016\/S1474-4422(09)70085-7","article-title":"NORdic Trial of Oral Methylprednisolone as Add-on Therapy to Interferon Beta-1a for Treatment of Relapsing-Remitting Multiple Sclerosis (NORMIMS Study): A Randomised, Placebo-Controlled Trial","volume":"8","author":"Sorensen","year":"2009","journal-title":"Lancet Neurol."},{"key":"ref_21","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_22","doi-asserted-by":"crossref","first-page":"238","DOI":"10.1177\/1352458509354551","article-title":"Sleep Disturbance and Fatigue in Mild Relapsing Remitting Multiple Sclerosis Patients on Chronic Immunomodulant Therapy: An Actigraphic Study","volume":"16","author":"Mendozzi","year":"2010","journal-title":"Mult. Scler. J."},{"key":"ref_23","doi-asserted-by":"crossref","unstructured":"Kotterba, S., Neusser, T., Norenberg, C., Bussfeld, P., Glaser, T., D\u00f6rner, M., and Sch\u00fcrks, M. (2018). Sleep Quality, Daytime Sleepiness, Fatigue, and Quality of Life in Patients with Multiple Sclerosis Treated with Interferon Beta-1b: Results from a Prospective Observational Cohort Study. BMC Neurol., 18.","DOI":"10.1186\/s12883-018-1113-5"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"5","DOI":"10.1177\/1352458516664034","article-title":"The Impact of Drugs for Multiple Sclerosis on Sleep","volume":"23","author":"Lanza","year":"2017","journal-title":"Mult. Scler. J."},{"key":"ref_25","first-page":"249","article-title":"Features of Sleep Disturbances in Multiple Sclerosis Patients","volume":"26","author":"Leonavicius","year":"2014","journal-title":"Psychiatr. Danub."},{"key":"ref_26","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."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"24","DOI":"10.1111\/ane.12046","article-title":"Clinical Assessment and Management of Sleep Disorders in Multiple Sclerosis: A Literature Review","volume":"127","author":"Lunde","year":"2013","journal-title":"Acta Neurol. Scand."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"17","DOI":"10.1186\/s41983-018-0016-0","article-title":"Insomnia among Non-Depressed Multiple Sclerosis Patients: A Cross-Sectional Study","volume":"54","author":"Alhazzani","year":"2018","journal-title":"Egypt. J. Neurol. Psychiatry Neurosurg."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"553","DOI":"10.5664\/jcsm.4702","article-title":"Sleep Disorders in Patients with Multiple Sclerosis","volume":"11","year":"2015","journal-title":"J. Clin. Sleep Med."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"3","DOI":"10.1016\/j.smrv.2011.08.005","article-title":"Definition of Acute Insomnia: Diagnostic and Treatment Implications","volume":"16","author":"Morin","year":"2012","journal-title":"Sleep Med. Rev."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"1094","DOI":"10.1002\/jclp.22000","article-title":"Transient Insomnia Versus Chronic Insomnia: A Comparison Study of Sleep-Related Psychological\/Behavioral Characteristics: Transient Insomnia Versus Chronic Insomnia","volume":"69","author":"Yang","year":"2013","journal-title":"J. Clin. Psychol."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"215","DOI":"10.1146\/annurev.psych.53.100901.135243","article-title":"Insomnia: Conceptual Issues in the Development, Persistence, and Treatment of Sleep Disorder in Adults","volume":"53","author":"Espie","year":"2002","journal-title":"Annu. Rev. Psychol."},{"key":"ref_33","doi-asserted-by":"crossref","unstructured":"B\u00f8e Lunde, H.M., Aae, T.F., Indrev\u00e5g, W., Aarseth, J., Bjorvatn, B., Myhr, K.