| Myasthenia gravis(MG) is an autoimmune disease which is mediated by auto-antibodies against the acetylcholine receptor(ACh R) at the postsynaptic membrane of the neuromuscular junction and significantly dependents on the participation of the cellular immunity and complement system. Autoantibodies against acetycholine receptor(ACh Rab)cause the transmission disorder of neuromuscular junction and disability of the skeletal muscle. MG can be found in any age and in both male and female. The number of MG patients younger than 40 in female is much more than that in male and the major abnormality of thymus is thymic hyperplasia. The number of MG patients older than 50 in male ismuch more than that in female and the major abnormality of thymus is thymoma.MG can be classified into ocular myasthenia gravis(OMG) and generalized myasthenia gravis(GMG) according to the muscle involved. About 80% of OMG patients turn to GMG with in two years. The distinctive clinical manifestation of MG was fluctuating muscle weakness and fatigability, such as ocular symptoms(diplopia, Eyelid Ptosis), weakness of limbs, neck muscle weakness, medulla oblongata muscle weakness. Some of the MG patients can manifest as respiratory failure and death. Most of the MG patients have a implicit onset form, remission and recurrence emerge alternately and the muscle weakness of some of them was sustainable progress. The disease duration of MG patients was of various lengths, it can last for several months, several years and even decades of years.MG can severely affect the physical and psychological health of patients.Some of them can manifest as negative mood such as anxiety and depression. The muscle fatigue and the illness volatility not only can affect the ordinary life of MG patients, but also can aggravate their psychological burden, and furthermore might induce the aggravation of the patient’s condition. As for whether the MG patients can manifest sleep disorder, no conclusion can be found so far.Objective The objective of this study was to assess the quality of life and quality of sleep of MG patients by means of questionnaire survey to, analyze the factors which can affect the quality of life and quality of sleep of MG patients, uncover the influences of the quality of life and quality of sleep on the clinical symptoms, with the hope to improve the quality of life and quality of sleep of MG patients and improve the MG condition.Method We enrolled the outpatient MG patients who signed the informed consent and can coordinate the survey from Tangdu Hospital from February 2013 to June 2014 by means of questionnaire survey. Quantitative Myasthenia Gravis(QMG) score was used to assess the severity of MG. The Medical Outcome Survey 36-Item Short-Form Health Survey(SF-36) was used to assess the HRQOL. Hamilton Depression Rating Scale(HDRS) and Hamilton Anxiety Rating Scale(HARS) were used to assess the depression and anxiety symptoms. The SPSS17.0 was used to analyze all the collected data.Result We collected 509 outpatient MG patients in total, we assessed the quality of life of 188 MG patients, assessed the quality of sleep of 321 MG patients. Among the 188 MG patients who were assessed the quality of life, 95 male, 93 female, the proportion of male and female was 1.02:1, the average age was 42.8±15.8. The education level was classified into three layers, elementary 29(15.4%), secondary 104(55.3%), and university 55(29.3%). Intellectual work 65(34.6%), physical work 75(39.9%), retired 28(14.9%), and student 20(10.6%). The average disease duration was 4.2±5.8 years. As for the MGFA, typeⅠ104(55.3%);type Ⅱa 26(13.8%);type Ⅱb 13(6.9%);type Ⅲa 8(4.3%);type Ⅲb 33(17.6%);type Ⅳa1(0.5%);type Ⅳb 3(1.6%)。The average QMG score was 6.7±4.9. The average HARS score was 7.4±5.9. The average HDRS score was 8.1±6.7. No significant difference was found between the male and female MG patients. Statistically significant difference existed between elementary and university groups in subscale BP, in domain PF and RP between intellectual work and student groups, between physical work and student groups in subscale RP. As for the composite scores of SF-36, the statistically significant difference turned up in PCS between intellectual work and student groups, physical work and student groups, retired and student groups, MG patients of student group had higher PCS than anyone of the other three groups. The statistically significant differences were found between OMG and GMG groups in PCS and MCS and between the OMG progressed to GMG and always GMG groups in PCS. Among the 321 MG patients who were assessed the quality of sleep,male 156,female 165,the proportion of male and female was 1:1.06. The onset age was 20-79,the average age was 41.64±16.26, the number of 20-30 years was 100(31.15%), the number of 31-40 years was 45(14.02%), the number of 41-50 years was 69(21.49%), the number of 51-60 years was 39(12.15%), the number of 61-70 years was 39(12.15%), the number of >70 years was 11(3.43%). The number of patients whose disease duration less than 1 year was 49,1-3 years was155,3-5 years was46,more than 5years was71. According to Osserman classification,when the disease started, the number of typeⅠwas 253(78.82%), the number of type Ⅱa was 48(14.95%), the number of type Ⅱb was 20(6.23%). According to the present outpatient assessment, the number of type Ⅰwas 153(47.67), the number of type Ⅱa was 71(14.64), the number of type Ⅱb was52(16.2%). Among those MG patients, the number of patients who progressed from OMG to GM was 100, the number of patients who did not progress from OMG to GM was 153. The proportion of patients who had the sleep disorder was73.11%. The comparison between male and female MG patients according to disease duration, clinical symptom score and sleep quality index had no significant difference. Among the male MG patients who had poor sleep quality and PSQI﹥7, most of them were 20-30 and 41-50 years and some were 51-60 years, as for the patients had poor sleep quality and PSQI<5,most of them were 31-40、41-50 years.Among the female MG patients who had poor sleep quality and PSQI﹥7, most of them were 20-30 and 41-50 years and some were 31-40 years, as for the patients had poor sleep quality and PSQI<5,most of them were 61-70 years. The PSQI score of OMG patients who progressed to GMG increased significantly compared to the OMG patients who did not. The high PSQI score of OMG patients mainly existed in sleep disorder, daily function disorder and quality of sleep. The high PSQI score of OMG patients who progressed to GMG mainly existed in quality of sleep, the time to fall asleep, sleep disorder and daily function disorder.ConclusionThe influences facors of HRQo L in MG patients were age, educational level, occupation, the situation of the thymus, the type of MG and generalized myasthenia gravis(GMG), the severity of the disease, the psychological disorder. Higher QMG and HARS scores can prognosticate lower Physical Composite Score(PCS) and Mental Composite Score(MCS), older age can only prognosticate lower PCS. Myasthenia gravis patients have poor sleep quality, and the main disorders of sleep quality were sleep time, sleep efficiency, sleep disturbances, daytime function. We should pay attention to the improvement of the sleep quality of the MG patients when we treat the clinical symptoms of them, so as to promote the improvement of the clinical symptoms. |
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