Sleep quality and associated factors among adult patients with epilepsy attending follow-up care at referral hospitals in Amhara region, Ethiopia

Sintayehu Simie Tsega; Birhaneselassie Gebeyehu Yazew; Kennean Mekonnen

doi:10.1371/journal.pone.0261386

Peer Review History

Original SubmissionAugust 17, 2021
11 Oct 2021 Decision Letter - Hamidreza Karimi-Sari, Editor PONE-D-21-26585Sleep quality and associated factors among adult patients with epilepsy attending follow-up care at Referral Hospitals in Amhara Region, EthiopiaPLOS ONE Dear Dr. Simie, Thank you for submitting your manuscript to PLOS ONE. After careful consideration, we feel that it has merit but does not fully meet PLOS ONE’s publication criteria as it currently stands. Therefore, we invite you to submit a revised version of the manuscript that addresses the points raised during the review process. Please submit your revised manuscript by Nov 25 2021 11:59PM. If you will need more time than this to complete your revisions, please reply to this message or contact the journal office at plosone@plos.org. When you're ready to submit your revision, log on to https://www.editorialmanager.com/pone/ and select the 'Submissions Needing Revision' folder to locate your manuscript file. 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We will only publish funding information present in the Funding Statement section of the online submission form. Please remove any funding-related text from the manuscript and let us know how you would like to update your Funding Statement. Currently, your Funding Statement reads as follows: “The University of Gondar College of Medicine and Health sciences was the funding source for this study. It was funding for data collection and we acknowledge it.” Please include your amended statements within your cover letter; we will change the online submission form on your behalf. Reviewers' comments: Reviewer's Responses to Questions Comments to the Author 1. Is the manuscript technically sound, and do the data support the conclusions? The manuscript must describe a technically sound piece of scientific research with data that supports the conclusions. Experiments must have been conducted rigorously, with appropriate controls, replication, and sample sizes. The conclusions must be drawn appropriately based on the data presented. Reviewer #1: Yes Reviewer #2: Yes ******** 2. Has the statistical analysis been performed appropriately and rigorously? Reviewer #1: Yes Reviewer #2: Yes ****** 3. Have the authors made all data underlying the findings in their manuscript fully available? The PLOS Data policy requires authors to make all data underlying the findings described in their manuscript fully available without restriction, with rare exception (please refer to the Data Availability Statement in the manuscript PDF file). The data should be provided as part of the manuscript or its supporting information, or deposited to a public repository. For example, in addition to summary statistics, the data points behind means, medians and variance measures should be available. If there are restrictions on publicly sharing data—e.g. participant privacy or use of data from a third party—those must be specified. Reviewer #1: No Reviewer #2: Yes ****** 4. Is the manuscript presented in an intelligible fashion and written in standard English? PLOS ONE does not copyedit accepted manuscripts, so the language in submitted articles must be clear, correct, and unambiguous. Any typographical or grammatical errors should be corrected at revision, so please note any specific errors here. Reviewer #1: No Reviewer #2: Yes ****** 5. Review Comments to the Author Please use the space provided to explain your answers to the questions above. You may also include additional comments for the author, including concerns about dual publication, research ethics, or publication ethics. (Please upload your review as an attachment if it exceeds 20,000 characters) Reviewer #1: The authors have used multiple questionnaires and logistic regression to assess sleep quality in the Amhara Region, Ethiopia. The authors have found that medical adherence, social support, education level and anti-epileptic drug load are significant predictors for sleep quality. Major points: 1. The language and punctuation throughout the manuscript needs attention. There are many instances where errors make it difficult to interpret the authors meaning. Some examples of the errors are listed below (please note that the errors listed are from the first page but there are many more errors on that first page and throughout the entire manuscript than are listed here): - Correct neurologic to neurological in the abstract - Line 52: capitalize first letter at the beginning of the sentence. - Line 55: incorrect placement of commas - Line 59: I believe the authors might mean ‘measured’ or ‘gauged’ rather than manifested - Line 65: replace ‘later’ with ‘after’ - Line 67: poor should be poorer 2. I found the discussion of Cronbach’s alpha confusing and unclear. How was it actually being used and how was it being calculated. Please include the formula for how Cronbach’s alpha is calculated in the paper and explain more clearly how it is being used. For example: Cronbach alpha was calculated for each questionnaire to determine internal consistency, meaning that each question was assessing the same concept. It would also be useful to describe that the value varies between 0 and 1 and that a higher value indicates a higher internal consistency. What is the cut-off value for the questionnaire to be considered ‘valid and reliable’? 