Problems with disturbed sleep affect 2 in 3 people with stable MG: Study
Poor rest tied to anxiety, depression, and a greater risk of sleep apnea
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Two-thirds of stable myasthenia gravis patients involved in a survey study in China were found to experience disturbed sleep.
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Sleep issues were linked to sleep apnea, anxiety, depression, and poorer quality of life.
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The researchers say these data show that MG management should address psychological factors and health-related quality of life.
More than two-thirds of people with clinically stable myasthenia gravis (MG) have problems with disturbed sleep, with resulting negative effects on their quality of life, a survey study of hundreds of MG patients in China has found.
Further, those with sleep problems were significantly more likely to have obstructive sleep apnea, a serious sleep disorder marked by repeated stops in breathing during sleep, the data showed. That was in addition to more anxiety and depression, all creating a poorer quality of life, according to the researchers.
“Sleep disturbances are prevalent among patients with MG,” the team wrote, adding that “psychological factors such as anxiety and health-related quality of life warrant increased attention in the management of these patients.”
The study, “Sleep disturbances in patients with myasthenia gravis: A cross-sectional study,” was published in the journal Neurología.
MG is usually caused by self-reactive antibodies that attack proteins involved in nerve-muscle communication, most commonly the acetylcholine receptor (AChR) protein in muscle cells. This results in disease symptoms that include muscle weakness and fatigue.
“Recent reports highlight an increased prevalence of sleep disorders in patients with MG, including poor sleep quality, sleep-disordered breathing (SDB) [abnormal respiratory patterns during sleep], and excessive daytime sleepiness, with profound effects on physical, emotional, and social well-being,” the researchers wrote.
Investigating risk factors for disturbed sleep in MG
Now, a team of scientists in Central China evaluated rates of sleep problems and potential risk factors among people with clinically stable MG. This was defined as having achieved minimal disease manifestations with a low dosage of standard corticosteroids.
A total of 306 patients were recruited at three specialized MG centers in Hubei Province. All completed an online self-report survey that addressed three main domains: demographic factors, clinical characteristics of MG, and additional conditions — including sleep quality, sleep apnea, depression, and anxiety.
Most participants (93%) were 18 or older, and more than two-thirds were female. Slightly more than half had generalized MG, where the disease affects muscle group throughout the body, and about half had lived with the disease for more than five years.
A total of 33% had experienced at least one myasthenic crisis, a life-threatening complication that occurs when respiratory muscles become too weak, impairing a patient’s ability to breathe. Another third had a history of thymoma, a cancer in the thymus gland that is closely associated with MG.
The researchers noted that more than two-thirds of participants, including five adolescents, had sleep disturbances, defined as a score of six or higher on the Pittsburgh Sleep Quality Index (PSQI) scale.
All PSQI domains, including subjective sleep quality, time to fall asleep, sleep duration, daytime dysfunction, sleep efficiency, and sleep medication use, were significantly higher in the group with sleep disturbances.
More problems also seen for older patients, after surgery
When looking for potential differences between the group with and without sleep problems, the team found that older age, lower education level, and being coupled or married were associated with sleep dysfunction in MG patients.
Participants with sleep issues were also significantly more likely to have late disease onset (after 55 years of age; 38% vs. 15%), generalized MG (71% vs. 50%), and anti-AChR antibodies (32% vs. 17%) compared with those without sleep problems.
A history of myasthenic crisis, thymoma, and thymectomy, which is a surgical procedure to remove the thymus, were also significantly more common in the sleep-impaired group.
However, no significant associations were detected between sleep dysfunction and disease duration, coexisting health conditions, or medications.
Our findings underscore the importance of addressing psychological factors, such as anxiety, and assessing health related quality of life in clinically stable patients.
Data also showed that participants experiencing sleep dysfunction were significantly more likely to be at risk of obstructive sleep apnea (51% vs. 31%), and to have anxiety (55% vs. 15%) and depression (72.6% vs. 29.6%).
The sleep-impaired group also showed significantly higher scores on the Myasthenia Gravis Quality of Life 15 scale, reflecting poorer quality of life, compared with the group without sleep problems.
Further analysis revealed that sex, marital status, and scores in sleep apnea, anxiety, and quality of life scales were significantly associated with the PSQI score, indicating “a strong correlation between these factors and the severity of sleep disorders observed in patients with MG,” the team wrote.
“Our findings underscore the importance of addressing psychological factors, such as anxiety, and assessing health related quality of life in clinically stable patients,” the researchers wrote. “By recognizing and addressing these aspects of patient care, healthcare providers can better support the overall wellbeing of individuals living with MG.”
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