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  IAS 2023
July 23rd - 26th
12th IAS Conference on HIV Science
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Sleep Disorder 25% More Likely With Than Without HIV
  IAS 2023, July 23-26, 2023. Brisbane
Mark Mascolini
Sleep disorders of any kind proved 25% more likely in people with HIV than in matched HIV-negative people in the same large US healthcare system [1]. Insomnia was 50% more likely with HIV than in the matched HIV-negative population. But people with HIV had more than a 10% lower risk of sleep apnea in this 262,000-person analysis.
Researchers at Kaiser Permanente Northern California, a large integrated healthcare system, noted that poor sleep remains a common complaint of people with HIV, and research links it to poor health outcomes and lower quality of life. But because few recent studies compared clinically diagnosed sleep disorders in people with versus without HIV infection, the Kaiser team undertook this analysis.
Kaiser investigators started with HIV-positive people at least 18 years old and matched them by sex, age, race/ethnicity, and year entering the study to people without HIV in the same healthcare system. For every 1 person with HIV they found 20 matching people without HIV. Everyone in both groups had been in the Kaiser system at least 1 year between July 2013 and December 2021. The researchers identified sleep disorders by ICD codes as insomnia, sleep apnea, movement disorder/leg cramps, hypersomnia (excessive daytime sleepiness), parasomnia (disruptive movements and talking), circadian rhythm disorder, narcolepsy, and other/unspecified.
The 12,675 people with HIV and the matched 249,403 without HIV had a median age of about 49, 90% were men, 49% white, and about 19% Hispanic, 17% black, 9% Asian, and the rest some other race or ethnicity. Majorities of people with HIV (59.1%) and without HIV (63.8%) were overweight or obese. Depression was more frequent with than without HIV (38.3% vs 14.6%), as was anxiety (36.4% vs 20.4%) and a smoking history (52.1% vs 35.4%). Unhealthy alcohol use affected about 10% in both groups.
Higher proportions of people with HIV had 1 sleep disorder (22.7% vs 14.4%) or 2 or more sleep disorders (6.4% vs 3.8%). People with HIV had higher rates of insomnia (19.2% vs 7.9%) and other/unspecified sleep disorders (6.9% vs 3.8%) but a similar rate of sleep apnea (9.1% and 10.1%). Prevalence of the other sleep disorders considered was low and did not differ between the HIV group and matched controls.
Modified Poisson regression calculated prevalence ratios (PR) of sleep disorders by HIV status, and models adjusted for frequency of healthcare visits figured adjusted PRs for all sleep disorders combined and individually for insomnia and sleep apnea, the two most frequent sleep disorders. Adjusted analyses determined that any kind of sleep disorder was about 25% more likely with than without HIV (adjusted PR 1.24, 95% confidence interval [CI] 1.20 to 1.27) and insomnia was 50% more likely with HIV (aPR 1.50, 95% CI 1.44 to 1.56). But sleep apnea was over 10% less likely with HIV (aPR 0.87, 95% CI 0.83 to 0.93).
The Kaiser investigators did not speculate on why sleep apnea was significantly less likely with HIV infection, saying that further study is needed to confirm that finding. They suggested that exploring risk factors for specific types of sleep disorders—as well as possible differences by HIV status—could help fashion preventive and treatment strategies for people with HIV.
1. Lam JO, Hou CE, Alexeeff S, et al. Sleep disorder diagnoses in people with versus without HIV infection in an integrated healthcare system. IAS 2023, July 23-26, 2023. Brisbane. Abstract EPB0164.
IAS: Sleep disorder diagnoses in people with versus without HIV infection in an integrated healthcare system: Insomnia Most Common. PWH More Likely to have Sleep Disorder by 32%. - (07/25/23)