3. Sleep comorbidities? Were patients with sleep comorbidities included in this study? If so, please look at how those patients might be influencing the results and include a thorough discussion as to how this might bias your results. Minor points: 4. Line 239: I assume the patients wakeup at 7AM not PM on average? 5. How does 8pm bedtime compare to healthy individuals in the region? Is that an earlier bedtime than normal? 6. Please separate the discussion of each questionnaire in the methods section into individual paragraphs. It is confusing having some paragraphs discuss one questionnaire and others discuss multiple unrelated questionnaires. 7. Please make sure you are clear for each questionnaire as to how the questions are scored (what range of numbers) and whether a higher/lower score indicates better/worse sleep hygiene (for example). 8. Is the high prevalence of pain causing wake up thought to be related to their epilepsy or is this consistent with the healthy population from the region? 9. Was the ability to read and write associated with medication adherence? Seems with the data at hand you could actually test the theory you are putting forward on lines 295-296. 10. Spelling mistake in title of final figure Reviewer #2: Important paper that seeks to relate the quality of sleep with sociodemographic, clinical, behavioral and psychosocial factors in patients with epilepsy. Here are suggestions for modification: In the abstract and in line 87, replace "literature" by "authors" because it is the latter who suggest or show something. There is no need in the summary and discussion to represent the confidence interval. In line 42, replace "common" with important, great presence, any term that stands out more than common. In the introduction, line 58, improve sleep description. It is not "started" by a circadian cycle but has circadian rhythmicity. Furthermore, the correct one is the phase of wakefulness and not the period. Nor would I say that the quality of sleep "manifests" itself and the term "slumbering" is not very common in the literature. In line 66, is cited multitude of sequelae, I would like to see this paragraph more developed. The same applies for the consequences of poor sleep quality, on line 71. I suggest paying attention to some parts of the work regarding the writing of English. For example, the paragraph in line 74 is a science communication text and not a text for a scientific journal at the PLOS ONE level. It should not be abandoned but rewritten with greater scientific rigor. There are also several small grammar errors throughout the text that a review by an English language specialist can be helpful. In line 83, complete the study description reasoning. On line 91, remove "As to our search of the literature" I didn't understand the justification in lines 93, 94, 95. Elaborate this part better. On line 96, "Would be able" gets too vague. Need to be more assertive. In the results, in Table 1: Why age groups are not homogeneous: 18-24; 25-31; 32-38; 39-45; and > 45. I suggest using 5 groups. In the body of the text, provide more details on the results shown in table 1, 2. Table 2 can be joined with table 3. Rethink the need to include figure 1, or include the other factors that are associated with poor sleep quality, "Being incapable of reading and writing", "undergoing polytherapy", "having poor medication adherence" and "having poor and moderate social support". In table 4, it is not clear "<15mints + not during the last month" (?). Describe in the caption what IQR means. I see no need for Figure 2 unless the results are discussed in the later section. Remove the subheadings "Subjective sleep quality rate (component one)", "Sleep disturbance (component five)" and "Sleep quality prevalence" Provide a more detailed and joint description of all PSQI results. Discussion Do not repeat in line 272 what the objectives of the study are. Add the first paragraphs and remove any mention of standard deviations, confidence intervals, for example (95% CI; 64.8%, 72.5%) because we are in the discussion part and not the results part. The last paragraph reflects my criticism of the need to revise English. I understood what the authors mean but the text can improve a lot. It is necessary to discuss with references about the outcome of pain (component five). In the conclusions, cite what was said in the summary of the work about how to improve the quality of sleep in these patients. ****** 6. PLOS authors have the option to publish the peer review history of their article (what does this mean?). If published, this will include your full peer review and any attached files. If you choose “no”, your identity will remain anonymous but your review may still be made public. Do you want your identity to be public for this peer review? For information about this choice, including consent withdrawal, please see our Privacy Policy. Reviewer #1: No Reviewer #2: Yes:** Leandro Lourenção Duarte [NOTE: If reviewer comments were submitted as an attachment file, they will be attached to this email and accessible via the submission site. Please log into your account, locate the manuscript record, and check for the action link "View Attachments". If this link does not appear, there are no attachment files.] While revising your submission, please upload your figure files to the Preflight Analysis and Conversion Engine (PACE) digital diagnostic tool, https://pacev2.apexcovantage.com/. PACE helps ensure that figures meet PLOS requirements. To use PACE, you must first register as a user. Registration is free. Then, login and navigate to the UPLOAD tab, where you will find detailed instructions on how to use the tool. If you encounter any issues or have any questions when using PACE, please email PLOS at figures@plos.org. Please note that Supporting Information files do not need this step. https://doi.org/10.1371/journal.pone.0261386.r001
