Relationship of sleep disorders with long-term complications and health-related quality of life in people with well-controlled human immunodeficiency virus

Abstract

Although sleep disorders are common in patients with human immunodeficiency virus (HIV) infection, they have not been adequately evaluated under currently advanced treatments, mainly with integrase strand transfer inhibitors. However, the relationship of sleep disorders with long-term complications and quality of life (QOL) status in patients infected with HIV is still poorly understood. Such associations are important in the management of outpatients with HIV. Hence, this study aimed to evaluate these associations.This cross-sectional observational study assessed the QOL changes of patients with HIV before and after the treatment regimen change. Male patients with well-controlled HIV who attended our hospital and changed HIV medications for reasons other than treatment failure between October 2019 and September 2021 were included. At the time of regimen change, sleep disorder status was assessed according to the Pittsburgh sleep quality index (PSQI), and health-related QOL (HRQOL) was assessed using the medical outcomes study 8-item short form health survey. In addition, we collected information on age, blood tests, and long-term comorbid conditions present during the evaluation. The HIV treatment regimen was also reviewed.Out of 45 male Japanese patients with HIV that were included in this study, 24 (53.3%) and 21 (46.7%) were classified into the sleep disorder group and nonsleep disorder group, respectively, according to their PSQI scores. The sleep disorder group had a significantly lower HRQOL mental component summary (P = .0222) than the nonsleep disorder group. The prevalence rates of hypertension, dyslipidemia, and diabetes mellitus were not significantly different between the 2 groups. In addition, a significant correlation was observed between PSQI scores and the HRQOL status (mental component summary, P = .0450; physical component summary, P = .0350).Sleep disorders remain common in patients with well-controlled HIV infection receiving current treatment. Sleep disorder is significantly associated with a low HRQOL in these patients. Hence, sleep status evaluation is necessary to improve HIV management. Abbreviations: HIV = human immunodeficiency virus; HRQOL = health-related quality of life; INSTI = integrase strand transfer inhibitor; MCS = mental component summary; PLWH = people living with HIV; PSQI = Pittsburgh sleep quality index; QOL = quality of life; SF-8 = medical outcomes study 8-item short form health survey.

Effects of frailty, geriatric syndromes, and comorbidity on mortality and quality of life in older adults with HIV

“…The prevalence of each syndrome was 15.6, 26.8, 12.1 and 18.1%, respectively. QOL was reported to be fair or poor in 57.7% patients, the median VACS Index score was 22 (17)(18)(19)(20)(21)(22)(23)(24)(25)(26)(27)(28)(29), and the median estimated risk of all-cause 5-year mortality according to the VACS Index was 7.8% (5.8-11.3). Differences by sex are shown in Table 1.…”

“…Among the four geriatric syndromes evaluated, the only one associated with higher risk of all-cause 5-year mortality was cognitive impairment (24 [17][18][19][20][21][22][23][24][25][26][27][28][29][30][31][32][33] vs. 18 [17][18][19][20][21][22][23][24][25][26][27][28][29], P = 0.01).…”

“…Because HIV infection has become a chronic disease, it is particularly important not to focus solely on survival but rather on QOL; however, the evidence in this sense is insufficient. Recently, studies have found that specific comorbidities such as hypertension [ 16 ], hepatic steatosis [ 17 ], sleep disorders [ 18 ], and depression [ 19 , 20 ], negatively affect health-related QOL, but only one study has specifically assessed the effect of the burden of comorbidity on QOL [ 21 ], and only one study has examined the relationship between frailty and QOL [ 22 ]. No evidence is available about geriatric syndromes and QOL in OAWH.…”

Self-Reported Health-Related Quality of Life and Residual Symptoms among Virologically Suppressed People Living with HIV in the Era of Single-Tablet Regimens in Taiwan: A Cross-Sectional Study

“…Studies have shown that concerns about appearance-related side effects underlay psychological distress, depression, and ART non-adherence among PLWH [ 47 , 48 ]. Sleep-related issues, such as insomnia or hypersomnia, usually associated with extreme fatigue, were also common among virologically suppressed PLWH or long-term ART [ 49 , 50 , 51 ]. HIV-related sleep disturbances have been linked to psychological disturbances and pain [ 52 , 53 ].…”

Do sleep disturbances contribute to comorbidities in HIV?

“…The EMA study previously discussed also assessed mood and found that both subjective and objective sleep were associated with next-day depressive symptoms [30 && ]. Worse subjective sleep from PSQI questionnaires has also been associated with worse mental component scores of HRQoL in men in Japan (n ¼ 45 PWH) [32], more depressive symptoms in Ethiopia (n ¼ 399 PWH) [33], and more depressive and anxiety symptoms in women in the United States (n ¼ 1583 PWH) [34]. Another study in Nigeria (n ¼ 406 PWH) showed no association between PSQI scores and depressive symptoms, but showed an association between short sleep duration (a component of RU-SATED sleep health dimensions) and depressive symptoms [35].…”