Objective:

To determine if people with multiple sclerosis (PwMS) and comorbid obstructive sleep apnea (OSA) experience worse clinical outcomes and greater healthcare burden than PwMS without OSA.

Background:

OSA is a highly prevalent sleep disorder characterized by recurrent upper airway obstruction during sleep. It is associated with excessive daytime sleepiness, impaired cognition, and greater healthcare utilization in the general population. PwMS already face elevated risks for fatigue and sleep disturbances and may be at an increased risk for OSA. Large-scale comparative studies examining OSA in this population are limited.

Design/Methods:

Using the TriNetX Research Network, we examined adult (ages 18–79) PwMS with comorbid OSA (n=15,896) versus adult PwMS without OSA (n=204,557) from 2010 to 2025. PwMS with histories of other neurologic conditions (Alzheimer’s disease, Parkinson’s disease, Huntington’s disease, amyotrophic lateral sclerosis, stroke) and sleep disorders (narcolepsy, primary central sleep apnea, hypersomnia, and circadian rhythm sleep disorders) were excluded. The cohorts were restricted to patients with active healthcare engagement, defined as ≥3 ambulatory visits during the study period. Propensity score matching (PSM) adjusted for age, sex, race, ethnicity, tobacco use, body mass index, and disease-modifying therapies.

Results:

OSA prevalence in PwMS (8.81%) increased over the study duration and was higher for any interval compared to the general population. After 1:1 PSM (n=15,896), comorbid OSA in PwMS was associated with higher risks of emergency room visits (RR=1.540, p<0.001), hospitalizations (RR=1.548, p<0.001), and steroid use (RR=1.448, p<0.001) compared to PwMS without OSA. OSA in PwMS was also associated with higher risks for new diagnoses of insomnia (RR=2.701, p<0.001) and cognitive impairment (RR=2.110, p<0.001).

Conclusions:

OSA is common in PwMS and is associated with increased healthcare utilization and elevated risk of new medical comorbidities. These findings highlight the necessity of routine screening for OSA as part of the comprehensive management of multiple sclerosis.