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2021, Number 1

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Rev Cubana Hig Epidemiol 2021; 58 (1)

Sleep and immune response in the context of the COVID-19 pandemic

González NJE, Rodríguez A

Language: Spanish
References: 73
Page: 1-16
PDF size: 641.24 Kb.


ABSTRACT

Introduction: A close relationship exists between the immune system and sleep. Objective: Present elements showing the relationship between the immune system and the sleep process. Methods: A bibliographic review was conducted in online databases related to sleep alterations and the immune status. The publications selected were original papers about prospective or retrospective studies and review papers. The period analyzed covered 46 years: from 1974 to 2020. Data analysis and integration: The immune system and sleep are circadian processes governed by the suprachiasmatic nucleus of the hypothalamus which interact with one another modifying their mutual functions. Numerous studies agree that normal sleep enhances immune defenses, whereas sleep deprivation tends to lower them. During the COVID-19 pandemic, lifestyle changes have been described which include a reduction in the number of sleep hours, which may negatively impact an adequate immune response in the current context. Conclusions: Regulation of the immune system and the sleep/wake cycle share a common circadian rhythm. A number of factors leading to sleep deprivation expose individuals to displaying unfavorable immune responses. Changes in our habits and customs caused by the current COVID-19 pandemic situation have led to the appearance of various sleep alterations in the population which may have a negative impact on our immune response.


REFERENCES

  1. Sudhansu C. Medicina de los Trastornos del Sueño. Aspectos básicos, consideraciones técnicas y aplicaciones clínicas. España: Elsevier; 2011 [acceso 19/03/2020]. Disponible en: Disponible en: https://www.sciencedirect.com/book/9788480867337/medicina-de-los-trastornos-del-sueno#book-info

  2. Irwin MR. Sleep and infectious disease risk. Sleep. 2012 [acceso 19/03/2020]; 35(8):1025-6. Disponible en: Disponible en: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3397805/

  3. Hobson JA. Dreaming: An introduction to the science of sleep. EE. UU.: Oxford University Press; 2002.

  4. Irwin MR. Why sleep is important for health: A psychoneuroimmunology perspective. Ann Rev Psychol. 2015 [acceso 19/03/2020];66:143-72. Disponible en: Disponible en: https://pubmed.ncbi.nlm.nih.gov/25061767/

  5. Rico-Rosillo MG, Vega-Robledo GB. Sueño y sistema inmune. Rev Alerg Mex. 2018 [acceso 22/03/2020];65(2):60-170. Disponible en: Disponible en: https://www.revistaalergia.mx/ojs/index.php/ram/article/view/359/866

  6. Toraldo DM, De Nuccio F, De Benedetto M, Scoditti E. Obstructive sleep apnoea syndrome: a new paradigm by chronic nocturnal intermittent hypoxia and sleep disruption. Acta Otorhinolaryngol Ital. 2015 [acceso 22/03/2020];35(2):69-74. Disponible en: Disponible en: https://pubmed.ncbi.nlm.nih.gov/26019388/

  7. Toraldo DM, De Benedetto M, Scoditti E, De Nuccio F. Obstructive sleep apnea syndrome: coagulation anomalies and treatment with continuous positive airway pressure. Sleep Breath. 2016 [acceso 22/03/2020];20(2):457-65. Disponible en: Disponible en: https://pubmed.ncbi.nlm.nih.gov/26169715/

  8. Colla-Machado PE, Luzzi AA, Balian NR, Pigretti SG, Zurrú-Ganen MC, Cristiano E, Valiensi SM. Prevalence of silent cerebrovascular lesions in patients with obstructive sleep apnea syndrome. Rev Neurol. 2016 [acceso 26/03/2020];62(3):113-7. Disponible en: Disponible en: https://pubmed.ncbi.nlm.nih.gov/26815848/

  9. Marquez-Romero JM, Morales-Ramírez M, Arauz A. Non-breathing-related sleep disorders following stroke. Neurologia. 2014 [acceso 26/03/2020];29(9):511-6. Disponible en: Disponible en: https://pubmed.ncbi.nlm.nih.gov/23810485/

