Sleep Disorders and Cognitive Function in Multiple Sclerosis: A Systematic Review of Polysomnographic Studies and Implications for Neurorehabilitation Strategies.

Cognitive rehabilitation represents a cornerstone of disease management in multiple sclerosis (MS), targeting the progressive cognitive decline that affects a significant proportion of patients. Despite growing evidence supporting its clinical utility, rehabilitation outcomes remain variable, and identifying modifiable factors that limit its efficacy has become a research priority. Sleep disorders are common in MS and have been increasingly linked to cognitive impairment, yet evidence based on objective polysomnographic assessment remains limited, and the specific parameters that influence cognitive function are poorly understood. This review synthesizes evidence from polysomnographic studies examining how sleep disturbances influence cognitive performance in MS patients. Following a systematic search of PubMed, EMBASE, and the Cochrane Library, 488 patients were included. Sleep fragmentation, reduced sleep efficiency, and oxygen desaturation indices were associated with impairments in attention, information processing speed, and verbal memory, with nocturnal hypoxia emerging as a potentially important mechanism of cognitive impairment. These findings suggest that identifying and treating sleep disorders may be essential for optimizing cognitive rehabilitation outcomes in MS. Further longitudinal studies are needed to determine whether addressing sleep pathology can enhance rehabilitation efficacy and preserve cognitive function over time.