Prevalence and clinical associations of sleep-disordered breathing in multiple sclerosis: a systematic review and meta-analysis.

BACKGROUND

Sleep-disordered breathing (SDB), including obstructive and central sleep apnoea, may contribute to fatigue, cognitive impairment, and reduced quality of life in people with multiple sclerosis (PwMS). Reported prevalence varies widely, and the influence of MS-specific factors on SDB risk remains unclear.

METHODS

We conducted a systematic review and meta-analysis of studies reporting objective measures of SDB in adults with MS. Databases were searched up to July 2025. Pooled prevalence and mean apnoea-hypopnoea or respiratory event index (AHI/REI) were estimated using random-effects models. Meta-regression examined associations with demographic and MS-related factors. Case-control studies were pooled to compare SDB odds in PwMS versus controls. Certainty of evidence was assessed using GRADE.

RESULTS

29 studies including 1167 PwMS were included. Pooled prevalence of SDB was 30% (95% CI: 21-40%), with a mean AHI of 7.2 events/hour (95% CI: 4.2-10.2), indicating predominantly mild SDB. Meta-regression identified higher body mass index (BMI), longer disease duration, greater disability (EDSS), and a higher proportion of people with progressive MS in the population studied as predictors of elevated AHI. Case-control studies (n = 7) did not show significantly increased odds of SDB in PwMS versus controls; however, case-control participants had relatively low EDSS scores. Heterogeneity was substantial, and certainty of evidence was very low across outcomes.

CONCLUSION

SDB affects a considerable proportion of PwMS, particularly those with more advanced disease or higher BMI. Although most SDB identified was mild and fatigue in MS has multifactorial origins, the potential contribution of SDB to sleep quality and cognitive function supports targeted screening approaches. Further research should evaluate whether MS-adapted assessment strategies improve detection and whether treatment of SDB improves MS-related outcomes.