  10. Julia Santín M. Sueño y Epilepsia. Rev Med Clin Condes. 2013 [acceso 04/03/2020];24(3):480-5. Disponible en: Disponible en: https://www.elsevier.es/es-revista-revista-medica-clinica-las-condes-202-articulo-sueno-epilepsia-S0716864013701846

  11. Justa Elizabeth GN, Alfonso-Alfonso M, Grass-Fernández D, Morales-Chacón LM, Pedroso-Ibáñez I, Ricardo-de la Fe Y, et al. Analysis of Sleep Macrostructure in Patients Diagnosed with Parkinson’s Disease. Behav Sc. 2019 [acceso 04/03/2020];9(1):6. Disponible en: Disponible en: https://pubmed.ncbi.nlm.nih.gov/30625988/

  12. Salvador J, Iriarte J, Silva C, Gómez Ambrosi J, Díez Caballero A, Frühbeck G. The obstructive sleep apnoea syndrome in obesity: a conspirator in the shadow. Rev Med Univ Navarra. 2004 [acceso 04/03/2020];48(2):55-62. Disponible en: Disponible en: https://pubmed.ncbi.nlm.nih.gov/15382614/

  13. Chen XF, Zhang Y, Xu X, Wang W, Yan H, Li Sh, et al. Mediating effects of anxiety, self-efficacy and sleep quality on the relationship between doctor-patient’s empathy and inflammatory marker in patients with ulcerative colitis. Med Sc Monit. 2019 [acceso 10/04/2020];25:7889-97. Disponible en: Disponible en: https://pubmed.ncbi.nlm.nih.gov/31634896/

  14. Zhang W, Xu H, Zhao S, Yin S, Wang X, Guo J, et. al. Prevalence and influencing factors of co-morbid depression in patients with type 2 diabetes mellitus: A general hospital based study. Diabetol Metab Syndr. 2015 [acceso 10/04/2020];7:60. Disponible en: Disponible en: https://pubmed.ncbi.nlm.nih.gov/26167205/

  15. Philip P, Taillard J, Micoulaud-Franchi JA. Sleep restriction, Sleep Hygiene, and Driving Safety: The importance of Situational Sleepiness. Sleep Med Clin. 2019 Dec; 14(4):407-412. doi: 10.1016/j.jsmc.2019.07.002. Epub 2019 Sep 27. PMID: 31640868

  16. Xiao H, Zhang Y, Kong D, Li Sh, Yang N. Social Capital and Sleep Quality in Individuals Who Self-Isolated for 14 Days During the Coronavirus Disease 2019 (COVID-19) Outbreak in January 2020 in China. Med Sc Monit. 2020 [acceso 13/04/2020];26:e923921. Disponible en: Disponible en: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7111105/

  17. Xiao H. Medical staff treating COVID-19 ©. Med Sc Monit. 2020;26: e923549.

  18. Zhang Ch, Yang L, Liu Sh, Ma S, Wang Y, Cai Zh, et al. Survey of Insomnia and Related Social Psychological Factors Among Medical Staff Involved in the 2019 Novel Coronavirus Disease Outbreak. Front Psychiatry. 2020 [acceso 13/04/2020];11:306. Disponible en: Disponible en: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7171048/

  19. Diekelmann S, Born J. The memory function of sleep. Nat Rev Neurosc. 2010 [acceso 13/04/2020];11(2):114-26. Disponible en: Disponible en: https://www.nature.com/articles/nrn2762

  20. Irwin MR, Opp MR. Sleep Health: Reciprocal Regulation of Sleep and Innate Immunity. Neuropsychopharmacology. 2017 [acceso 13/04/2020];42(1):129-55. Disponible en: Disponible en: https://pubmed.ncbi.nlm.nih.gov/27510422/

  21. Obal FJr, Krueger JM. Biochemical regulation of non-rapid-eye-movement sleep. Frontiers Biosc. 2003 [acceso 16/04/2020];8(4):520-50. Disponible en: Disponible en: https://fbscience.com/Landmark/articles/10.2741/1033

