Sleep disorders in myasthenia gravis: clinical, pathophysiological and therapeutic aspects

Myasthenia gravis (MG) is a chronic autoimmune disorder of the neuromuscular junction, the clinical burden of which is not limited to fluctuating muscle weakness. Data on the prevalence of sleep disorders in patients with MG vary considerably, which is due to the heterogeneity of clinical approaches and the limited use of objective methods for assessing sleep. At the same time, a number of studies point to specific patterns of sleep disorders in this patient group. For example, in one study, obstructive sleep apnea was detected in 36% of patients with MG, compared with the expected 15–20% in the general population. Restless legs syndrome was also detected more than twice as frequently: in 43.2% of patients with MG and in 20% of the control group. According to a recent systematic review, the prevalence of excessive daytime sleepiness reached 75% in some studies. The impact of treatment deserves special attention: among patients with generalized myasthenia gravis who had been receiving oral glucocorticoids (GCs) for at least one year, insomnia was observed in 23.1%.

The development of sleep disorders in MG is likely to be multifactorial. Sleep-related breathing disorders may be associated with weakness of the respiratory muscles and an increased risk of nocturnal hypoventilation and episodes of desaturation, particularly during the rapid eye movement (REM) phase. Difficulties in falling asleep and maintaining sleep may arise against a background of fatigue, anxiety and depressive disorders, and treatment, primarily with GCs. The role of immuno-inflammatory mechanisms is of interest but requires further investigation.

The aim of this review is to summarize current evidence on the clinical manifestations, possible mechanisms, diagnosis and management of sleep disorders in myasthenia gravis. Particular attention is paid to insomnia, sleep-related breathing disorders, restless legs syndrome, the impact of treatment and the need for active screening for sleep disorders in clinical practice.

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