Sleep disturbances are a common problem among patients with myasthenia gravis (MG), and adversely impact quality of life. These findings were recently reported in a study published in Sleep Medicine.
While fluctuating generalized fatigue is a well-characterized feature of MG, studies indicate that many patients also experience sleep disturbances. These may manifest as difficulty sleeping at night (i.e., insomnia) or difficulty staying awake during the day.
Sleep disturbances in MG can exacerbate existing fatigue and adversely impact daily function. However, sleep dysfunction in MG can be difficult to quantify due to a lack of standardized screening tools.
Investigators hence sought to better understand this symptom in patients with MG. They reviewed existing studies on this subject by combing through academic search engines. Specifically, investigators sought to review observational studies that looked into sleep disorders among patients with a clinical diagnosis of MG. A total of 27 studies were selected for analysis after a thorough screening process.
Read more about MG testing and diagnosis
The research team found that there were significant discrepancies between the studies. Obstructive sleep apnea (a sleep disorder caused by the blockage or narrowing of airways during sleep) was estimated to occur in as few as 5% to as many as 64% of patients. The studies reported that 33% to 77% of patients with MG had poor sleep quality, and between 12% and 75% had excessive daytime sleepiness. Around 10.5% to 47.6% of patients reported having restless leg syndrome.
The authors determined that there was a discrepancy in terms of the responses of patients in questionnaires (which are subjective) and polysomnography (objective sleep assessments carried out using clinical tools). Specifically, they found that questionnaires tended to overestimate the risk of obstructive sleep apnea due to overlapping symptoms, while polysomnography was able to more accurately pinpoint the exact diagnosis.
“Sleep disorders are exceedingly common in MG, but the inherent limitations of subjective questionnaires confound their assessment,” the authors of the study wrote. “The dissociation from disease severity suggests a distinct, multifactorial pathophysiology.”
The authors found that male sex and having a higher body mass index were both significant risk factors for obstructive sleep apnea and sleep-disordered breathing.
In addition, researchers found that sleep disturbances in MG had a significant impact on the disease burden. Specifically, patients with sleep disorders were more likely to have worsened fatigue and depression, in addition to a poorer quality of life.
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