Sleep disorders in myasthenia gravis: A systematic review on prevalence, clinical associations, and the accuracy of assessment methodologies.

[BACKGROUND] Sleep disorders are a frequently reported yet poorly characterized aspect of myasthenia gravis (MG), contributing significantly to fatigue and reduced quality of life. The accuracy of standard screening tools in this population remains a major clinical challenge.

[OBJECTIVES] This systematic review synthesizes evidence on the prevalence, types, and assessment challenges of sleep disorders in MG.

[METHODS] A systematic search of PubMed, Embase, and PsycInfo was conducted from inception to April 2025. Observational studies reporting on sleep disorders in patients with clinically diagnosed MG were included. Study quality was assessed using the Joanna Briggs Institute (JBI) tools.

[RESULTS] Of 812 unique records, 27 studies (n = 4135 participants) were included. The prevalence was 5-64 % for obstructive sleep apnea (OSA) and 38-77 % for poor sleep quality (PSQI >5). Restless leg syndrome (10.5-47.6 %) and excessive daytime sleepiness (12-75 %) were also highly prevalent. Higher body mass index and male sex were significant risk factors for OSA and sleep-disordered breathing. A critical finding was the significant discrepancy between subjective questionnaires and objective polysomnography. Subjective questionnaires overestimated OSA risk due to symptom overlap, while objective polysomnography provided more specific diagnoses. Sleep disorders were strongly correlated with worsened MG-specific quality of life, fatigue, and depression scores.

[CONCLUSION] Sleep disorders are exceedingly common in MG, but the inherent limitations of subjective questionnaires confound their assessment. The dissociation from disease severity suggests a distinct, multifactorial pathophysiology.