The Efficacy of Non-Pharmacological Interventions for Sleep Disorders in People With Multiple Sclerosis: a Systematic Review and Meta-Analysis

Abstract

Sleep disorders significantly impact the quality of life in people with multiple sclerosis (pwMS), affecting up to 60% of this population. These disorders, including insomnia, sleep apnea, restless legs syndrome, narcolepsy, and REM sleep behaviour disorders, result from both the direct neurological impacts of MS and secondary factors, such as pain and medication side effects. Non-pharmacological interventions offer potential benefits without the adverse effects associated with medications. This systematic review and meta-analysis aimed to evaluate the efficacy of non-pharmacological interventions in improving sleep disorders in pwMS, address inconsistencies in individual studies, and provide estimates of the magnitude of improvement. The review followed PRISMA guidelines and included randomised controlled trials, even if pilot studies, that examined non-pharmacological interventions for sleep disorders in pwMS. The literature search was completed in April 2024 in PubMed, Embase, and Web of Science databases. Data were extracted on study design, participant characteristics, intervention details, and outcomes. Quality was assessed using the PEDro scale, and a random-effects meta-analysis was conducted. The primary outcome was the assessment of sleep quality. Nine studies met the inclusion criteria, encompassing various non-pharmacological interventions such as cognitive-behavioural therapy, mindfulness, aerobic exercise, and occupational therapy. Non-pharmacological interventions may effectively improve sleep disorders in pwMS, while also providing additional benefits for overall psychological well-being and quality of life. Future research should focus on long-term effects, underlying mechanisms, and standardising intervention protocols to enhance comparability and generalisability. The major limitation of the meta-analysis is the high heterogeneity among eligible studies.