| Objective:This systematic review and meta-analysis was conducted to investigate the occurrence and related factors of non-motor symptoms involving sleep,emotional and cognitive dysfunction in patients with myasthenia gravis(MG).Methods:A systematic literature search of the PubMed,Embase,Cochrane library,Web of science,ClinicalTrials.gov,CNKI,VIP,CBMdisc,Wanfang Database was performed to identify all relevant studies published up to January 7,2019.The studies focusing on the sleep,emotion and cognition in patients with MG were selected according to the inclusion and exclusion criteria by two independent researchers.The Agency for Healthcare Research and Quality(AHRQ)and the Newcastle-Ottawa Scale(NOS)were used to evaluate the quality of included studies.The meta-analysis were performed using the Stata 14.0 software and RevMan 5.3 software.The sensitivity analysis was performed to test the stability of the results.The existence of bias was analyzed by using the funnel plot,Egger’s and Begg’s tests.Results:(1)Thirteen studies involving 366 patients were ultimately included in the quality evaluation and eleven studies were included in the meta-analysis of the sleep-disordered breathing(SDB)in patients with MG,all these studies were published in English.Five studies showed that the risk factors of SDB in patients with MG were BMI,duration,age,male gender,total lung capacity,daytime blood gas concentrations,and the use of azathioprine.The results showed that the prevalence of SDB in patients with MG was 47%.Subgroup analysis showed that the prevalence of SDB with the Apnea-Hypopnea Index(AHI)and the Respiratory Distress Index(RDI)were 45%and 37%,respectively.The prevalence of mild,moderate and severe SDB were 19%,12%and 12%,respectively.(2)Thirteen studies involving 815 patients were ultimately included in the analysis of the anxiety in patients with MG,including 4 in Chinese and 9 in English.The results showed that the incidence of anxiety in patients with MG was 44%.Subgroup analysis showed that the incidence of anxiety in the HAMA,the HADS,the BAI,the SAS and the other group were 45%,34%,56%,43%,and 48%,respectively.The incidence of anxiety in China,the United States,Brazil,Turkey and other countries were 45%,56%,45%,39%,and 37%,respectively.Fifteen studies involving 1031 patients were ultimately included in the analysis of the depression in patients with MG,including 5 in Chinese and 10 in English.The results showed that the incidence of depression in patients with MG was 43%.Subgroup analysis showed that the incidence of depression in the HADS,the BDI,the SDS,the HAMD and the other group were 28%,45%,60%,48%,and 27%,respectively.(3)Twelve studies involving 377 patients with MG and 277 controls were ultimately included in the analysis of the cognition in patients with MG,including 4 in Chinese and 8 in English.The results showed that the Boston naming test[SMD=-0.40,95%CI(-0.67,-0.12),P=0.004],the finger tapping[the preferred hand:SMD=-0.75,95%CI(-1.17,-0.34),P=0.0004;the non-preferred hand:SMD=-0.67,95%CI(-1.09,-0.26),P=0.001],the animal fluency[SMD=-1.07,95%CI(-1.47,-0.68),P<0.00001],the logical memory[immediate:SMD=-0.79,95%CI(-1.20,-0.38),P=0.0002;delayed:SMD=-0.84,95%CI(-1.20,-0.48),P<0.00001],the symbol digit modalities test[SMD=-0.84,95%CI(-1.22,-0.46),P<0.0001],the trail making test A[SMD=0.62,95%CI(0.28,0.97),P=0.0004]and the event-based prospective memory[SMD=-1.26,95%CI(-1.68,-0.85),P<0.00001]were significantly different from the control.The letter fluency[SMD=-0.65,95%CI(-1.20,-0.11),P=0.02],the semantic fluency[SMD=-0.42,95%CI(-0.83,-0.02),P=0.04],the immediate verbal recall memory[SMD=-0.70,95%CI(-1.28,-0.13),P=0.02]and the visual immediate recall memory[SMD=-0.32,95%CI(-0.60,-0.03),P=0.03]were statistically different from the control.The MMSE[SMD=-0.31,95%CI(-0.80,0.18),P--0.22],the delayed verbal recall memory[SMD=-0.39,95%CI(-0.85,0.07),P=0.09],the verbal recognition[SMD=-0.01,95%CI(-0.67,0.65),P=0.97],the visual delayed recall memory[SMD=-0.38,95%CI(-0.78,0.01),P=0.06],the digit span test[digit forward:SMD=-0.49,95%CI(-1.14,0.17),P=0.14;digit backward:SMD=-0.20,95%CI(-0.49,0.08)P=0.16],the stroop color words test C[time:SMD=0.60,95%CI(-0.55,1.74),P=0.31;error:SMD=0.44,95%CI(-0.78,1.66),P=0.48]and the time-based prospective memory[SMD=-0.20,95%CI(-0.58,0.18),P=0.31]were not statistically different from the control.Conclusion:The prevalence of SDB,anxiety and depression in patients with MG are high,and there are multiple damage of cognitive domains,which should be paid more attention and take corresponding preventive measures. |
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