-M., and B\u00f8, L. (2012). Poor Sleep in Patients with Multiple Sclerosis. PLoS ONE, 7.","DOI":"10.1371\/journal.pone.0049996"},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"95","DOI":"10.1016\/j.smrv.2016.03.004","article-title":"Daytime Sleepiness versus Fatigue in Patients with Multiple Sclerosis: A Systematic Review on the Epworth Sleepiness Scale as an Assessment Tool","volume":"32","author":"Popp","year":"2017","journal-title":"Sleep Med. Rev."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"144","DOI":"10.1136\/jnnp.68.2.144","article-title":"Treatment of Multiple Sclerosis with Interferon Beta: An Appraisal of Cost-Effectiveness and Quality of Life","volume":"68","author":"Parkin","year":"2000","journal-title":"J. Neurol. Neurosurg. Psychiatry"},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"1291","DOI":"10.1080\/09638280310001608591","article-title":"A Review about the Impact of Multiple Sclerosis on Health-Related Quality of Life","volume":"25","author":"Mitchell","year":"2003","journal-title":"Disabil. Rehabil."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"1237","DOI":"10.1001\/archneur.1992.00530360035014","article-title":"Quality of Life in Multiple Sclerosis. Comparison with Inflammatory Bowel Disease and Rheumatoid Arthritis","volume":"49","author":"Rudick","year":"1992","journal-title":"Arch. Neurol."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"1339","DOI":"10.1177\/1352458509107016","article-title":"Gender Differences in Health-Related Quality of Life in Multiple Sclerosis","volume":"15","author":"Casetta","year":"2009","journal-title":"Mult. Scler. J."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"63","DOI":"10.1191\/1352458503ms871oa","article-title":"The Use of Quality of Life Measures in Multiple Sclerosis Research","volume":"9","author":"Nortvedt","year":"2003","journal-title":"Mult. Scler. Houndmills Basingstoke Engl."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"26","DOI":"10.1016\/j.sleep.2007.11.004","article-title":"Prevalence of \u2018Poor Sleep\u2019 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_41","doi-asserted-by":"crossref","unstructured":"World Medical Association (2013). World Medical Association Declaration of Helsinki: Ethical Principles for Medical Research Involving Human Subjects. JAMA, 310, 2191\u20132194.","DOI":"10.1001\/jama.2013.281053"},{"key":"ref_42","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_43","first-page":"32","article-title":"Rozszerzona Skala Niesprawno\u015bci (EDSS, Expanded Disability Status Scale)\u2014Wed\u0142ug, J. Kurtzkego","volume":"13","author":"Walczak","year":"2017","journal-title":"Pol. Prz. Neurol."},{"key":"ref_44","first-page":"211","article-title":"Walidacja Ate\u0144skiej Skali Bezsenno\u015bci","volume":"45","author":"Szelenberger","year":"2011","journal-title":"Psychiatr. Pol."},{"key":"ref_45","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_46","unstructured":"Strzemecka, J. (2019). Zaburzenia Dotycz\u0105ce Snu u Personelu Medycznego Wykonuj\u0105cego Prac\u0119 Zmianow\u0105 z Uwzgl\u0119dnieniem Aktywno\u015bci Oko\u0142odobowej, PZWL."},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"235","DOI":"10.1016\/S0028-3843(14)60076-1","article-title":"Validation Analysis of the Polish Version of the Multiple Sclerosis International Quality of Life Questionnaire (MusiQoL)","volume":"45","author":"Stelmasiak","year":"2011","journal-title":"Neurol. Neurochir. Pol."},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"937","DOI":"10.1007\/s12529-017-9653-4","article-title":"Factors Associated with Poor Sleep in Older Adults with Multiple Sclerosis","volume":"24","author":"Garland","year":"2017","journal-title":"Int. J. Behav. Med."