Anthropometry in the prediction of sleep disordered breathing in HIV-positive and HIV-negative men

Abstract

Background Body mass index (BMI), waist circumference (WC) and neck circumference (NC) are important screening tools for sleep disordered breathing (SDB). However, the utility of anthropometry for this purpose has not been evaluated among HIV-infected patients. Methods HIV-uninfected men (HIV−; n=60), HIV-infected men receiving highly active antiretroviral therapy (HIV+/HAART; n=58), and HIV-infected men not receiving HAART (HIV+/No HAART; n=41) from the Multicenter AIDS Cohort Study underwent a nocturnal sleep study and anthropomorphic assessment. Moderate-severe SDB was defined as an apnea/hypopnea event rate ≥15 episodes/hour. Receiver operating characteristic (ROC) curves were used to compare the ability of different anthropometric measurements to predict SDB within each group. Results Moderate-severe SDB was found in 48% (HIV−:57%; HIV+/HAART: 41%; HIV+/No HAART−: 44%). The performance of BMI, WC, and NC to predict SDB was excellent among the HIV− men (ROC areas-under-the curve (AUC): 0.83, 0.88, 0.88, respectively) and fair among the HIV+/HAART group (AUCs: 0.71, 0.77, 0.77, respectively). In contrast, these measurements had no predictive value in the HIV+/No HAART group (AUCs: 0.43, 0.41, 0.45, respectively). Moreover, in the HIV+/No HAART group, moderate-severe SDB was independently associated with serum C-reactive protein ≥3.0 mg/L (Odds Ratio (OR) 6.9; p=0.04) and HIV RNA > 10,000 copies/ml (OR 7.1; p=0.05). Conclusions BMI, waist circumference, and neck circumference had better predictive value for moderate-severe SDB in HIV-uninfected men compared to HIV-infected men, and had no value among HIV-infected men not receiving HAART. Among this latter group, systemic inflammation may contribute to the pathogenesis of SDB.

Sleep Disordered Breathing, Fatigue, and Sleepiness in HIV-Infected and -Uninfected Men

“…HIV infection may predispose to SDB either through adenotonsillar hypertrophy, which narrows the airway, [15], [16], but is uncommon since the advent of HAART, or through increased systemic production of somnogenic cytokines such as TNF-α and IL-1β [6], [48]–[50], which act through neural mechanisms [23]. We recently reported preliminary evidence that elevated plasma HIV viral loads and serum C-reactive protein concentrations were independently associated with moderate-to-severe SDB [51]. Further support for this inflammatory mechanism comes from the finding that etanercept, a TNF-α inhibitor, reduced RDI and sleepiness, and lowered serum IL-6 levels [52].…”

Association between Systemic Inflammation and Obstructive Sleep Apnea in Men with or at Risk for HIV Infection

“…15 HAART was defined according to the DHHS/Kaiser Guidelines. 19 Men who had not received HAART in the previous 12 months were permitted to enroll into the HIV+/No HAART group.…”

“…15 OSA severity was characterized by the respiratory disturbance index (RDI). The RDI was defined as the total number of apneas or hypopneas per hour of sleep.…”

“…In a sub-study of the Multicenter AIDS Cohort Study (MACS) named SIESTA (Study of Immunes Effect on Sleep, HIV Treatment, and Apnea) we found a high prevalence of OSA regardless of HIV-status, and regardless of HAART treatment. 15 Interestingly, OSA was associated with higher waist circumference and trunk fat in the HAART-treated men, but not in the HIV-infected men who were not receiving HAART. In an exploratory analysis in a subset of this group, we found that moderate-severe OSA (defined as a respiratory disturbance index (RDI) ≥ 15 events/hour) was independently associated with higher serum hsCRP and higher plasma HIV RNA concentrations.…”

“…11,12,13 Furthermore, inflammatory markers are associated with OSA independent of adiposity and may be due to hypoxemia-induced oxidative stress. 10,14,15,16 …”