Sleep, Rhythm, and Mental Burden: Disruption of Psychobiological Balance in Patients with Myasthenia Gravis

Abstract

This study aimed to provide a comprehensive assessment of biological rhythm disturbances, sleep quality, and psychiatric symptoms in patients with myasthenia gravis (MG), while examining how these variables differ by clinical subtype and electrophysiological status. Forty-six MG patients and 46 demographically matched healthy controls were evaluated using the Biological Rhythms Interview of Assessment in Neuropsychiatry (BRIAN), Pittsburgh Sleep Quality Index (PSQI), Beck Depression Inventory (BDI), and Beck Anxiety Inventory (BAI). All MG patients also underwent electrophysiological assessments, including EEG, EMG, and RNS. Subgroup analyses were conducted based on MG subtype (generalized vs. ocular) and EEG findings (decrement-positive vs. decrement-negative). Compared to controls, MG patients demonstrated significantly greater disruptions across multiple rhythm domains - sleep, activity, social interaction, and eating behavior - alongside poorer sleep quality and higher levels of depression and anxiety (all p < 0.001). Sleep quality strongly correlated with depression (r = 0.895) and anxiety (r = 0.851). Patients with generalized MG exhibited more severe psychiatric symptoms than those with ocular involvement. Importantly, decrement-positive EEG findings were associated with worse sleep quality, anxiety, and rhythm irregularities, particularly in activity and social domains. Our findings reveal a distinct psychobiological profile in MG characterized by multidimensional rhythm dysregulation and elevated psychiatric burden, especially among patients with generalized MG and decrement-positive EEGs. These results underscore the systemic nature of MG and highlight the clinical value of incorporating chronobiological and psychiatric evaluations into standard diagnostic and treatment paradigms.