},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"466","DOI":"10.1016\/j.dhjo.2014.05.004","article-title":"Factors Associated with Poor Sleep Quality in Patients with Multiple Sclerosis Differ by Disease Duration","volume":"7","author":"Vitkova","year":"2014","journal-title":"Disabil. Health J."},{"key":"ref_50","first-page":"17","article-title":"Sleep Quality in Patients with Multiple Sclerosis","volume":"3","author":"Mosarrezaii","year":"2018","journal-title":"J. Sleep Sci."},{"key":"ref_51","doi-asserted-by":"crossref","first-page":"268","DOI":"10.7224\/1537-2073.2014-046","article-title":"Fatigue, Sleep Quality, and Disability in Relation to Quality of Life in Multiple Sclerosis","volume":"17","author":"Tabrizi","year":"2015","journal-title":"Int. J. MS Care"},{"key":"ref_52","doi-asserted-by":"crossref","first-page":"1127","DOI":"10.1177\/1352458508092807","article-title":"Prevalence of Sleep Problems in Individuals with Multiple Sclerosis","volume":"14","author":"Bamer","year":"2008","journal-title":"Mult. Scler. J."},{"key":"ref_53","doi-asserted-by":"crossref","first-page":"106","DOI":"10.1080\/15402002.2016.1173555","article-title":"Is Poor Sleep Quality Associated With Greater Disability in Patients With Multiple Sclerosis?","volume":"16","author":"Vitkova","year":"2018","journal-title":"Behav. Sleep Med."},{"key":"ref_54","first-page":"1582","article-title":"Relationship between Sleep Quality and Quality of Life InpPatients with Multiple Sclerosis","volume":"5","author":"Sarraf","year":"2014","journal-title":"Int. J. Prev. Med."},{"key":"ref_55","doi-asserted-by":"crossref","first-page":"203","DOI":"10.3934\/medsci.2016.2.203","article-title":"Factors Associated with Sleep Quality in Patients with Multiple Sclerosis","volume":"3","author":"Kara","year":"2016","journal-title":"AIMS Med. Sci."},{"key":"ref_56","doi-asserted-by":"crossref","first-page":"387","DOI":"10.1016\/j.jns.2016.10.040","article-title":"Sleep and Fatigue in Multiple Sclerosis: A Questionnaire-Based, Cross-Sectional, Cohort Study","volume":"372","author":"Nociti","year":"2017","journal-title":"J. Neurol. Sci."},{"key":"ref_57","doi-asserted-by":"crossref","first-page":"149","DOI":"10.1007\/s11325-016-1416-y","article-title":"Sleep Disorders in Patients with Multiple Sclerosis in China","volume":"21","author":"Ma","year":"2017","journal-title":"Sleep Breath."},{"key":"ref_58","doi-asserted-by":"crossref","first-page":"1333","DOI":"10.1111\/j.1468-1331.2006.01499.x","article-title":"Fatigue and Sleep Disturbance in Multiple Sclerosis","volume":"13","author":"Kaynak","year":"2006","journal-title":"Eur. J. Neurol."},{"key":"ref_59","doi-asserted-by":"crossref","first-page":"258","DOI":"10.1159\/000470904","article-title":"Sleep Disorder as a Triggering Factor for Relapse in Multiple Sclerosis","volume":"77","author":"Sahraian","year":"2017","journal-title":"Eur. Neurol."},{"key":"ref_60","doi-asserted-by":"crossref","unstructured":"Tassi, P., and De Seze, J. (2018). Non Pharmacological Treatment of Insomnia in Multiple Sclerosis Patients: A Brief Review. J. Sleep Disord. Med. Care, 1.","DOI":"10.16966\/2577-882X.101"},{"key":"ref_61","doi-asserted-by":"crossref","first-page":"309","DOI":"10.5114\/ninp.2012.30261","article-title":"Fatigue and Its Association with Sleep Disorders, Depressive Symptoms and Anxiety in Patients with Multiple Sclerosis","volume":"46","author":"Skrzypek","year":"2012","journal-title":"Neurol. Neurochir. Pol."},{"key":"ref_62","doi-asserted-by":"crossref","first-page":"477","DOI":"10.1016\/j.msard.2015.07.010","article-title":"InMS: Chronic Insomnia Disorder in Multiple Sclerosis\u2014A Portuguese Multicentre Study on Prevalence, Subtypes, Associated Factors and Impact on Quality of Life","volume":"4","author":"Viana","year":"2015","journal-title":"Mult. Scler. Relat. Disord."