Revision 1
16 Nov 2021 Author Response Point by point response for editors/reviewers comments PLOS ONE Journal Manuscript title: Sleep quality and associated factors among adult patients with epilepsy attending follow-up care at Referral Hospitals in Amhara Region, Ethiopia Manuscript ID: PONE-D-21-26585 Dear editor/reviewer. Dear all, We would like to thank you for this constructive, building, and improvable comments on this manuscript that would improve the content of the manuscript. We considered each comment and clarification questions of editors and reviewers on the manuscript thoroughly. Our point-by-point responses for each comment and question are described in detail on the following pages. Further, the details of changes were shown by track changes in the supplementary document attached. Response to reviewers’ comment Reviewer#1 1. The language and punctuation throughout the manuscript needs attention. There are many instances where errors make it difficult to interpret the authors meaning. Some examples of the errors are listed below (please note that the errors listed are from the first page but there are many more errors on that first page and throughout the entire manuscript than are listed here) -Correct neurologic to neurological in the abstract - Line 52: capitalize first letter at the beginning of the sentence. - Line 55: incorrect placement of commas - Line 59: I believe the authors might mean ‘measured’ or ‘gauged’ rather than manifested - Line 65: replace ‘later’ with ‘after’ - Line 67: poor should be poorer Authors’ response: Thank you for reviewer for the comments. We have addressed all the comments. We had extensively edited the entire manuscript for grammatical errors, sentence structure and typographical errors with the help of language experts at the University. (See the revised manuscript) 2. I found the discussion of Cronbach’s alpha confusing and unclear. How was it actually being used and how was it being calculated. Please include the formula for how Cronbach’s alpha is calculated in the paper and explain more clearly how it is being used. For example: Cronbach’s alpha was calculated for each questionnaire to determine internal consistency, meaning that each question was assessing the same concept. It would also be useful to describe that the value varies between 0 and 1 and that a higher value indicates a higher internal consistency. What is the cut-off value for the questionnaire to be considered ‘valid and reliable’? Authors’ response: Thank you reviewer for the comments. As you said we assessed Cronbach’s alpha to assess the internal consistency, it is ranged from 0 to 1. Literatures suggested that as general rule that α of 0.6 – 0.7 indicates an acceptable level of reliability, and 0.8 and above is considered as a very good level of internal consistency. For further we have included the formula to calculate Cronbach’s alpha and some statement about it. If you need further justification we are ready to provide it. (See the Method section, Page 5-6, line 153-163) 3. Sleep comorbidities? Were patients with sleep comorbidities included in this study? If so, please look at how those patients might be influencing the results and include a thorough discussion as to how this might bias your results. Authors’ response: Thank you reviewer for the comments. As you said sleep comorbidities like underlying medical conditions which may have association with sleep quality might influence our findings. And therefore, we considered underlying comorbidity other than epilepsy as independent variable and considered in the analysis. We planned to consider this variable during analysis to control its confounding effect on others, but unfortunately this variable did not fulfill the chi-square assumption /in the bivariable binary logistic regression analysis and we did not considered in the multivariable binary logistic regression analysis. That is why we did not discuss this in the discussion section. (See the revised manuscript) Minor points 4. Line 239: I assume the patients’ wakeup at 7AM not PM on average? Authors’ response: Thank you reviewer for the comments. It was editorial error and we have addressed the comment. (See the revised manuscript) 5. How does 8pm bedtime compare to healthy individuals in the region? Is that an earlier bedtime than normal? Authors’ response: Thank you reviewer for the comment. We have asked this question to compute the component habitual sleep efficiency (PSQI) (Component 4: Habitual sleep efficiency Component 4 (total # of hours asleep) / (total # of hours in bed) x 100 (>85%=0, 75%-84%=1, 65%-74%=2, <65%=3). Simultaneously, we have reported average bedtime, relatively which is usual time in case of Ethiopia. Therefore, if our response does not convince you we are ready to remove this sentence in the manuscript as it is not standalone variable in this study. 