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. 2025 Feb 1;21(2):269-276.
doi: 10.5664/jcsm.11386.

Prevalence of restless legs and association with patient-reported outcome measures in myasthenia gravis

Mohanad AlGaeed  1 , Tarrant McPherson  2 , Ikjae Lee  3 , Michelle Feese  4 , Inmaculada Aban  4 , Gary Cutter  4 , Henry J Kaminski  1 , Elias G Karroum  1   5
Affiliations

Prevalence of restless legs and association with patient-reported outcome measures in myasthenia gravis

Mohanad AlGaeed et al. J Clin Sleep Med. .

Abstract

Study objectives: Inflammatory and immune mechanisms are considered in restless legs syndrome (RLS) pathophysiology with several autoimmune diseases associated with RLS. There is a paucity of studies examining RLS prevalence in myasthenia gravis (MG), an autoimmune neuromuscular disease. This study investigated RLS prevalence and association with patient-reported measures in a large registry of participants with MG using a validated RLS diagnostic questionnaire.

Methods: The Myasthenia Gravis Foundation of America MG Patient Registry is used on a semiannual basis to survey participants with MG. Patients aged ≥ 18 years, living in the United States, and answering "yes" to physician diagnosed MG were invited by email to enroll in an RLS-customized web-based survey. Collection of data included demographics, disease variables, patient-reported measures with a simple depression scale, MG-quality of life-15 revised, MG-activities of daily living instruments, and 13-item short-form Cambridge-Hopkins diagnostic questionnaire for RLS. Multivariable logistic regression models explored the association between RLS and MG variables of interest.

Results: A total of 630 eligible participants with MG (age: 62.8 ± 13.2; 54.9% female; 91.6% White) completed the survey. The overall prevalence of RLS was 14.8%. The prevalence of clinically significant RLS was 8.4%. The odds of having RLS were increased with higher (worse) MG-activities of daily living, MG-quality of life-15 revised, and depression scores. History of "thymic tumor with thymectomy" and "continuous positive airway pressure therapy" were also independent predictors of RLS.

Conclusions: RLS is common in patients with MG and is associated with worse functional status, quality of life, and depression. The thymus could play a key role in an autoimmune process associating MG with RLS.

Citation: AlGaeed M, McPherson T, Lee I, et al. Prevalence of restless legs and association with patient-reported outcome measures in myasthenia gravis. J Clin Sleep Med. 2025;21(2):269-276.

Keywords: association; myasthenia gravis; prevalence; restless legs syndrome.

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Conflict of interest statement

All authors have seen and approved the manuscript. This work was performed primarily at the Department of Neurology & Rehabilitation Medicine, The George Washington University School of Medicine and Health Sciences, Washington, DC. Ikjae Lee, MD, has received research funding from the Myasthenia Gravis Foundation of America (MGFA), the American Academy of Neurology, the CReATe consortium, the American Brain Foundation and the National Institutes of Health (NIH). He has received honorarium from Alexion, Amylyx Pharmaceuticals, Medscape, and he is on the Independent Data Monitoring Committee for Regeneron Pharmaceuticals. Inmaculada Aban, PhD, is on the Steering Committee (Consulting) for Roche. She also has been consulting in the past for the MGFA, Ra/UCB Pharmaceutical through MGFA, Alexion through MGFA, Argenx through MGFA, Catalyst through MGFA, and Verona Pharmaceutical. Gary Cutter, PhD, is on the Data and Safety Monitoring Boards of: Applied Therapeutics, AI therapeutics, AMO Pharma, Astra-Zeneca, Avexis Pharmaceuticals, Bristol Meyers Squibb/Celgene, CSL Behring, Cynata Therapeutics, Horizon Pharmaceuticals, Immunic, Karuna Therapeutics, Kezar Life Sciences, Mapi Pharmaceuticals LTD, Merck, Mitsubishi Tanabe Pharma Holdings, Opko Biologics, Prothena Biosciences, Novartis, Regeneron, Sanofi-Aventis, Reata Pharmaceuticals, Teva Pharmaceuticals, National Heart, Lung, and Blood Institute (Protocol Review Committee), University of Texas Southwestern, University of Pennsylvania, Visioneering Technologies, Inc. He is also on the Consulting or Advisory Boards of: Alexion, Antisense Therapeutics, Avotres, Biogen, Clene Nanomedicine, Clinical Trial Solutions LLC, Endra Life Sciences, Entelexo Biotherapeutics, Inc., Genzyme, Genentech, GW Pharmaceuticals, Hoya Corporation, Immunic, Immunosis Pty Ltd, Klein-Buendel Incorporated, Linical, Merck/Serono, Novartis, Perception Neurosciences, Protalix Biotherapeutics, Regeneron, Roche, SAB Biotherapeutics, Sapience Therapeutics. Dr. Cutter is employed by the University of Alabama at Birmingham and President of Pythagoras, Inc. a private consulting company located in Birmingham, Alabama. Henry J. Kaminski, MD, is principal investigator for the Rare Disease Network, MGNet supported by NIH grant U54NS115054 and a consultant for R43NS12432. He is a consultant for Roche, Takeda, Cabaletta Bio, UCB Pharmaceuticals, EMD Serono, Ono Pharmaceuticals, Gilde Healthcare, and Admirix, Inc. Argenix provides an unrestricted educational grant to George Washington University. The other authors report no conflicts of interest.

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