},{"key":"ref_63","first-page":"464","article-title":"Depression, Sleep Disturbances and Anxiety in Patients with Relapsing-Remitting Multiple Sclerosis: A Longitudinal Cohort Observation","volume":"29","author":"Brozek","year":"2017","journal-title":"Psychiatr. Danub."},{"key":"ref_64","doi-asserted-by":"crossref","first-page":"1291","DOI":"10.1007\/s10072-012-1229-0","article-title":"Sleep Disturbances in Patients with Multiple Sclerosis","volume":"34","author":"Gruszka","year":"2013","journal-title":"Neurol. Sci."},{"key":"ref_65","doi-asserted-by":"crossref","first-page":"129","DOI":"10.7705\/biomedica.4759","article-title":"Quality of Life in Patients with Multiple Sclerosis and Their Caregivers in Colombia: One-Year Follow-Up","volume":"40","author":"Zarco","year":"2020","journal-title":"Biom\u00e9dica"},{"key":"ref_66","doi-asserted-by":"crossref","first-page":"21","DOI":"10.1016\/j.msard.2015.12.003","article-title":"Quality of Life and Coping Strategies in Lebanese Multiple Sclerosis Patients: A Pilot Study","volume":"6","author":"Farran","year":"2016","journal-title":"Mult. Scler. Relat. Disord."},{"key":"ref_67","doi-asserted-by":"crossref","first-page":"174","DOI":"10.1111\/ane.12854","article-title":"Self-Assessments and Determinants of HRQoL in a German MS Population","volume":"137","author":"Nickel","year":"2018","journal-title":"Acta Neurol. Scand."},{"key":"ref_68","doi-asserted-by":"crossref","unstructured":"Fern\u00e1ndez, O., Fern\u00e1ndez, V., Baumstarck-Barrau, K., Mu\u00f1oz, L., Gonzalez Alvarez, M.d.M., Arrabal, J.C., Le\u00f3n, A., Alonso, A., L\u00f3pez-Madrona, J.C., and Bustamante, R. (2011). Validation of the Spanish Version of the Multiple Sclerosis International Quality of Life (Musiqol) Questionnaire. BMC Neurol., 11.","DOI":"10.1186\/1471-2377-11-127"},{"key":"ref_69","doi-asserted-by":"crossref","first-page":"171","DOI":"10.1111\/j.1600-0404.2011.01518.x","article-title":"Validation of the Multiple Sclerosis International Quality of Life (MusiQoL) Questionnaire in Norwegian Patients: MusiQoL Validation in Norway","volume":"125","author":"Beiske","year":"2012","journal-title":"Acta Neurol. Scand."},{"key":"ref_70","doi-asserted-by":"crossref","first-page":"559","DOI":"10.5664\/jcsm.2750","article-title":"Sleep Habits, Insomnia, and Daytime Sleepiness in a Large and Healthy Community-Based Sample of New Zealanders","volume":"9","author":"Wilsmore","year":"2013","journal-title":"J. Clin. Sleep Med."},{"key":"ref_71","doi-asserted-by":"crossref","first-page":"16514","DOI":"10.3390\/ijms160716514","article-title":"Sleep Disorders Reduce Health-Related Quality of Life in Multiple Sclerosis (Nottingham Health Profile Data in Patients with Multiple Sclerosis)","volume":"16","author":"Veauthier","year":"2015","journal-title":"Int. J. Mol. Sci."}],"container-title":["International Journal of Environmental Research and Public Health"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1660-4601\/19\/6\/3271\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T22:34:26Z","timestamp":1760135666000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1660-4601\/19\/6\/3271"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,3,10]]},"references-count":71,"journal-issue":{"issue":"6","published-online":{"date-parts":[[2022,3]]}},"alternative-id":["ijerph19063271"],"URL":"https:\/\/doi.org\/10.3390\/ijerph19063271","relation":{},"ISSN":["1660-4601"],"issn-type":[{"value":"1660-4601","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,3,10]]}}}