Castro-Marrero, Jesús, Zaragozá, Maria C, González-Garcia, Sergio et al. · Journal of sleep research · 2018 · DOI
This study looked at sleep problems in 1,455 Spanish ME/CFS patients and found that nearly all of them reported poor sleep quality that wasn't refreshing, even when they slept. The researchers discovered that poor sleep was strongly linked to worse pain, fatigue, anxiety, depression, and lower quality of life overall. Several factors—including pain intensity, mood problems, fibromyalgia, and autonomic nervous system dysfunction—were particularly associated with sleep difficulties.
Sleep disturbance is a core diagnostic feature of ME/CFS, yet this study provides rare large-scale data on how pervasive and severe self-reported sleep problems are in this population. Understanding the associations between sleep quality and other symptoms helps clinicians recognize interconnected symptom clusters and may inform targeted interventions to improve quality of life.
This study cannot establish causation—it does not prove that poor sleep causes other symptoms or vice versa, only that they co-occur. It relies entirely on patient self-report without objective sleep measurements such as polysomnography, which may not capture actual sleep architecture or objective sleep duration. The cross-sectional design prevents determining whether addressing sleep quality would improve other symptoms.
About the PEM badge: “PEM required” means post-exertional malaise was an explicit required diagnostic criterion for participant inclusion in this study — not that PEM was studied, observed, or discussed. Studies using criteria that do not require PEM (e.g. Fukuda, Oxford) are tagged “PEM not required”. How the atlas works →
The first block is for the primary paper and is the citation you should use in research work. The atlas-snapshot line only applies if you are specifically referring to this atlas’s reading of the paper on the date shown.
Primary citation
Castro-Marrero, Jesús, Zaragozá, Maria C, González-Garcia, Sergio, Aliste, Luisa, Sáez-Francàs, Naia, Romero, Odile, et al. (2018). Poor self-reported sleep quality and health-related quality of life in patients with chronic fatigue syndrome/myalgic encephalomyelitis.. Journal of sleep research. https://doi.org/10.1111/jsr.12703
BibTeX
@article{mecfsatlas-castro-marrero-2018-poor-self,
author = {Castro-Marrero, Jesús and Zaragozá, Maria C and González-Garcia, Sergio and Aliste, Luisa and Sáez-Francàs, Naia and Romero, Odile and Ferré, Alex and Fernández de Sevilla, Tomás and Alegre, José},
title = {Poor self-reported sleep quality and health-related quality of life in patients with chronic fatigue syndrome/myalgic encephalomyelitis.},
journal = {Journal of sleep research},
year = {2018},
doi = {10.1111/jsr.12703},
note = {PubMed: 29770505},
url = {https://www.mecfsatlas.com/evidence/castro-marrero-2018-poor-self},
}Atlas snapshot reference
ME/CFS Atlas. Generator v1 / Scanner v1.4 / policy v0.1. Accessed 2026-05-30. https://www.mecfsatlas.com/evidence/castro-marrero-2018-poor-self
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