6. Please separate the discussion of each questionnaire in the methods section into individual paragraphs. It is confusing having some paragraphs discuss one questionnaire and others discuss multiple unrelated questionnaires. Authors’ response: Thank you reviewer for the comment. We accept it and use separate paragraph for each questionnaire. (See Method section, line 146-182, and page 5-6) 7. Please make sure you are clear for each questionnaire as to how the questions are scored (what range of numbers) and whether a higher/lower score indicates better/worse sleep hygiene (for example). Authors’ response: Thank you for the comments. We have computed each scores based on the tools recommendation and we make sure that we have checked the scores are correct. (See the revised manuscript) 8. Is the high prevalence of pain causing wake up thought to be related to their epilepsy or is this consistent with the healthy population from the region? Authors’ response: Thank you reviewer for the comment. To compute Component 5, there is one question about sleep disturbance and cause of disturbance. One of the option was pain and the high prevalence of pain causing wake up was high and we believe that this pain is related to epilepsy and its associated morbidity than the healthy population. (See Revised manuscript) 9. Was the ability to read and write associated with medication adherence? Seems with the data at hand you could actually test the theory you are putting forward on lines 295-296. Authors’ response: Thank you reviewer for the comment. We gave this possible explanation for why those who were unable to read and write had higher odds of poor sleep quality than who attained college and above based on our knowledge. As per your suggestion we have checked whether there was significant association between education and adherence using chi-square and odds ratio based on the cells in cross tabulation, which indicated that there was no significant association between them and we remove that statement in the discussion section. (See the revised manuscript) 10. Spelling mistake in title of final figure Authors’ response: Thank you reviewer for the comment. We have modified it. (See the revised manuscript) Reviewer#2 1. In the abstract and in line 87, replace "literature" by "authors" because it is the latter who suggest or show something. There is no need in the summary and discussion to represent the confidence interval. In line 42, replace "common" with important, great presence, any term that stands out more than common. Authors’ response: Thank you for the comments, we have addressed all the comments. (See the revised manuscript) 2. In the introduction, line 58, improve sleep description. It is not "started" by a circadian cycle but has circadian rhythmicity. Furthermore, the correct one is the phase of wakefulness and not the period. Nor would I say that the quality of sleep "manifests" itself and the term "slumbering" is not very common in the literature. Authors’ response: Thank you reviewer for the comment. We rephrase it and use the most appropriate definitions of sleep quality. (See the revised manuscript) 3. In line 66, is cited multitude of sequelae, I would like to see this paragraph more developed. The same applies for the consequences of poor sleep quality, on line 71. Authors’ response: Thank you reviewer for the comments. We have addressed it. (See the revised manuscript) 4. I suggest paying attention to some parts of the work regarding the writing of English. For example, the paragraph in line 74 is a science communication text and not a text for a scientific journal at the PLOS ONE level. It should not be abandoned but rewritten with greater scientific rigor. There are also several small grammar errors throughout the text that a review by an English language specialist can be helpful. Authors’ response: Thank you for the comments. We extensively modified the entire manuscript with the help of language experts. (See the revised manuscript) 5. In line 83, complete the study description reasoning. On line 91, remove "As to our search of the literature" Authors’ response: Thank you reviewer for the comment. We have modified it. (See the revised manuscript) 6. I didn't understand the justification in lines 93, 94, 95. Elaborate this part better. On line 96, "Would be able" gets too vague. Need to be more assertive. Authors’ response: Thank you reviewer for the comments. We have rewrote it. (See the revised manuscript) 7. In the results, in Table 1: Why age groups are not homogeneous: 18-24; 25-31; 32-38; 39-45; and > 45. I suggest using 5 groups. Authors’ response: Thank you reviewer for the suggestions but we have categorizing the variable age based on previous literature and scientific evidence that is why the category is not homogeneous. Therefore, we keep it as it is. 8. In the body of the text, provide more details on the results shown in table 1, 2. Table 2 can be joined with table 3. Rethink the need to include figure 1, or include the other factors that are associated with poor sleep quality, "Being incapable of reading and writing", "undergoing polytherapy", "having poor medication adherence" and "having poor and moderate social support". Authors’ response: Thank you reviewer for comments. The tables and figure have different information and we prefer it to present separately. (See the revised manuscript) 9. In table 4, it is not clear "<15mints + not during the last month" (?). Authors’ response: Thank you for the comments, in the PSQI questionnaire tool component two was assessed as question #2 (after recoding was done ) sum with question #5a Score meaning that #2 Score (<15min (0), 16-30min (1), 31-60 min (2), >60min (3))+ #5a Score (if sum is equal 0=0; 1-2=1; 3-4=2; 5-6=3). 