Can the Myasthenia Gravis Activities of Daily Life (MG-ADL) Score Predict Sleep Disturbance and Fatigue Among Patients with Myasthenia Gravis?
Christina Marini1, Julia Greenberg1, Sophia Tong1, Azizi Seixas2, Kiril Kiprovski1, Ricardo Osorio1, Laura Balcer1, Sujata Thawani1
1Neurology, NYU Langone Health, 2University of Miami Miller School of Medicine
Objective:
To examine the association between fatigue and sleep disturbances and MG-ADL among patients with generalized MG.
Background:
Fatigue is associated with worse quality of life and greater disease severity in patients with MG. Patients with MG also have higher rates of disordered sleep than their non-MG counterparts, however the impact of sleep on fatigue and quality of life in MG is understudied.
Design/Methods:
We examined cross-sectionally the relationship between MG symptoms as measured by the Myasthenia Gravis-Quality of Life 15 (MG-QOL 15) and sleep disturbance in a cohort of outpatients with ocular and generalized MG. All models were adjusted for age, sex, pre-existing obstructive sleep apnea (OSA), major depression, and use of corticosteroids.
Results:
70% of participants (7/10) enrolled were male with a mean age of 43.90 years (SD ∓ 15.98). 60% of participants (6/10) enrolled were currently using corticosteroids. Worse health-related quality life defined by MG-QoL 15 score was associated with worse sleep as measured by the Functional Outcomes of Sleep Questionnaire (FOSQ-10) (p=0.036) and Insomnia Severity Index (ISI) (p=0.005), but not the Neuro-QoL Sleep T-score, Epworth Sleepiness Scale (ESS), or Pittsburgh Sleep Quality Index (PSQI). Severity of disability defined by MG-ADL was associated with worse sleep as measured by the ESS (p=0.018), PQSI (p=0.017), and Neuro-QoL Sleep T-score (p=0.045), but not the ISI or FOSQ-10.
Conclusions:
Higher MG-ADL scores predicted greater sleep disturbance and fatigue among individuals with generalized MG, even after adjusting for OSA. These findings emphasize the bidirectional relationship between quality of life and disordered sleep and fatigue in patients with MG, and the need for further research into the mechanisms driving this relationship.