NeurologyPEM-relevant

Sleep

272 studies in the atlas

Unrefreshing sleep is a core feature of ME/CFS, reported by nearly all patients. Despite spending adequate or even excessive time in bed, patients consistently wake feeling unrestored. Sleep studies have documented abnormalities in sleep architecture, though these findings are not always consistent across studies.

What we know

Unrefreshing sleep is reported by nearly all ME/CFS patients and is included in most diagnostic criteria
Sleep architecture abnormalities, including disrupted slow-wave sleep, have been documented in some studies
Sleep quality does not improve proportionally with increased sleep duration in most patients
Conventional sleep disorders (apnea, insomnia) may coexist but do not explain the unrefreshing quality

What remains uncertain

Whether unrefreshing sleep is a primary feature or secondary to autonomic, immune, or metabolic abnormalities
The specific sleep architecture changes that distinguish ME/CFS from primary sleep disorders are not well defined
Whether targeted sleep interventions improve overall ME/CFS outcomes or only sleep-specific symptoms
The relationship between unrefreshing sleep and PEM susceptibility is poorly understood

What is emerging

Which aspects of sleep disturbance in ME/CFS are most amenable to intervention
Whether sleep biomarkers could contribute to ME/CFS diagnosis
The role of glymphatic clearance during sleep and its potential impairment in ME/CFS
Whether sleep interventions can reduce PEM frequency or severity

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E0 ConsensusPEM required

The persistence of myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) after SARS-CoV-2 infection: A systematic review and meta-analysis.

Dehlia, Ankush, Guthridge, Mark A·The Journal of infection·2024

Researchers looked at studies of people with Long COVID to see how many also meet the diagnostic criteria for ME/CFS. They found that about half of Long COVID patients have symptoms that match ME/CFS, including severe fatigue, sleep problems, muscle and joint pain, and post-exertional malaise (feeling much worse after physical activity). This suggests that Long COVID and ME/CFS may be very similar conditions, at least in some patients.

Research Momentum

266 publications over 37 years. Recent trend: decreasing (7/year over the last 3 years).

Top Studies

60 of 272, sorted by evidence level and year

E0ReviewPEM ?

Neuroendocrine signature of ME/CFS: Meta-analytic evidence for bioactive cortisol deficit and exaggerated feedback sensitivity.

2026

Woo, Tae-Wook et al.·Molecular psychiatry·Meta-Analysis

E0ReviewPEM ?

The efficacy of exercise in patients with myalgic encephalomyelitis/chronic fatigue syndrome: A systematic review and meta-analysis.

2026

Zhao, Liping et al.·Journal of psychosomatic research·Systematic-Review

E0ReviewPEM ?

Comparative effectiveness of non-pharmacological traditional Chinese medicine therapies for chronic fatigue syndrome: a systematic review and network meta-analysis.

2026

Zhang, Yihan et al.·Frontiers in medicine·Systematic-Review

Sleep

What we know

What remains uncertain

What is emerging

The persistence of myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) after SARS-CoV-2 infection: A systematic review and meta-analysis.

Research Momentum

Top Studies

Neuroendocrine signature of ME/CFS: Meta-analytic evidence for bioactive cortisol deficit and exaggerated feedback sensitivity.

The efficacy of exercise in patients with myalgic encephalomyelitis/chronic fatigue syndrome: A systematic review and meta-analysis.

Comparative effectiveness of non-pharmacological traditional Chinese medicine therapies for chronic fatigue syndrome: a systematic review and network meta-analysis.

Evaluation of safety and effectiveness of NAD in different clinical conditions: a systematic review.

Objective sleep measures in chronic fatigue syndrome patients: A systematic review and meta-analysis.

Effects of traditional Chinese mind-body exercises for patients with chronic fatigue syndrome: A systematic review and meta-analysis.

A Comprehensive Update of the Current Understanding of Chronic Fatigue Syndrome.

Systematic Review of Sleep Characteristics in Myalgic Encephalomyelitis/Chronic Fatigue Syndrome.

Do evidence based interventions for chronic fatigue syndrome improve sleep? A systematic review and narrative synthesis.

Exercise therapy for chronic fatigue syndrome.

Exercise therapy for chronic fatigue syndrome.

Exercise therapy for chronic fatigue syndrome.

Sleep Disturbances in Pediatric Chronic Fatigue Syndrome: A Review of Current Research.

Exercise therapy for chronic fatigue syndrome.

Sleep, pain, fibromyalgia, and chronic fatigue syndrome.

Review of clinical and psychobiological dimensions of the chronic fatigue syndrome: differentiation from depression and contribution of sleep dysfunctions.

The persistence of myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) after SARS-CoV-2 infection: A systematic review and meta-analysis.

Exploring the Effects of Qigong, Tai Chi, and Yoga on Fatigue, Mental Health, and Sleep Quality in Chronic Fatigue and Post-COVID Syndromes: A Systematic Review with Meta-Analysis.

Effects of yoga on depressive symptoms, anxiety, sleep quality, and mood in patients with rheumatic diseases: Systematic review and meta-analysis.

