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This chapter describes both the impact of medical diseases and their treatments on sleep, and how disordered sleep can contribute to medical illnesses. Airway function has a normal circadian variation, with peak airflow in the afternoon and the lowest in the early morning. In people with asthma, this morning trough is associated with worsening of asthma symptoms and sleep disturbance. In individuals with heartburn at least once weekly, three-quarters complain of heartburn affecting their sleep. Polysomnography helps to clarify the nature and severity of the primary sleep disorder and aid in the management of end-stage renal disease (ESRD). Disruption of sleep is common in people with arthritic or muscular pain. Pain, sleep disturbance, and low mood are all believed to contribute to fatigue, a common complaint of those with rheumatic disorders. Circadian sleep/wakefulness is intricately linked to neuroendocrine and neuroimmune functions.
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