  22. Del Gallo F, Opp MR, Imeri L. The reciprocal link between sleep and immune responses. Arch Ital Biol. 2014 [acceso 16/04/2020];152(2-3):93-102. Disponible en: Disponible en: https://pubmed.ncbi.nlm.nih.gov/25828681/

  23. Shneider A, Kudriavtsev A, Vakhrusheva A. Can melatonin reduce the severity of COVID-19 pandemic? Int Rev Immunol. 2020 [acceso 16/04/2020];39(4):153-62. Disponible en: Disponible en: https://pubmed.ncbi.nlm.nih.gov/32347747/

  24. Ramos RMA, Leon LA. Cronobiología del sistema inmune. Rev Cubana Hematol Inmunol Hemoter. 2016 [acceso 16/04/2020];32(3):316-24. Disponible en: Disponible en: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5955790/

  25. Rockstrom MD, Chen L, Taishi P, Nguyen JT, Gibbons CM, Veasey SC, et al. Tumor necrosis factor alpha in sleep regulation. Sleep Rev Med. 2018 [acceso 19/04/2020];40:69-78. Disponible en: Disponible en: https://www.sciencedirect.com/science/article/abs/pii/S1087079217301478?via%3Dihub

  26. Kapsimalis F, Richardson G, Opp MR, Kryger M. Cytokines and normal sleep. Curr Opin Pulm Med. 2005 [acceso 19/04/2020];11(6):481-4. Disponible en: Disponible en: https://pubmed.ncbi.nlm.nih.gov/16217172/

  27. Imeri L, Opp MR. How (and why) the immune system makes us sleep. Nat Rev Neurosc. 2009 [acceso 19/04/2020];10(3):199-210. Disponible en: Disponible en: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2839418/

  28. Raison ChL, Rye DB, Woolwine BJ, Vogt GJ, Bautista BM, Spivey JR, et al. Chronic interferon-alpha administration disrupts sleep continuity and depth in patients with hepatitis C: association with fatigue, motor slowing, and increased evening cortisol. Biol Psychiatry. 2010 [acceso 19/04/2020];68(10):942-49. Disponible en: Disponible en: https://pubmed.ncbi.nlm.nih.gov/20537611/

  29. Manfridi A, Brambilla D, Bianchi S, Mariotti M, Opp MR, Imeri L. Interleukin-1b enhances non-rapid eye movement sleep when microinjected into the dorsal raphe nucleus and inhibits serotonergic neurons in vitro. Eur J Neurosc. 2003 [acceso 19/04/2020];18(5):1041-9. Disponible en: Disponible en: https://pubmed.ncbi.nlm.nih.gov/12956704/

  30. Morrow JD, Opp MR. Sleep-wake behavior and responses of interleukin-6 deficient mice to sleep deprivation. Brain Behav Immunol. 2005 [acceso 19/04/2020];19(1):28-39. Disponible en: Disponible en: https://pubmed.ncbi.nlm.nih.gov/15581736/

  31. O'Neill JS, Reddy AB. Circadian clocks in human red blood cells. Nature. 2011 [acceso 19/04/2020];469:498-503. Disponible en: Disponible en: https://www.nature.com/articles/nature09702

  32. Mendez-Ferrer S, Lucas D, Battista M, Frenette PS. Haematopoietic stem cell release is regulated by circadian oscillations. Nature. 2008 [acceso 23/04/2020];452:442-7. Disponible en: Disponible en: https://www.nature.com/articles/nature06685

  33. Lucas D, Battista M, Shi PA, Isola L, Frenette PS. Mobilized hematopoietic stem cell yield depends on species-specific circadian timing. Cell Stem Cell. 2008 [acceso 23/04/2020];3(4):364-6. Disponible en: Disponible en: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4089094/

  34. Cho H, Zhao X, Hatori M, Yu RT, Barish GD, Lam MT, et al. Regulationof circadian behaviour and metabolism by REV-ERB-alpha and REVERB-beta. Nature. 2012 [acceso 23/04/2020];485(7396):123-7. Disponible en: Disponible en: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3367514/

