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

Abstract

Background To determine whether markers of systemic inflammation are associated with the presence of moderate-to-severe obstructive sleep apnea (OSA), and whether this association differs based on HIV and HIV treatment status. Methods HIV-uninfected men (HIV−; n=60), HIV-infected men receiving HAART (HIV+/HAART; n=58), and HIV-infected men not receiving HAART (HIV+/ No HAART; n=41) underwent polysomnograpy and measurement of plasma levels of TNF-alpha, soluble TNF-alpha receptors I and II (sTNFRI and sTNFRII) and IL-6. The relationship between moderate-severe OSA (respiratory disturbance index ≥15 apnea/hypopnea events/hour) and inflammatory markers was assessed with multivariable regression models. Results Compared to the HIV− men, HIV+/HAART men and HIV+/No HAART men had higher levels of TNF-alpha, sTNFRI, and sTNFRII, independent of age, race, smoking status, obstructive lung disease (OLD), and BMI. Moderate-to-severe OSA was present in 48% of the sample (HIV−:57%; HIV+/HAART: 41%; HIV+/No HAART: 44%). Among the HIV+/No HAART men, but not in the other groups, TNF-alpha, sTNFRII, and IL-6 levels were higher in those with moderate-severe OSA compared to men with no-to-mild OSA after adjustment for age, race, smoking status, OLD, and BMI. Within this group, the association of high TNF-alpha concentrations with moderate-severe OSA was also independent of CD4 cell count and plasma HIV RNA concentration. Conclusions Compared to HIV-infected men on HAART and HIV-uninfected men, markers of systemic inflammation were higher in HIV-infected men not receiving HAART. In these men, TNF-alpha was significantly related to obstructive sleep apnea, independent of HIV-related covariates.

Risk Factors for Incident Diabetes in a Cohort Taking First-Line Nonnucleoside Reverse Transcriptase Inhibitor-Based Antiretroviral Therapy

“… 26 We found a crude incidence of diabetes of 13.24 per 1000 PYFU, which is at the upper end of the range reported from cohort studies in high income countries (4.2–14.1 per 1000 PYFU). 2 , 26 – 28 Factors contributing to the increased risk of diabetes in people with HIV include insulin resistance due to the chronic inflammatory response to HIV infection, 29 which persists despite effective ART 29 , 30 and the effects of certain antiretroviral drugs. Our finding that the NRTIs stavudine and zidovudine were both associated with an increased incidence of diabetes has previously been reported.…”

Association of Markers of Inflammation with Sleep and Physical Activity Among People Living with HIV or AIDS

“…Determining which combination of these lifestyle factors is most strongly associated with inflammation could aid health care providers and researchers in developing lifestyle intervention and treatment programs that would be most effective in reducing systemic inflammation levels. This is especially true among PLWH who suffer from numerous sleep complaints [34-36] and increased inflammation, even when effectively undergoing ART treatment [42]. Therefore, future treatment or intervention studies among PLWH should incorporate components for sleep improvement and participation in physical activity to investigate avenues to reduce inflammation or disease progression (e.g., viral load).…”

“…For example, a recent study by Brigham and colleagues compared a sample of men who were HIV-negative with two groups of HIV-positive men (those receiving ART and those who were not). They found that plasma levels of TNF-alpha and IL-6 were higher only in those who were HIV+ with moderate to severe OSA compared to those with no OSA or mild levels of OSA independent of HIV-related covariates or treatment [42]. Other studies have shown increased plasma levels of various cytokines and markers of inflammation among PLWH regardless of ART treatment [43,44].…”

Sleep and neuropsychological performance in HIV+ subjects on efavirenz-based therapy and response to switch in therapy

“…In our study, lower CD4 percent was associated with poorer sleep efficiency and sleep maintenance efficacy as well as increased sleep fragmentation as reflected by higher WASO %. SDB in untreated HIV has been reported to be associated with higher HIV viral loads as well as high CRP, TNFα, TNFRII and IL-6 levels 37,38 . Even with the use of potent combination ART, HIV-associated immune activation may result in OSA via blunted neuromuscular control of the upper airway 39 .…”