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

Patil, Susheel P.; Brown, Todd T.; Jacobson, Lisa P.; Margolick, Joseph B.; Laffan, Alison M.; Johnson-Hill, Lisette M.; Godfrey, Rebecca; Johnson, Jacquett R.; Reynolds, S. R. M.; Schwartz, Alan R.; Smith, Philip L.

doi:10.1371/journal.pone.0099258

Cited by 39 publications

(40 citation statements)

References 57 publications

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“…We note several important differences between our study and the study by Patil and colleagues 34 that may explain the lack of association between fatigue and OSA in their study. Although their study included detailed measurement of sleep parameters in all participants using overnight in-lab polysomnography (the gold standard for diagnosis of OSA), the assessment of fatigue was based only on two questions asking about feeling of tiredness for 3 consecutive days for 2 or more weeks.…”

Section: Sleep Apnea and Fatigue In Hiv 593contrasting

confidence: 89%

“…33 In addition to these sleep disorders, PLWH are increasingly developing typical risk factors for OSA such as obesity and aging. 20,22,34,35 Conditions like insomnia, poor night time sleep, and excessive daytime sleepiness may also directly result from the frequent arousals caused by OSA and can have important consequences that influence HIV disease outcomes such as adherence to medications. 36 There remains a paucity of studies that have explored the association of OSA with fatigue and other sleep disorders in PLWH.…”

Section: Sleep Apnea and Fatigue In Hiv 593mentioning

confidence: 99%

“…36 There remains a paucity of studies that have explored the association of OSA with fatigue and other sleep disorders in PLWH. Patil and colleagues 34 enrolled 159 men who have sex with men (60 without HIV and 99 with HIV-58 treated with ART treatment and 41 with no ART for at least 1 year) and performed overnight polysomnography. They found a very high prevalence of OSA (70.7% in those with HIV with ART use, 73.2% in those with HIV but no ART use, and 86.7% in those without HIV) among all participants.…”

Section: Sleep Apnea and Fatigue In Hiv 593mentioning

confidence: 99%

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Sleep Apnea Symptoms as a Predictor of Fatigue in an Urban HIV Clinic

Goswami

Baker

Wang

et al. 2015

AIDS Patient Care and STDs

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Fatigue is common among persons living with HIV (PLWH), and risk factors for obstructive sleep apnea (OSA) such as older age and obesity are increasingly prevalent. Studies of OSA among PLWH are lacking, so we aimed to characterize OSA symptoms and associated clinical consequences (e.g., fatigue) among a contemporary population of PLWH. Self-administered surveys containing 23 items that included self-reported snoring, witnessed apneas, estimated sleep duration, the Epworth Sleepiness Score (ESS), and the FACIT-Fatigue score were mailed to PLWH receiving care at an urban HIV clinic. Clinical/demographic data were collected from the medical record. Multivariable linear regression models were created to study relationships between fatigue, clinical variables, and OSA symptoms. Of 535 surveys, 203 (38%) responded. Eight patients (3.9%) had known OSA. Among those without known OSA, mean respondent characteristics included: age 47 years; 80% male, 41% African American, 48% Caucasian, BMI 26.4 kg/m 2 , duration of HIV diagnosis 12 years, 93% on antiretroviral therapy, and 81% with <50 HIV RNA copies/mL. 27% reported snoring, 24% reported witnessed apneas, and 38% had excessive daytime sleepiness. Witnessed apnea was the strongest independent predictor of fatigue (lower FACIT-Fatigue score; b = -6.49; p < 0.001); this difference of 6.49 points exceeds the accepted minimal clinically important difference of 3.0 points. Other predictors included opioid use (b = -5.53; p < 0.001), depression (b = -4.18; p = 0.02), antidepressant use (b = -4.25; p = 0.02), and sleep duration < 6 h (b = -3.42; p = 0.02). Our data strongly support the need for increased efforts directed at OSA screening and treatment in PLWH.

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Section: Sleep Apnea and Fatigue In Hiv 593contrasting

confidence: 89%

Section: Sleep Apnea and Fatigue In Hiv 593mentioning

confidence: 99%

Section: Sleep Apnea and Fatigue In Hiv 593mentioning

confidence: 99%

See 1 more Smart Citation

Sleep Apnea Symptoms as a Predictor of Fatigue in an Urban HIV Clinic

Goswami

Baker

Wang

et al. 2015

AIDS Patient Care and STDs

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“…One observational study reported that 56 % of HIV+ individuals fulfilled the criteria for insomnia, and another recent publication found that HIV+ status was associated with an OR of 1.17 (95 % CI 1.04-1.34) for insomnia [13,14]. The prevalence of sleep disordered breathing, defined by an increased upper airway resistance that results in obstructive sleep apnea, upper airway resistance syndrome, and loud snoring, has been reported to be as high 73 % in HIV+ individuals [15]. However, the prevalence of sleep disorders and poor sleep quality among HIV+ individuals has varied by study, and it is not yet clear whether they differ by HIV status [15,67].…”

Section: Sleepmentioning

confidence: 99%

“…The prevalence of sleep disordered breathing, defined by an increased upper airway resistance that results in obstructive sleep apnea, upper airway resistance syndrome, and loud snoring, has been reported to be as high 73 % in HIV+ individuals [15]. However, the prevalence of sleep disorders and poor sleep quality among HIV+ individuals has varied by study, and it is not yet clear whether they differ by HIV status [15,67]. In the general population, sleep apnea, sleepiness, and sleep disturbances have been associated with increased CVD risk [68][69][70][71].…”

Section: Sleepmentioning

confidence: 99%

Mechanisms Influencing Circadian Blood Pressure Patterns Among Individuals with HIV

et al. 2015

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HIV+ individuals have an increased risk for cardiovascular disease (CVD), but the mechanisms behind this association are poorly understood. While hypertension is a well-established CVD risk factor, clinic-based blood pressure (BP) assessment by itself cannot identify several important BP patterns, including white coat hypertension, masked hypertension, nighttime hypertension, and nighttime BP dipping. These BP patterns can be identified over a 24-h period by ambulatory BP monitoring (ABPM). In this review, we provide an overview of the potential value of conducting ABPM in HIV+ individuals. ABPM phenotypes associated with increased CVD risk include masked hypertension (i.e., elevated out-of-clinic BP despite non-elevated clinic BP), nighttime hypertension, and a non-dipping BP pattern (i.e., a drop in BP of <10 % from daytime to nighttime). These adverse ABPM phenotypes may be highly relevant in the setting of HIV infection, given that increased levels of inflammatory biomarkers, high psychosocial burden, high prevalence of sleep disturbance, and autonomic dysfunction have been commonly reported in HIV+ persons. Additionally, although antiretroviral therapy (ART) is associated with lower AIDS-related morbidity and CVD risk, the mitochondrial toxicity, oxidative stress, lipodystrophy, and insulin resistance associated with long-term ART use potentially lead to adverse ABPM phenotypes. Existing data on ABPM phenotypes in the setting of HIV are limited, but suggest an increased prevalence of a non-dipping BP pattern. In conclusion, identifying ABPM phenotypes may provide crucial information regarding the mechanisms underlying the excess CVD risk in HIV+ individuals.

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