Impact of pharmacological and non-pharmacological approaches on the sleep quality of MS patients: A systematic review

Multiple sclerosis (MS) is an autoimmune disease of the central nervous system, recognized by various symptoms, like fatigue, pain, cognitive impairment, and mood disorders, which can impact sleep and cause sleep disorders. Due to the scattered nature of existing evidence and the significant clinical impact of sleep disturbances among patients with MS, this systematic review seeks to comprehensively integrate current pharmacological and non-pharmacological treatment approaches while identifying prevailing knowledge gaps and outlining directions for future investigations. A systematic search was conducted in PubMed, Web of Science, and Scopus databases up to September 2024, following PRISMA guidelines. The research was guided by the question: “What therapeutic approaches are effective in improving sleep quality in MS patients?” The PICOS framework defined the inclusion criteria (P = MS patients, I = Any intervention, C = Compared to other interventions, O = Sleep quality, S = Randomized controlled trials). After removing duplicates, the remaining articles were screened based on predefined inclusion/exclusion criteria. A total of 24 full-text articles were evaluated, and 16 studies met the final inclusion criteria. Data were extracted on study characteristics, intervention details, and outcomes. The quality of included studies was assessed using the NIH quality assessment tool for controlled intervention studies. Sixteen randomized controlled trials (RCTs) were included. This study confirms the efficacy of melatonin and CBT-I as primary interventions while highlighting the potential of relaxation and mindfulness-based approaches. All studies referenced in this article were of acceptable quality, demonstrating either good or fair quality standards. This review provides valuable insights into the management of sleep disturbances in individuals with MS. It confirms the efficacy of melatonin and CBT-I as primary interventions while highlighting the potential of relaxation and mindfulness-based approaches.While melatonin showed some benefits, other medications had limited or mixed effects. These findings underscore the need for methodological improvements and more targeted research. Addressing these gaps will help refine clinical practices, ensuring better sleep quality and overall well-being for individuals with MS.