10. Describe in the caption what IQR means. I see no need for Figure 2 unless the results are discussed in the later section. Authors’ response: Thank you for the comments, we have addressed all the comments. (See the revised manuscript) 11. Remove the subheadings "Subjective sleep quality rate (component one)", "Sleep disturbance (component five)" and "Sleep quality prevalence" Provide a more detailed and joint description of all PSQI results. Authors’ response: Thank you for the comments, we have addressed all the comments. (See the revised manuscript) 12. Do not repeat in line 272 what the objectives of the study are. Add the first paragraphs and remove any mention of standard deviations, confidence intervals, for example (95% CI; 64.8%, 72.5%) because we are in the discussion part and not the results part. Authors’ response: Thank you for the comments, we have addressed all the comments. (See the revised manuscript) 13. The last paragraph reflects my criticism of the need to revise English. I understood what the authors mean but the text can improve a lot. It is necessary to discuss with references about the outcome of pain (component five). In the conclusions, cite what was said in the summary of the work about how to improve the quality of sleep in these patients. Authors’ response: Thank you reviewer for the concerns. We used pain as one item to compute component five but not considered as a separate variable, then we aggregate the seven components to generate sleep quality global score. Then, based on the score we computed we categorized as poor or good. Therefore, we have not discuss about pain as it was not our objective/was not our independent variables. If these does not convince you we are ready to discuss about it, if it does not make our document lose its focus. (See the revised manuscript) Attachments Attachment Submitted filename: Point by point response.docx https://doi.org/10.1371/journal.pone.0261386.r002
25 Nov 2021 Decision Letter - Hamidreza Karimi-Sari, Editor PONE-D-21-26585R1Sleep quality and associated factors among adult patients with epilepsy attending follow-up care at Referral Hospitals in Amhara Region, EthiopiaPLOS ONE Dear Dr. Simie, Thank you for submitting your manuscript to PLOS ONE. After careful consideration, we feel that it has merit but does not fully meet PLOS ONE’s publication criteria as it currently stands. Therefore, we invite you to submit a revised version of the manuscript that addresses the points raised during the review process. ACADEMIC EDITOR:I appreciate the authors' work to revise their manuscript. This version of manuscript is significantly improved compared to the last version. I have another minor comment which should be addressed before being published. The figure one is not necessary. So, please remove this figure. Instead, you can mention the frequency and frequency percent of these reasons in the text. For example: The most frequent reason for the difficulty in maintaining sleep was pain in XX participant (59.12%), followed by midnight wakeup in XX patients (48.32%),... Please submit your revised manuscript by Jan 09 2022 11:59PM. If you will need more time than this to complete your revisions, please reply to this message or contact the journal office at plosone@plos.org. When you're ready to submit your revision, log on to https://www.editorialmanager.com/pone/ and select the 'Submissions Needing Revision' folder to locate your manuscript file. Please include the following items when submitting your revised manuscript: A rebuttal letter that responds to each point raised by the academic editor and reviewer(s). You should upload this letter as a separate file labeled 'Response to Reviewers'. A marked-up copy of your manuscript that highlights changes made to the original version. You should upload this as a separate file labeled 'Revised Manuscript with Track Changes'. An unmarked version of your revised paper without tracked changes. You should upload this as a separate file labeled 'Manuscript'. If you would like to make changes to your financial disclosure, please include your updated statement in your cover letter. Guidelines for resubmitting your figure files are available below the reviewer comments at the end of this letter. If applicable, we recommend that you deposit your laboratory protocols in protocols.io to enhance the reproducibility of your results. Protocols.io assigns your protocol its own identifier (DOI) so that it can be cited independently in the future. For instructions see: https://journals.plos.org/plosone/s/submission-guidelines#loc-laboratory-protocols. Additionally, PLOS ONE offers an option for publishing peer-reviewed Lab Protocol articles, which describe protocols hosted on protocols.io. Read more information on sharing protocols at https://plos.org/protocols?utm_medium=editorial-email&utm_source=authorletters&utm_campaign=protocols. We look forward to receiving your revised manuscript. Kind regards, Hamidreza Karimi-Sari, MD Academic Editor PLOS ONE Journal Requirements: Please review your reference list to ensure that it is complete and correct. If you have cited papers that have been retracted, please include the rationale for doing so in the manuscript text, or remove these references and replace