Ahmad A Toubasi, Thuraya N Al-Sayegh
It is fundamental to screen patients with MS for OSA and offer management options such as continuous positive airway pressure (CPAP) when appropriate.
BACKGROUND: Patients with multiple sclerosis (MS) report high prevalence of sleep fragmentation and poor sleep quality. However, the relationship between sleep and MS is poorly understood.
OBJECTIVES: To identify the prevalence of obstructive sleep apnea (OSA) among patients with MS, assess the difference between patients with MS and healthy controls in sleep metrics detected by polysomnography, and evaluate the impact of OSA metrics on disability indices.
DESIGN: Systematic review and meta-analysis.
METHODS: On September 29, 2025, we searched PubMed, Embase, Scopus, CINAHL and CENTRAL. The inclusion criteria were observational studies that included patients with MS who underwent polysomnography and reported the prevalence of OSA, the difference in polysomnography data such as total sleep time, sleep efficiency, and apnea hypopnea index (AHI) between patients with MS and healthy controls or the correlation between the aforementioned polysomnography variables and MS disability indicated by expanded disability status scale (EDSS) or symbol digit modality test (SDMT). Weighted mean difference (WMD) and rho (r) correlation coefficient and their associated 95% confidence intervals (95%CI) were used as the effect measures in the analysis.
RESULTS: A total of 3,264 patients with MS and 679 healthy controls from 40 studies were included in the analysis. The prevalence of OSA among patients with MS was 44% (95%CI: 33%-56%). Patients with MS had lower total sleep time (WMD=-37.70; 95%CI: -62.27- -13.12) and sleep efficiency (WMD=-6.38; 95%CI: -9.71- -3.06) and higher AHI (WMD=1.76; 95%CI: 0.20-3.32) compared to healthy controls. Sleep efficiency (r=-0.16; 95%CI: -0.02- -0.29) and AHI (r=0.41; 95%CI: 0.26-0.54) were correlated with EDSS.
CONCLUSIONS: It is fundamental to screen patients with MS for OSA and offer management options such as continuous positive airway pressure (CPAP) when appropriate.