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Sleep disturbances and their correlation with cardiovascular risk, obesity, and mood disorders in people with HIV
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Download the PDF here
Download the PDF here
May 1 2023
The present study highlighted that sleep disorders are a very common problem in PWH, with an overall prevalence of 77%. Over 60% of participant reported low sleep quality and over 30% of patients suffered from insomnia or obstructive sleep apnoea.
Results of our study confirmed associations between BQ and elevated cardiovascular risk. Although insomnia and poor sleep quality have not been associated with increased cardiovascular risk in our cohort.
In conclusion, our study highlighted the high prevalence of SD in PWH, and their close association with psychiatric disorders such as depression and anxiety, as well as an increased cardiovascular risk. In order not to underestimate SD, psychiatric disorders, and other related issues, with the aim of improving the quality of life of PWH, we suggest that the assessment of both sleep and mood disorders in this population should be investigated once a year (for mood disorder, the screening is already suggested by guidelines, but unfortunately poorly applied in clinical practice). Moreover, sleep health and SD assessment should be included as factors significantly contributing to maintain cardiovascular and metabolic health. We believe that, in the light of these results, it would be advisable to consider the possibility of setting up a dedicated service, with a multidimensional medical (including sleep experts) and psychological support[74].
EDITORIAL
Overall, the study by Mazzitelli et al.[6] showed that factors associated with sleep disorders in PWH on contemporary ART, optimal viral control and immune reconstitution resemble most likely those observed in the general population. The main contributors to sleep disorders in PWH remain mood disorders, and the iatrogenic effects of drugs other than antiretrovirals. However, this study did not include a control uninfected group and was not designed to properly address causation between antiretrovirals and sleep disorders. To date, not a single study has focused on the associations between biomarkers of bacterial translocation, immune activation and inflammation with sleep disorders in PWH. Emerging evidence has suggested that abnormal immunological function may contribute to poor quality of sleep [7]. Thus, an unmet need in the field is the evaluation of the microbiome [8] and biomarkers of bacterial translocation and immune dysfunction in PWH in association with independent sleep disorders scales and cardiovascular risk factors. Assessment of both sleep and mood disorders in PWH may improve the overall assessment of these patients in the clinic but is often neglected in clinical practice.
Abstract
Background:
The relationship between sleep disorders (SDs), cardiovascular risk (CVR), and mood disorders (MDs) has been studied in detail in the general population, but far less in people with HIV (PWH).
Methods:
Cross-sectional analysis in single centre cohort of PWH. Sleep quality was assessed using by Epworth Sleepiness Scale (ESS), Insomnia Severity Index (ISI), Berlin Questionnaire (BQ), Pittsburgh Sleep Quality Index (PSQI); anxiety and depression were evaluated by the Generalized Anxiety Disorder-7 and Patient Health Questionnaire-9. Demographic, clinical and HIV-related data were collected, and Framingham and Data collection on Adverse effects of anti-HIV Drugs (DAD)-10 scores were computed in modelling associations with each SDs scale.
Results:
Data were collected for 721 PWH on stable combination antiretroviral therapy (cART) (median age of 53 years, 71.8% males, 96% with undetectable HIV RNA, 50.3% on cART potentially affecting sleep, and 20.4% on hypno-inducing drugs), 76.9% had SDs 60.3, 31.3, 31.1, and 7.9% at PSQI, BQ, ISI, and ESS, respectively. Anxiety and depression were detected in 28.3 and 16.1% participants, respectively. BQ score was independently associated with high BMI (P < 0.001), Framingham risk >10% (P < 0.001), and both DAD-10R and -10F score >10% (P < 0.001 and P = 0.031). PSQI and ISI scores were independently associated with depression and anxiety (P < 0.001). No association between SDs and specific antiretroviral regimens, nor HIV-related parameters was detected.
Conclusions:
In our cohort of PWH on stable ART, despite the alarmingly higher prevalence, SDs were associated with the same determinants (cardiovascular risk factors and MDs) observed in the general population.
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