  35. Moldofsky H, Lue FA, Eisen J, Keystone E, Gorcz Ynski RM. The relationship of interleukin-1 and immune functions to sleep in humans. Psychosom Med. 1986 [acceso 23/04/2020];48(5):309-18. Disponible en: Disponible en: https://pubmed.ncbi.nlm.nih.gov/3487810/

  36. Darko DF, Miller JC, Gallen C, White J, Koziol J, Brow SJ, et al. Sleep electroencephalogram delta frequency amplitude, night plasma levels of tumor necrosis factor α and human immunodeficiency virus infection. Proc Natl Acad Sc. 1995 [acceso 23/04/2020];92(26):12080-4. Disponible en: Disponible en: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC40300/

  37. Pabst MJ, Beranova S, Krueger JM. Effects of muramyl peptides on macrophages, monokines and sleep. Neuroimmunomodulation. 1999 [acceso 23/04/2020];6:261283. Disponible en: Disponible en: https://www.karger.com/Article/Abstract/26384

  38. Prather AA. Better together: Sleep, circadian genes, and immunity. Brain Beh Immun. 2020 [acceso 23/04/2020];87:202. Disponible en: Disponible en: https://www.sciencedirect.com/science/article/abs/pii/S088915912030475X?via%3Dihub

  39. Palmblad J, Petrini B, Wasserman J, Åkerstedt T. Lymphocyte and granulocyte reactions during sleep deprivation. Psychosom Med. 1979 [acceso 23/04/2020];41(4):273-8. Disponible en: Disponible en: https://pubmed.ncbi.nlm.nih.gov/482523/

  40. Benca RM, Kushida CA, Everson CA, Kalski R, Berfmann BM, Rechtschaffenc A. Sleep deprivation in the rat: VII. Immune function. Sleep. 1989 [acceso 27/04/2020];12(1):47-52. Disponible en: Disponible en: https://academic.oup.com/sleep/article/12/1/47/2742646

  41. Dinges DF, Douglas SD, Zaugg L, Campbell DE, McMann JM, Whitehosuse WG, et al. Leukocytosis and natural killer cell function parallel neurobehavioral fatigue induced by 64 hours of sleep deprivation. J Clin Invest. 1994 [acceso 27/04/2020];93(5):1930-9. Disponible en: Disponible en: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC294300/

  42. Born J, Lange T, Hansen K, Mölle M, Fehm HL. Effects of sleep and circadian rhythm on human circulating immune cells. J Immunol. 1997 [acceso 27/04/2020];158(9):4454-64. Disponible en: Disponible en: https://pubmed.ncbi.nlm.nih.gov/9127011/

  43. Moldofsky H, Lue FA, Davidson J. Comparison of sleepwake circadian immune functions in women vs men. Sleep Res. 1989;18:431.

  44. Westermann J, Lange T, Textor J, Born J. System Consolidation during Sleep-A Common Principle Underlying Psychological and Immunological Memory Formation. Trends Neurosc. 2015 [acceso 30/04/2020];38(10):585-97. Disponible en: Disponible en: https://www.sciencedirect.com/science/article/abs/pii/S0166223615001745?via%3Dihub

  45. Spiegel K, Sheridan JF, Van-Cauter E. Effect of sleep deprivation on response to immunization. JAMA. 2002 [acceso 30/04/2020];288(12):1471-2. Disponible en: Disponible en: https://jamanetwork.com/journals/jama/article-abstract/1032061

  46. Straub RH, Cutolo M, Buttgereit F, Pongratz G. Energy regulation and neuroendocrine-immune control in chronic inflammatory diseases. J Inter Med. 2010 [acceso 30/04/2020];267(6):543-60. Disponible en: Disponible en: https://onlinelibrary.wiley.com/doi/full/10.1111/j.1365-2796.2010.02218.x

  47. Mills P, Kim JH, Bardwell W, Hong S, Dimsdale JE. Predictors of fatigue in obstructive sleep apnea. Sleep Breath. 2008 [acceso 30/04/2020];12(4):397-9. Disponible en: Disponible en: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2633300/

