Background and Objective: People that undergo assisted infertility treatments experience more sleep problems. Alt-hough Pittsburgh Sleep Quality Index (PSQI) frequently has been used as a sleep quality assessment scale in different clinical and non-clinical settings, different sample characteristics may account for different structures. The current study aimed to evaluate the factor structure of PSQI among women seeking infertility treatment in Iran.

Materials and Methods: Using a convenience sampling method, 157 infertile women or women whose husbands had infertility problems were included in a cross-sectional study in Royan Institute, a main referral infertility center in Teh-ran, Iran. The factor structure of PSQI was evaluated through exploratory factor analysis (EFA) and confirmatory factor analysis (CFA).

Results: The Cronbach’s alpha coefficient for PSQI was 0.65. A two-factor model was extracted by EFA; 56% of the total variance was accounted for by this model. The results of CFA indicated that extracted model obtained acceptable fit statistics [comparative fit index (CFI) = 0.942, standardized root mean square residual (SRMR) = 0.042, root mean square error of approximation (RMSEA) = 0.128, χ2 = 19.8, degree of freedom (df) = 12, P = 0.071] compared to other original single-factor or 3-factor models.

Conclusion: Our results revealed the limited usefulness of single-factor structure of PSQI. A two-factor model of Per-sian version of PSQI should be used to assess sleep problems among women seeking assisted infertility treatments.

Background and Objective: Alopecia is one of the most common skin disorders that can affect the quality of life (QOL) in patients. Since few studies have simultaneously evaluated the QOL and quality of sleep in patients with alo-pecia, this study aimed to evaluate these two important factors in patients with different types of hair loss and among demographic variables.

Materials and Methods: Using a convenience sampling method, this cross-sectional study was performed on all pa-tients with various types of alopecia referring to the Dermatology Clinic of Rasoul-e-Akram Hospital, Tehran, Iran, in 2016. For data collection, Dermatology Life Quality Index (DLQI), Short Form Health Survey (SF-36), and Pittsburgh Sleep Quality Index (PSQI) questionnaires were used.

Results: A total of 70 patients with four types of hair loss, including androgenic alopecia, alopecia areata, telogen ef-fluvium, and discoid lupus erythematosus (DLE) were evaluated. The overall sleep quality score was 5.51 ± 2.93, which was not significantly different in all four patient groups (P > 0.05). The overall DLQI score was 4.40 ± 4.30, which had little effect on the QOL in most patients with alopecia (40.6%). The overall QOL and quality of sleep scores were not significantly correlated with such demographic variables as age, gender, marital status, education, and employment (P > 0.05). The SF-36 questionnaire and DLQI had a significant inverse relationship (r = -0.285, P = 0.026).

Conclusion: Our study showed that the quality of sleep and QOL were affected in all four types of patients with alope-cia. As a result, attention to quality of sleep and QOL in these patients with any demographic characteristics is im-portant. However, more studies are needed to confirm the results.

Background and Objective: Studies indicate that people with multiple sclerosis (MS) are at increased risk of sleep disorders and the resulting outcomes. The aim of this study is to evaluate sleep quality in patients with MS.

Materials and Methods: In this case-control study, 110 patients with all of the confirmed types of MS as a case group and 110 healthy subjects as control group were evaluated in terms of sleep quality using Pittsburgh Sleep Quality Index (PSQI). The data collected was analyzed using t-test and chi-square tests.

Results: The total score of PSQI was significantly higher in patients with MS than that of the control group (7.32 ± 2.78 vs. 5.30 ± 2.00, P = 0.001). Furthermore, PSQI scores of patients with MS was significantly higher than that of the con-trol group in subscales including sleep latency (1.14 ± 0.99 vs 0.85 ± 0.91, P = 0.029), sleep duration (1.09 ± 0.80 vs. 0.83 ± 0.88, P = 0.048), habitual sleep efficiency (1.15 ± 0.92 vs. 0.85 ± 0.83, P = 0.017), sleep disturbance (??? ± 0.96 vs 0.51 ± 0.88, P = 0.013), use of sleep medication (0.69 ± 0.94 vs. 0.33 ± 0.65, P = 0.001), and daytime dysfunction (0.88 ± 0.93 vs. 32.2 ± 0.69, P = 0.001).