Identification of mental health and quality of life outcomes in primary care databases in the UK: a systematic review.

Psychiatric aspects of chronic fatigue syndrome and fibromyalgia.

Central nervous system abnormalities in fibromyalgia and chronic fatigue syndrome: new concepts in treatment.

Fibromyalgia and chronic fatigue syndrome: similarities and differences.

[Efficacy and safety of fonturacetam in asthenia: a systematic review and meta-analysis].

Effects of traditional Chinese exercise on sleep quality: A systematic review and meta-analysis of randomized controlled trials.

Homeopathic treatments in psychiatry: a systematic review of randomized placebo-controlled studies.

Sleep disturbances in multiple sclerosis.

Clinical uses of melatonin: evaluation of human trials.

Approved and investigational uses of modafinil : an evidence-based review.

Tuina therapy for patients with chronic fatigue syndrome: a randomized controlled trial.

Acupoint massage at Shenque (CV 8) for chronic fatigue syndrome: a randomized controlled trial.

Effects of Yijinjing Qigongin Alleviating Fatigue, Sleep Quality, and Health Status on Patients with Chronic Fatigue Syndrome: A Randomized, Controlled, and Parallel Group Clinical Study.

The Qigong of Prolong Life With Nine Turn Method Relieve Fatigue, Sleep, Anxiety and Depression in Patients With Chronic Fatigue Syndrome: A Randomized Controlled Clinical Study.

Effect of Melatonin Plus Zinc Supplementation on Fatigue Perception in Myalgic Encephalomyelitis/Chronic Fatigue Syndrome: A Randomized, Double-Blind, Placebo-Controlled Trial.

Effect of Dietary Coenzyme Q10 Plus NADH Supplementation on Fatigue Perception and Health-Related Quality of Life in Individuals with Myalgic Encephalomyelitis/Chronic Fatigue Syndrome: A Prospective, Randomized, Double-Blind, Placebo-Controlled Trial.

The effectiveness of cupping therapy on chronic fatigue syndrome: A single-blind randomized controlled trial.

[Effect of ginger-separated moxibustion on fatigue, sleep quality and depression in patients with chronic fatigue syndrome: a randomized controlled trial].

Qigong exercise for chronic fatigue syndrome.

Qigong exercise alleviates fatigue, anxiety, and depressive symptoms, improves sleep quality, and shortens sleep latency in persons with chronic fatigue syndrome-like illness.

Pilot study investigating the utility of a specialized online symptom management program for individuals with myalgic encephalomyelitis/chronic fatigue syndrome as compared to an online meditation program.

Agomelatine but not melatonin improves fatigue perception: a longitudinal proof-of-concept study.

Effect of topical nasal corticosteroids on patients with chronic fatigue syndrome and rhinitis.

Therapy of circadian rhythm disorders in chronic fatigue syndrome: no symptomatic improvement with melatonin or phototherapy.

Effectiveness of a brief multicomponent intervention to improve physical activity level and functional capacity in fibromyalgia and chronic fatigue syndrome (Synchronize+).

Efficacy of aquatic vs land-based therapy for pain management in women with fibromyalgia: a randomised controlled trial.

The Effect of Parenteral or Oral Iron Supplementation on Fatigue, Sleep, Quality of Life and Restless Legs Syndrome in Iron-Deficient Blood Donors: A Secondary Analysis of the IronWoMan RCT.

Effects of sleep restriction and exercise deprivation on somatic symptoms and mood in healthy adults.

[The use of melatonin in the treatment of chronic fatigue syndrome and circadian rhythm disorders in Parkinson's disease].

Associated factors and assessment of clinical symptoms including fatigue, insomnia, and gastrointestinal discomfort of chronic fatigue syndrome: a cross-sectional case-control study.

Sleep in myalgic encephalomyelitis/chronic fatigue syndrome shows marked night-to-night fluctuation under free-living conditions-results from a matched case-control study.

The Implications and Predictability of Sleep Reversal for People with Myalgic Encephalomyelitis/Chronic Fatigue Syndrome: A Machine Learning Approach.

Co-occurrence of severe fatigue and insomnia: implications for the outcome of cognitive behavioural therapies.

Efficacy of Eszopiclone Plus Acupuncture Therapy by Dispersing the Stagnated Liver-Qi and Regulating the Spirit for Treating Chronic Fatigue Syndrome-Related Sleep Disorders.

Evaluating case diagnostic criteria for myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS): toward an empirical case definition.

Risk factors for suicidal ideation in a chronic illness.

Sleeping and Dietary Factors Associated with Chronic Fatigue Syndrome in Taiwanese Preschoolers.

Key Features of a Multi-Disciplinary Hospital-Based Rehabilitation Program for Children and Adolescents with Moderate to Severe Myalgic Encephalomyelitis/Chronic Fatigue Syndrome ME/CFS.

A description of the current status of chronic fatigue syndrome and associated factors among university students in Wuhan, China.

Tai Chi increases functional connectivity and decreases chronic fatigue syndrome: A pilot intervention study with machine learning and fMRI analysis.

Associations of physical and psychiatric conditions with chronic fatigue syndrome in Germany: an exploratory case-control study.