Evidence map›Paper›PMID 40891960›Full record

ArticleClinical endocrinology2025

The Relationship Between Sleep, Fatigue and Quality of Life in Young Adults With Autoimmune Addison's Disease.

Sara Fletcher-Sandersjöö, Annelies van T Westeinde, Tim Spelman, Tatja Hirvikosi, Svetlana Lajic, Sophie Bensing

Abstract read
In one paragraph

Article in Clinical endocrinology, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 3 papers, 1 of them a synthesis that pooled it.

0numbers the graph read from it
0cells of the map it votes in
3citing papers in PubMed, 1 pooled it
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

3 citing papers in PubMed, 1 synthesis or guideline pooled it.

  1. Pooled it
  2. Article
  3. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

6 authors.

Sara Fletcher-SandersjööDepartment of Molecular Medicine and Surgery, Karolinska Institutet and Department of Endocrinology, Karolinska University Hospital, Stockholm, Sweden.ORCID https://orcid.org/0009-0002-9744-3643
Annelies van T WesteindeDepartment of Women's and Children's Health, Karolinska Institutet, Pediatric Endocrinology Unit, Karolinska University Hospital, Stockholm, Sweden.
Tim SpelmanDepartment of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.
Tatja HirvikosiDepartment of Women's and Children's Health, Pediatric Neuropsychiatry Unit, Center for Neurodevelopmental Disorders at Karolinska Institutet (KIND), Center for Psychiatric Research, Karolinska Institutet, Stockholm, Sweden.
Svetlana LajicDepartment of Women's and Children's Health, Karolinska Institutet, Pediatric Endocrinology Unit, Karolinska University Hospital, Stockholm, Sweden.ORCID https://orcid.org/0000-0002-4398-0948
Sophie BensingDepartment of Molecular Medicine and Surgery, Karolinska Institutet and Department of Endocrinology, Karolinska University Hospital, Stockholm, Sweden.

Funding

This study was supported by the Regional Agreement on Medical Training and Clinical Research (ALF) between Stockholm County Council and Karolinska Institutet (to S.B.); the Marianne and Marcus Wallenberg Foundation; Stockholm County Council (ALF, to S.L.); the Swedish Research Council (DNR 2021-02440); Region Stockholm (clinical research appointment, DNR RS 2019-1140, to S.L.); the Lisa and Johan Grönberg Foundation; Stiftelsen Frimurare Barnhuset, Stockholm; Samariten; Jerringfonden; Sällskapet Barnavård; Wera Ekströms Stiftelse för Pediatrikforskning; and the Foundation for Research and Education in Pediatric Endocrinology.
6 · The paper itself

Abstract

objectiveStandard glucocorticoid (GC) replacement therapy in autoimmune Addison's disease (AAD) fails to replicate natural cortisol rhythms. Despite adherence, patients report persistent fatigue, reduced vitality, and impaired wellbeing, ultimately lowering health-related 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-reported sleep impairments and their associations with fatigue and HRQoL in young adults with AAD. PATIENTS AND

methodsSixty-four patients with AAD and 128 healthy controls completed validated questionnaires assessing sleep (Karolinska Sleep Questionnaire), fatigue (Multidimensional Fatigue Inventory), and HRQoL (Short Form-36).

resultsPatients reported significantly more non-restorative sleep (p = 0.015) than controls. While overall rates of clinically relevant sleep impairments were similar, patients more frequently experienced awakening difficulties (p = 0.011) and struggling to stay awake (p = 0.036). Patients also reported poorer physical health (p < 0.001) and greater general fatigue (p = 0.007), with female patients experiencing more mental fatigue (p = 0.013). 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.

conclusionNon-restorative 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.

Indexed as

Addison DiseaseFatigueQuality of LifeSleepSleep Wake DisordersAdolescentAdultCase-Control StudiesFemaleHumansHydrocortisoneMaleSurveys and QuestionnairesYoung AdultHydrocortisoneAddison′s diseasecortisolfatiguemental healthphysical healthquality of lifesleep

Identifiers

PMID40891960
PMCPMC12583308

What OpenQuestion holds

Textmetadata
LicenceCC BY-NC-ND
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Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.