Conclusion: Patients with MS had a significantly more improper sleep quality compared to the control group. So, poor sleep quality has a negative effect on daily activities and social communication of these patients and generally reduce their quality of life (QOL).

Background and Objective: Sleep is one of the important elements in life that is accompanied by physical and mental rehabilitation. Suitable sleep quality is necessary for health and it has a direct relationship with physical and mental health of the person. The objective of this study is to investigate the relationship between attachment styles and internet addiction and daytime sleepiness of students.

Materials and Methods: The statistical population of this study included students of Islamic Azad University, Saveh Branch, Saveh, Iran, including 1200 students. Using the random sampling method and according to Morgan’s table, 291 students were selected as the study sample and the Attachment Style Questionnaire (ASQ) by Hazan and Shaver, Young’s Internet Addiction Diagnostic Questionnaire (IADQ), and Epworth Sleepiness Scale (ESS) were distributed among them and data were analyzed by SPSS software.

Results: The results showed that a significant and positive relationship exists between sleepiness and avoidant attach-ment style as well as internet addiction and daytime sleepiness. The results of data analysis with regression showed that attachment styles and internet addiction predict 62% of daytime sleepiness changes.

Conclusion: According to the results of this study, it can be concluded that attachment styles and internet addiction are good predictors for daytime sleepiness.

Background and Objective: Insufficient sleep duration as well as quality is becoming endemic in our modern society. The time of going to bed and sleep quality and quantity are linked with students’ learning abilities and academic ac-complishment. Therefore, this paper firstly opted to measure the level of sleep quality of the students of Jahangirnagar University, Savar, Dhaka-1342, Bangladesh, and finally detect the association between quality of sleep and academic achievement among the students.

Materials and Methods: The primary data were collected through a self-administered questionnaire from 334 students with a response rate about 84 percent during February to March 2019. Pittsburgh Sleep Quality Index (PSQI) was used to measure the sleep quality of the students. The percent distribution, descriptive statistics, and multiple regression were employed to identify the influence of the components of sleep quality on academic performance.

Results: Only the sleep quality of one-fourth of the students was good. Moreover, sleep duration, subjective sleep quality, and daytime dysfunction were positively related to the academic performance; however, sleep latency, sleep disturbances, use of sleeping medications, and habitual sleep efficiency were inversely associated with the academic performance of the students.

Conclusion: Academic performance of a student was related to the components of sleep quality. Thus, this study indi-cates that students with poor academic performance have problems regarding sleep issues. Medical advice should be followed to maintain a healthier lifestyle including adequate rest time.

Background and Objective: Excessive sleepiness is a common reason for a referral to sleep medicine clinics. The clin-ical picture and context usually suggest the underlying cause; however, all possibilities should be considered and only after sleep studies are done, one can determine the likely cause of the patient’s symptoms.

Case Report: We presented the case of a man who was referred for evaluation of hypersomnolence along with snoring and possible apnea during sleep. Obstructive sleep apnea (OSA) was suspected, so home sleep apnea test (HSAT) and later polysomnography (PSG) were performed and both ruled out this possibility. The PSG showed frequent periodic limb movements (PLMs), some associated with arousal; abnormal sleep structure suggested the effect of medication. The patient had been taking baclofen for musculoskeletal pain and it was concluded that baclofen was the cause of the patient’s somnolence and PLMs. The patient’s clinical presentation was compounded by his history of post-traumatic stress disorder (PTSD) and gastroesophageal reflux which probably caused increased arousals and the subjective feeling of poor sleep quality.

Conclusion: Treatment with medications that have sedative effects should be considered in all patients presenting with excessive daytime sleepiness even if the initial clinical picture suggests another possible cause. Baclofen can cause PLMs, sedation, changes in N3 stage, and reduction in rapid eye movement (REM) sleep.

Corona virus disease 2019 (COVID-19) is a new infectious disease arisen in Wuhan, China, at the end of 2019, and expanded rapidly universal. This pandemic has placed extra-ordinary demands upon health care systems worldwide, and has led to various physical and psychological consequences.

I read with great interest the article entitled “Comparative investigation of sleep problems in opioid-dependent and normal subjects” by Madanifard et al. (1). I am grateful to authors for studying this important problem.