Treatment of insomnia in myasthenia gravis-A prospective study on non-benzodiazepine hypnotics in the treatment of myasthenia gravis patients with insomnia

Jingwen Yan; Minhui Yang; Michael Ke Li; Yangyu Huang; Ying Tan; Jiayu Shi; Qianqian Fan; Zhu Zhu; Yuzhou Guan; Liying Cui

doi:10.3389/fneur.2023.1266862

Treatment of insomnia in myasthenia gravis-A prospective study on non-benzodiazepine hypnotics in the treatment of myasthenia gravis patients with insomnia

Front Neurol. 2023 Sep 22:14:1266862. doi: 10.3389/fneur.2023.1266862. eCollection 2023.

Authors

Jingwen Yan^#¹, Minhui Yang^#², Michael Ke Li¹, Yangyu Huang¹, Ying Tan¹, Jiayu Shi¹, Qianqian Fan³, Zhu Zhu³, Yuzhou Guan¹, Liying Cui¹

Affiliations

¹ Department of Neurology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China.
² Department of Neurology, Central South University Xiangya School of Medicine Affiliated Haikou Hospital, Haikou, China.
³ Department of Pharmacy, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China.

^# Contributed equally.

Abstract

Objectives: This study aimed to evaluate the efficacy and safety of non-benzodiazepine hypnotics in the treatment of myasthenia gravis (MG) patients with insomnia.

Methods: This is a prospective longitudinal study. Outpatients who met the criteria for stable MG and insomnia diagnosis according to the International Classification of Sleep Disorders (third edition) were included in the study. They took a regular dose of non-benzodiazepine hypnotics (zolpidem 10 mg per night or zopiclone 7.5 mg per night) based on their own preferences. Patients received psychotherapy (including sleep health education) and were followed up for 4-5 weeks. Cases with lung diseases, respiratory disorders, or inappropriate use of hypnotic medications were excluded. The primary outcome is the difference in total Pittsburgh Sleep Quality Index (PSQI) score between baseline and the end of follow-up period. Secondary outcomes include the difference in Myasthenia Gravis Activities of Daily Living (MG-ADL) score, 7-item Generalized Anxiety Disorder Questionnaire (GAD-7), and the Patient Health Questionnaire-9 (PHQ-9) between baseline and the end of follow-up period and the safety of medication.

Results: A total of 75 MG patients with insomnia were included in this study. After 4-5 weeks of treatment, the total PSQI score and MG-ADL score were lower than baseline (p < 0.01). No patients had an increased MG-ADL score. The incidence rate of adverse events was 16.0% (12 cases), including dizziness (6 cases, 8.0%), drowsiness (3 cases, 4.0%), fatigue (2 cases, 2.7%), and nausea (1 case, 1.3%), all of which were mild. No patients had new onset breathing disorders.

Conclusion: Non-benzodiazepine hypnotics are safe and effective for stable MG patients who need insomnia treatment.

Keywords: insomnia; myasthenia gravis; non-benzodiazepine hypnotics; zolpidem; zopiclone.

Grants and funding

The author(s) declare that financial support was received for the research, authorship, and/or publication of this article. This work was supported by National High Level Hospital Clinical Research Funding (2022-PUMCH-B-017).