them with relevant current references. Any changes to the reference list should be mentioned in the rebuttal letter that accompanies your revised manuscript. If you need to cite a retracted article, indicate the article’s retracted status in the References list and also include a citation and full reference for the retraction notice. While revising your submission, please upload your figure files to the Preflight Analysis and Conversion Engine (PACE) digital diagnostic tool, https://pacev2.apexcovantage.com/. PACE helps ensure that figures meet PLOS requirements. To use PACE, you must first register as a user. Registration is free. Then, login and navigate to the UPLOAD tab, where you will find detailed instructions on how to use the tool. If you encounter any issues or have any questions when using PACE, please email PLOS at figures@plos.org. Please note that Supporting Information files do not need this step. https://doi.org/10.1371/journal.pone.0261386.r003
Revision 2
26 Nov 2021 Author Response Point by point response for editors/reviewers comments PLOS ONE Journal Manuscript title: Sleep quality and associated factors among adult patients with epilepsy attending follow-up care at Referral Hospitals in Amhara Region, Ethiopia Manuscript ID: PONE-D-21-26585R1 Dear editor/reviewer. Dear all, We would like to thank you for the constructive, building, and improvable comments on this manuscript that would improve the content of the manuscript. We considered each comment and clarification question of editors and reviewers on the manuscript thoroughly. Our point-by-point responses for each comment and question are described in detail on the following pages. Further, the details of changes were shown by track changes in the supplementary document attached. Response to Editors comment 1. I appreciate the authors' work to revise their manuscript. This version of manuscript is significantly improved compared to the last version. I have another minor comment which should be addressed before being published. The figure one is not necessary. So, please remove this figure. Instead, you can mention the frequency and frequency percent of these reasons in the text. For example: The most frequent reason for the difficulty in maintaining sleep was pain in XX participant (59.12%), followed by midnight wakeup in XX patients (48.32%),... Authors’ response: Thank you for the comments. As per your suggestion, we have removed Figure 1 and we wrote the frequencies with the corresponding percentage in text format. (See the revised manuscript) Attachments Attachment Submitted filename: Authors response.docx https://doi.org/10.1371/journal.pone.0261386.r004
1 Dec 2021 Decision Letter - Hamidreza Karimi-Sari, Editor Sleep quality and associated factors among adult patients with epilepsy attending follow-up care at Referral Hospitals in Amhara Region, Ethiopia PONE-D-21-26585R2 Dear Dr. Simie, We’re pleased to inform you that your manuscript has been judged scientifically suitable for publication and will be formally accepted for publication once it meets all outstanding technical requirements. Within one week, you’ll receive an e-mail detailing the required amendments. When these have been addressed, you’ll receive a formal acceptance letter and your manuscript will be scheduled for publication. An invoice for payment will follow shortly after the formal acceptance. To ensure an efficient process, please log into Editorial Manager at http://www.editorialmanager.com/pone/, click the 'Update My Information' link at the top of the page, and double check that your user information is up-to-date. If you have any billing related questions, please contact our Author Billing department directly at authorbilling@plos.org. If your institution or institutions have a press office, please notify them about your upcoming paper to help maximize its impact. If they’ll be preparing press materials, please inform our press team as soon as possible -- no later than 48 hours after receiving the formal acceptance. Your manuscript will remain under strict press embargo until 2 pm Eastern Time on the date of publication. For more information, please contact onepress@plos.org. Kind regards, Hamidreza Karimi-Sari, MD Academic Editor PLOS ONE https://doi.org/10.1371/journal.pone.0261386.r005
Formally Accepted
3 Dec 2021 Acceptance Letter - Hamidreza Karimi-Sari, Editor PONE-D-21-26585R2 Sleep quality and associated factors among adult patients with epilepsy attending follow-up care at Referral Hospitals in Amhara Region, Ethiopia Dear Dr. Simie Tsega: I'm pleased to inform you that your manuscript has been deemed suitable for publication in PLOS ONE. Congratulations! Your manuscript is now with our production department. If your institution or institutions have a press office, please let them know about your upcoming paper now to help maximize its impact. If they'll be preparing press materials, please inform our press team within the next 48 hours. Your manuscript will remain under strict press embargo until 2 pm Eastern Time on the date of publication. For more information please contact onepress@plos.org. If we can help with anything else, please email us at plosone@plos.org. Thank you for submitting your work to PLOS ONE and supporting open access. Kind regards, PLOS ONE Editorial Office Staff on behalf of Dr. Hamidreza Karimi-Sari Academic Editor PLOS ONE https://doi.org/10.1371/journal.pone.0261386.r006

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