Sleep quality in multiple sclerosis: A systematic review and meta-analysis based on Pittsburgh Sleep Quality Index

Background: Sleep quality is individual satisfaction with the sleep experience and the Pittsburgh Sleep Quality Index (PSQI), one of the most reliable subjective measurements of sleep quality, assesses the quality of sleep over the previous month. This study aimed to explore the sleep quality in multiple sclerosis (MS) patients in comparison to healthy controls (HCs). Methods: Following the Joanna Briggs Institute (JBI) methods and PRISMA statement, a systematic search was conducted through PubMed, Web of Science, Scopus, and Embase online databases and studies that assessed the sleep quality based on the PSQI, in MS patients and HCs were included. The risk of bias in the included studies was assessed using the JBI critical appraisal tools and meta-analysis was conducted by the third version of Comprehensive Meta-Analysis (CMA3) software. Results: Out of 1574 identified records, 13 studies were included. Regarding the PSQI scores, the difference was statistically significant between patients with MS and HCs (10 studies; I-2:94.59%; Standard difference in means: 1.056; 95%CI: 0.758-1.372; p-value < 0.001). MS patients were found to have more prevalence of poor sleep quality (PSQI > 5); however, the difference was not statistically significant (4 studies; I-2: 87.08%; odds ratio: 2.31;95% CIs: 0.82-6.35; p-value: 0.113). Conclusions: The limited available evidence suggests that subjective sleep quality is affected by MS and it should be considered by the clinicians for prevention of sleep-related symptoms such as depression and anxiety. Future well-designed prospective studies are needed to reach a comprehensive conclusion in this regard.