Differences in Sleep Disorders between HIV-Infected Persons and Matched Controls with Sleep Problems: A Matched-Cohort Study Based on Laboratory and Survey Data

Abstract

Objectives: Sleep disturbances are prevalent problems among human immunodeficiency virus (HIV)-infected persons. The recognition of comorbid sleep disorders in patients with HIV is currently hampered by limited knowledge of sleep-related symptoms, sleep architecture, and types of sleep disorders in this population. We aimed to compare the differences in sleep-related symptoms and polysomnography-based sleep disorders between HIV-infected persons and controls. Methods: The study evaluated 170 men with a Pittsburgh sleep quality index scores greater than 5, including 44 HIV-infected men and 126 male controls who were frequency-matched by sex, age (±3.0 years) and BMI (±3.0 kg/m2). For all participants, an overnight sleep study using a Somte V1 monitor was conducted. Differences in sleep-related symptoms and sleep disorders between HIV-infected patients and controls were examined using t-tests or chi-square tests. Results: HIV-infected persons with sleep disturbances more often had psychological disturbances (72.7% vs. 40.5%, p < 0.001) and suspected rapid eye movement behavior disorder (25.0% vs. 4.8%, p < 0.01) than controls. Sleep-disordered breathing was less common in HIV-infected persons than in controls (56.8% vs. 87.3%, p < 0.001). The mean percentage of rapid eye movement sleep was higher among HIV-infected patients than among controls (20.6% vs. 16.6%, p < 0.001). Nocturia was more common in HIV-infected persons than in controls (40.9% vs. 22.2%, p = 0.02). Conclusions: Psychological disturbances and sleep-disordered breathing can be possible explanations of sleep disturbances in HIV-infected persons in whom sleep-disordered breathing is notable. Further studies are warranted to examine the underlying factors of rapid eye movement behavior disorder among HIV-infected persons with sleep disturbances.

Sleep Disturbance in the Context of HIV: A Concept Analysis

“… Taibi et al (2013) suggested that “objective measures (polysomnography, actigraphy, sleep monitor) also show disruption of sleep onset and continuity as well as disruption of sleep stages.” Specifically, ( Faraut et al, 2021 ) defined sleep disturbance in HIV in terms of changes in sleep quality and sleep architecture observable using increases in the short-wave stage (SWS) of sleep, greater SWS during the latter half of the sleep period, and altered non-REM (NREM) and REM sleep cycles. These findings were echoed by Chen et al (2021) , who described similar objective characteristics of sleep disturbance in HIV based on polysomnography measurements, remarkably increased SWS during later sleep cycles, persistent alfa-intrusion into SWS, and suggestions of non-restorative sleep. Using actigraphy results, De Francesco et al (2021c) proposed that a sleep disturbance involved a longer sleep latency, shorter total sleep time, reduced sleep efficiency, and more time spent in stage 1 sleep.…”

“…In addition, the authors disagreed on how sleep disturbances among the PLWH population were identified. Chen et al (2021) concluded that limited data characterizes the type of sleep disturbance in these patients. Previous studies have not yielded consistent results.…”

“…The researched articles reveal that psychological factors are the most frequently described antecedent of sleep disturbance in the articles. According to Alikhani et al (2020) , Chen et al (2021) , Daubert et al (2022) , Han et al (2021) , Ren et al (2018) , Wang et al (2021) , and Yan et al (2021) , psychological factors, such as depression, anxiety, and stress-related to living with a chronic illness, preceded sleep disturbance in PLWH. The second antecedent of sleep disturbance involves biological factors, including low CD4 cell levels ( Shi et al, 2020 ), high viral load ( Balthazar et al, 2021a ), genetic involvement ( Aouizerat et al, 2021 ; Ding et al, 2018 ), sex ( De Francesco et al, 2021a ; Moore et al, 2020 ), brain damage ( Happe, 2020 ; Leone et al, 2021 ), disease progress and duration ( Faraut et al, 2018b ; Milinkovic et al, 2020 ), and decreased immune function ( Babson et al, 2013 ; Low et al, 2012 ; Taibi et al, 2013 ).…”

“…The concept of sleep disturbance has been used inconsistently in the HIV context. Although sleep disturbanc e was most used among the terms referring to similar concepts, several other concepts have been used interchangeably, including poor sleep ( Abdu & Dule, 2020 ; Alikhani et al, 2020 ; Cody et al, 2020 ), sleep complaint ( Faraut et al, 2021 ; González-Tomé et al, 2018 ), sleep difficulty ( Mahmood et al, 2018 ), sleep disruption ( Aouizerat et al, 2021 ; Hixon et al, 2020 ), sleep pattern problem ( Bedaso et al, 2020 ), sleep alteration ( Moore et al, 2020 ), sleep disorder ( Chen et al, 2021 ; Chenxi et al, 2019 ), and insomnia ( Buchanan et al, 2018 ; Cody et al, 2020 ; Luu et al, 2022 ; Pujasari et al, 2020 ). Many previous researchers have undertaken studies to examine sleep among PLWH; however, there is no consensus on an accurate definition of sleep disturbance.…”

“…Many previous researchers have undertaken studies to examine sleep among PLWH; however, there is no consensus on an accurate definition of sleep disturbance. The lack of an operational definition of sleep disturbance in the context of HIV has been identified in ( Chen et al, 2021 ; Chenxi et al, 2019 ). Due to the differing definitions of sleep disturbance among PLWH, reviewers in this area have not reached any firm conclusions ( Balthazar et al, 2021b ).…”