Objective and subjective sleep measures are associated with neurocognition in aging adults with and without HIV

Abstract

Objective: Poor sleep quality is related to worse neurocognition in older adults and in people with HIV (PWH); however, many previous studies have relied only on self-report sleep questionnaires, which are inconsistently correlated with objective sleep measures. We examined relationships between objective and subjective sleep quality and neurocognition in persons with and without HIV, aged 50 and older. Method: Eighty-five adults (PWH n ¼ 52, HIV-negative n ¼ 32) completed comprehensive neuropsychological testing to assess global and domain-specific neurocognition. Objective sleep quality was assessed with wrist actigraphy (total sleep time, efficiency, sleep fragmentation) for five to 14 nights. Subjective sleep quality was assessed with the Pittsburgh Sleep Quality Index. Results: Objective and subjective sleep measures were unrelated (p's > 0.30). Compared to HIV-negative participants, PWH had greater sleep efficiency (80% vs. 75%, p ¼ 0.05) and were more likely to be using prescription and/or over the counter sleep medication (p ¼ 0.04). In the whole sample, better sleep efficiency (p < 0.01) and greater total sleep time (p ¼ 0.05) were associated with better learning. Less sleep fragmentation was associated with better learning (p < 0.01) and recall (p ¼ 0.04). While PWH had slightly stronger relationships between total sleep time and sleep fragmentation, it is not clear if these differences are clinically meaningful. Better subjective sleep quality was associated with better executive function (p < 0.01) and working memory (p ¼ 0.05); this relationship was primarily driven by the HIV-negative group. Conclusions: Objective sleep quality was associated with learning and recall whereas subjective sleep quality was associated with executive function and working memory. Therefore, assessing objective and subjective sleep quality could be clinically useful, as they are both related to important domains of cognition frequently impacted in HIV-associated neurocognitive ARTICLE HISTORY

A Randomized Clinical Trial on the Impact of Individually Targeted Computerized Cognitive Training on Quality of Life Indicators in Adults With HIV-Associated Neurocognitive Disorder in the Southeastern United States

“…Because 30% to 50% of PLWH experience HAND, the incidence and severity of HAND may increase in the coming years and diminish quality of life (QoL; Small & Brew, 2018). In fact, PLWH with HAND have reported QoL issues associated with cognitive complaints, depression/mood problems (Waldrop et al, 2021), poor sleep quality (Campbell et al, 2020), and health-related QoL (Jones et al, 2019). Fortunately, cognitive remediation techniques, such as transcranial direct current stimulation or cognitive training to improve cognition, may improve QoL.…”

Do sleep disturbances contribute to comorbidities in HIV?

“…Better sleep latency and sleep efficiency were associated with better task completion in controls but not in PWH. Another US study ( n = 52 PWH and n = 32 controls), collected cognitive testing and 5–15 days of actigraphy data [26]. Better cognition was associated with less sleep fragmentation and greater sleep efficiency and sleep time overall but results were generally nonsignificant in the PWH stratum, with only sleep fragmentation associating with learning and recall cognitive domains and several other results just outside statistical significance thresholds.…”

“…Self-reported sleep symptoms often lack good correlation to actigraphy-based measures [26,27], but symptoms and actigraphy capture different dimensions of sleep. Although POPPY found no association between RU-SATED sleep dimensions and cognitive test results [19 ▪▪ ], other studies have demonstrated worse cognitive test results in PWH with self-reported daytime sleepiness (reported by 67% of n = 562 PWH in UK Biobank data and 58% of n = 562 matched controls) [28] and worse subjective cognitive complaints in PWH with self-reported poor sleep satisfaction (reported by 62% of n = 435 PWH in China), even after controlling for anxiety and fatigue symptoms [29].…”

Poor subjective sleep reported by people living with HIV is associated with impaired working memory

“…The Pittsburgh Sleep Quality Index (PSQI) is a well-validated measure of subjective sleep quality [12][13][14] that has been used in a variety of populations [e.g., 12,15,[16][17][18][19] with a global score ≥ 5 distinguishing good from poor sleepers [20]. Although subjective sleep indices such as the PSQI do not necessarily align with polysomnography measures [e.g., 21], they may nevertheless screen relevant aspects of sleep [e.g., 22,23]. Studies in the general population suggest potential relations between poor sleep and impaired cognitive performance [e.g., 24,25].…”