From the Research
Patients with myasthenia gravis (MG) should undergo a sleep study when they exhibit symptoms suggestive of sleep-disordered breathing, particularly obstructive sleep apnea (OSA), as identified in the most recent study 1. These symptoms include excessive daytime sleepiness, morning headaches, unrefreshing sleep, witnessed apneas, or worsening of MG symptoms upon awakening. Sleep studies are also recommended for MG patients with risk factors such as obesity, large neck circumference, craniofacial abnormalities, or those using medications that may worsen respiratory function during sleep (like benzodiazepines or opioids) 2. Additionally, patients with bulbar symptoms, respiratory muscle weakness, or those being evaluated for thymectomy should be considered for sleep studies as part of their preoperative assessment. The rationale for sleep studies in MG patients stems from the overlap between neuromuscular weakness in MG and sleep-related breathing disorders, as respiratory muscles affected by MG can further compromise breathing during sleep when muscle tone naturally decreases. Early identification of sleep disorders in MG patients is important because treating conditions like OSA can improve quality of life, reduce fatigue (which can be confused with MG symptoms), and potentially improve overall disease management, as suggested by recent research 3, 1. Some studies have shown that sleep-related respiratory disorders occur in patients with MG significantly more often than in the general population 4, 5, highlighting the need for sleep studies in this patient population. However, the most recent and highest quality study 1 found that patients with MG with stable clinical course and adequate treatment have sleep quality comparable to healthy controls, emphasizing the importance of considering individual patient factors when deciding on sleep studies. Key factors to consider when evaluating the need for a sleep study in MG patients include:
- Symptoms of sleep-disordered breathing
- Risk factors for OSA
- Presence of bulbar symptoms or respiratory muscle weakness
- Use of medications that may worsen respiratory function during sleep
- Evaluation for thymectomy By prioritizing these factors and considering the latest evidence 1, healthcare providers can make informed decisions about when to recommend sleep studies for patients with MG.