  48. Cavadini G, Petrzilka S, Kohler P, Jud C, Tobler I, Birchler Th. TNF-alpha suppresses the expression of clock genes by interfering with E-box-mediated transcription. Proc Natl Acad Sc. 2007 [acceso 30/04/2020];104(31):12843-8. Disponible en: Disponible en: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1937554/

  49. Prather AA, Janicki-Deverts D, Hall MH, Cohen S. Behaviorally assessed sleep and susceptibility to the common cold. Sleep. 2015 [acceso 30/04/2020];38(9):1353-9. Disponible en: Disponible en: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4531403/

  50. Patel SR, Malhotra A, Gao X, Hu FB, Neuman MI, Fawzi WW. A prospective study of sleep duration and pneumonia risk in women. Sleep. 2015 [acceso 02/05/2020];35(1):97-101. Disponible en: Disponible en: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3242694/

  51. Irwin MR, Wang M, Campomayor CO, Collado-Hidalgo A, Cole S. Sleep deprivation and activation of morning levels of cellular and genomic markers of inflammation. Arch Intern Med. 2006 [acceso 02/05/2020];166(16):1756-62. Disponible en: Disponible en: https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/410868

  52. Prather AA, Leung CW. Association of insufficient sleep with respiratory infection among adults in the United States. JAMA Intern Med. 2016 [acceso 02/05/2020];176(6):850-2. Disponible en: Disponible en: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4899278/

  53. Bollinger T, Bollinger A, Skrum L, Dimitrov S, Lange T, Solbach W. Sleep-dependent activity of T cells and regulatory T cells. Clin Exp Immunol. 2009 [acceso 04/05/2020];155(2):231-8. Disponible en: Disponible en: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2675254/

  54. Besedovsky L, Lange T, Born J. Sleep and immune function. Pflugers Arch. 2012 [acceso 04/05/2020];463(1):121-37. Disponible en: Disponible en: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3256323/

  55. Toth LA, Opp MR, Mao L. Somnogenic effects of sleep deprivation and Escherichia coli inoculation in rabbits. J Sleep Res. 1995 [acceso 04/05/2020];4(1):30-40. Disponible en: Disponible en: https://onlinelibrary.wiley.com/doi/abs/10.1111/j.1365-2869.1995.tb00148.x

  56. Brown R, Pang G, Husband AJ, King MG. Suppression of immunity to influenza virus infection in the respiratory tract following sleep disturbance. Reg Immunol. 1989;2(5):321-5.

  57. Renegar KB, Floyd RA, Krueger JM. Effects of short-term sleep deprivation on murine immunity to influenza virus in young adult and senescent mice. Sleep. 1998 [acceso 07/05/2020];21(3):241-8. Disponible en: Disponible en: https://academic.oup.com/sleep/article/21/3/241/2731636

  58. Lange T, Perras B, Fehm HL, Born J. Sleep enhances the human antibody response to hepatitis A vaccination. Psychosom Med. 2003 [acceso 07/05/2020];65:831-5. Disponible en: Disponible en: https://pubmed.ncbi.nlm.nih.gov/14508028/

  59. Everson CA, Toth LA. Systemic bacterial invasion induced by sleep deprivation. Am J Physiol Regul Integr Comp Physiol. 2000 [acceso 07/05/2020];278(4):905-16. Disponible en: Disponible en: https://journals.physiology.org/doi/full/10.1152/ajpregu.2000.278.4.R905?rfr_dat=cr_pub++0pubmed&url_ver=Z39.88-2003&rfr_id=ori%3Arid%3Acrossref.org

  60. Landis C, Pollack S, Helton WS. Microbial translocation and NK cell cytotoxicity in female rats sleep deprived on small platforms. Sleep Res. 1997; 26:619.

  61. Everson CA. Sustained sleep deprivation impairs host defense. Am J Physiol. 1993 [acceso 07/05/2020];265(5):1148-54. Disponible en: Disponible en: https://journals.physiology.org/doi/abs/10.1152/ajpregu.1993.265.5.R1148

  62. Casey FB, Eisenberg J, Peterson D, Pieper D. Altered antigen uptake and distribution due to exposure to extreme environmental temperatures or sleep deprivation. J Reticuloendothelial Soc. 1974;15(2):87-95.

