Talks：	Nocturnal respiratory insufficiency in myasthenia gravis
Name：	葉建宏
Position：	Director
Affiliation：	Department of Education and Research, Shin Kong Wu Ho-Su Memorial Hospital
Email：	M001074@ms.skh.org.tw
Photo：
Research Interests：	1.Clinical neurology 2. Neuromuscular diseases 3. Neuroimmunology 4. Medical education
Selected Publications：	◆Yeh JH, Chen WH, Chiu HC, Lee CT, Hsu CY. Plasmapheresis does not affect polysomnographic parameters in patients with myasthenia gravis: a case series study. Artif Organs 2010;34:E200-3. ◆Yeh JH, Lin CM, Chen WH, Chiu HC. Effects of double filtration plasmapheresis on nocturnal respiratory function in myasthenic patients. Artif Organs 2013;37:1076-9. ◆Yeh JH, Lin CC, Chen YK, Sung FC, Chiu HC, Kao CH. Excessive risk of cancer and in particular lymphoid malignancy in myasthenia gravis patients: A population-based cohort study. Neuromuscul Disord 2014;24:245-9. ◆葉建宏、林嘉謨、邱浩彰。肌無力症危象病人拔除氣管內管標準之驗證性研究. 臺灣醫學 2014;18:338-44. ◆Yeh JH, Chen HJ, Chen YK, Chiu HC, Kao CH. Excessive risk of osteoporosis in patients with myasthenia gravis: A population-based cohort study. Neurology 2014;83:1075-9. ◆Yeh JH, Lin CM, Chiu HC, Bai CH. Home sleep study for patients with myasthenia gravis. Acta Neurol Scand 2015;132:191-5.
Abstract：	Weak respiratory muscle power of the patients with myasthenia gravis (MG) will result in CO2 retention, hypoxemia, and even respiratory failure. Weakness of bulbar muscles could increase the upper airway resistance and impair the patency of airway especially during sleep. The prevalence of sleep-apnea syndrome (SAS) among patients with MG ranges from 11% to 75% and is remarkably higher than that of the general population (2-4%). We arranged overnight polysomnography (PSG) in 13 generalized MG patients without respiratory symptoms who received one course of plasmapheresis treatment for worsening of their clinical conditions. SAS was documented in 4 of 13 patients (31%) before plasmapheresis. Most of the apnea or hypopnea events were obstructive and happened during REM sleep. In addition, we prospectively studied 40 consecutive mild MG patients for a full night Watch-PAT. Sixteen patients (40%) had definitive sleep-disordered breathing (SDB), which was mild in 7 patients (17%), moderate in 5 (13%), and severe in 4 (10%). Assessing risk factors with multivariate models, we found four significant predictors (BMI, age, male gender, and use of azathioprine); BMI was the most powerful predictor. The severity and prevalence of SDB had no significant association with MG score, MG stage, or seropositivity of acetylcholine receptor antibody. Both myasthenia-specific factors (use of azathioprine) and general predictors in terms of BMI, age, and male gender predisposed the development of SDB in MG patients. Plasmapheresis is an effective technique for removing pathogenic antibodies, and the treatment has been shown to ameliorate muscle weakness in 80% patients with MG. A total of 18 patients with generalized MG underwent a standard course of plasmapheresis treatment for refractory weakness or thymectomy. After plasmapheresis treatment, minimum SpO2 levels as well as mean and maximum PtcCO2 levels improved significantly during sleep after plasmapheresis. Although plasmapheresis treatment resulted in minimal improvement of respiratory parameters, this treatment could provide immediate help for the MG patients with impaired respiratory function esp. during sleep.