Comparative efficacy of non-pharmacological interventions on sleep quality in patients with multiple sclerosis: a systematic review and network meta-analysis

BACKGROUND: This study aimed to evaluate the effectiveness of non-pharmacological interventions for improving sleep quality in patients with multiple sclerosis (MS) using a systematic review and network meta-analysis. METHOD: Randomized controlled trials examining the effects of non-pharmacological interventions on sleep quality in patients with MS were retrieved from PubMed, EMBASE, Cochrane Library, Web of Science, CINAHL, CNKI, Wanfang Database, and VIP Database. The search period spanned from database inception to October 31, 2025. We performed a network meta-analysis using RevMan and Stata software. RESULTS: We included 35 studies involving 2,804 participants and 20 distinct intervention types. The most frequently investigated interventions were exercise-based therapies and cognitive-behavioral approaches. Based on cumulative ranking probabilities, assessed using the surface under the cumulative ranking curve (SUCRA), occupational therapy-based sleep interventions were the most effective for improving subjective sleep quality (SUCRA = 94.2%), followed by mindfulness intervention (SUCRA = 85.9%) and sleep hygiene education (SUCRA = 78.6%). For reducing insomnia severity, effleurage massage ranked highest (SUCRA = 91.9%), followed by cognitive behavioral therapy (SUCRA = 80.1%) and reflexology (SUCRA = 77.0%). CONCLUSIONS: Occupational therapy-based sleep interventions and effleurage massage appear to be the most effective non-pharmacological strategies for improving sleep quality in patients with MS. However, further high-quality randomized controlled trials are needed to confirm these findings and strengthen the evidence base.