  63. Nikolich-Zugich J, Knox K, Tafich Rios C, Natt B, Bhattacharya D, Fain MJ. SARS-CoV-2 and COVID-19 in older adults: what we may expect regarding pathogenesis, immune responses, and outcomes. GeroScience. 2020 [acceso 07/05/2020];42(2):505-14. Disponible en: Disponible en: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7145538/

  64. Huang CH, Wang Y, Li X, Ren L, Zhao J, Hu Y, et al. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. Lancet. 2020;395:497-506. doi: 10.1016/S0140-6736(20)30183-5

  65. Oberfeld B. SnapShot: COVID-19. Cell. 2020 [acceso 07/05/2020];18(4):954. Disponible en: Disponible en: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7190493/

  66. Prompetchara E, Ketloy Ch, Palaga T. Immune responses in COVID-19 and potential vaccines: Lessons learned from SARS and MERS epidemic. Asian Pac J Allergy Immunol. 2020 [acceso 09/05/2020];38(1):1-9. Disponbile en: Disponbile en: https://pubmed.ncbi.nlm.nih.gov/32105090/

  67. Yang X, Yu Y, Xu J, Shu H, Xia J, Liu H, et al. Clinical course and outcomes of critically ill patients with SARS-CoV-2 pneumonia in Wuhan, China: a single-centered, retrospective, observational study. Lancet. 2020 [acceso 09/05/2020];8(5):475-481. Disponible en: Disponible en: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7102538/

  68. Wang D, Hu B, Hu Ch, Zhu F, Liu Ch, Zhang J, et al. Clinical characteristics of 138 hospitalized patients with 2019 novel coronavirus-infected pneumonia in Wuhan, China. JAMA. 2020 [acceso 09/05/2020];323(11):1061-9. Disponible en: Disponible en: https://jamanetwork.com/journals/jama/fullarticle/2761044

  69. Chen N, Zhou M, Dong X, Qu J, Gong F, Han Y, et al. Epidemiological and clinical characteristics of 99 cases of 2019 novel coronavirus pneumonia in Wuhan, China: a descriptive study. Lancet. 2020 [acceso 09/05/2020];395(10223):507-13. Disponible en: Disponible en: https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)30211-7/fulltext

  70. Méndez R, Menéndez R, Amara-Elori I, Feced L, Piró A, Ramírez P, et al. Lymphopenic community-acquired pneumonia is associated with a dysregulated immune response and increased severity and mortality. J Infect. 2019 [acceso 09/05/2020];78(6):423-31. Disponible en: Disponible en: https://pubmed.ncbi.nlm.nih.gov/30965065/

  71. Bermejo-Martin JF, Martín-Fernández M, López-Mestanza C, Duque P, Almansa R. Shared features of endothelial dysfunction between sepsis and its preceding risk factors (Aging and chronic disease). J Clin Med. 2018 [acceso 09/05/2020];7(11):400. Disponible en: Disponible en: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6262336/

  72. Morales-Blanhir JE, Valencia-Flores M, Lozano-Cruz OA. El síndrome de apnea obstructiva del sueño como factor de riesgo para enfermedades cardiovasculares y su asociación con hipertensión pulmonar. Neumol Cir Torax. 2017 [acceso 09/05/2020];76(1):51-60. Disponible en: Disponible en: http://www.scielo.org.mx/scielo.php?script=sci_arttext&pid=S0028-37462017000100051

  73. Merino-Andreu M, Álvarez-Ruiz de Larrinaga A, Madrid-Pérez JA, Martínez-Martínez MA, Puertas Cuesta FJ, Asencio-Guerra AJ, et al. Sueño saludable: evidencias y guías de actuación. Documento oficial de la Sociedad Española de Sueño. Rev Neurol. 2016 [acceso 09/05/2020];63(Supl 2):1-27.Disponible en: Disponible en: https://ses.org.es/blog-post/revista-neurologia-sueno-saludable-evidencias-guias-actuacion-documento-oficial-la-sociedad-espanola-sueno/




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