Anthropometry in the prediction of sleep disordered breathing in HIV-positive and HIV-negative men

Abstract

Background: Body mass index (BMI), waist circumference (WC) and neck circumference (NC) are important screening tools for sleep disordered breathing (SDB); however, the utility of anthropometry for this purpose has not been evaluated among HIV-positive patients.

Methods: HIV-negative men (n=60), HIV-positive men receiving highly active antiretroviral therapy (HIV-positive/HAART; n=58) and HIV-positive men not receiving HAART (HIV-positive/no HAART; n=41) from the Multicenter AIDS Cohort Study underwent a nocturnal sleep study and anthropomorphic assessment. Moderate-severe SDB was defined as an apnea/hypopnea event rate > or =15 episodes/h. Receiver operating characteristic (ROC) curves were used to compare the ability of different anthropometric measurements to predict SDB within each group.

Results: Moderate-severe SDB was found in 48% of men (HIV-negative [57%], HIV-positive/HAART [41%] and HIV-positive/no HAART [44%]). The performance of BMI, WC and NC to predict SDB was excellent among the HIV-negative men (ROC areas under the curve [AUCs] 0.83, 0.88 and 0.88, respectively) and fair among the HIV-positive/HAART group (AUC 0.71, 0.77 and 0.77, respectively). By contrast, these measurements had no predictive value in the HIV-positive/no HAART group (AUC 0.43, 0.41 and 0.45, respectively). Moreover, in the HIV-positive/no HAART group, moderate-severe SDB was independently associated with serum C-reactive protein > or =3.0 mg/l (odds ratio 6.9; P=0.04) and HIV RNA>10,000 copies/ml (odds ratio 7.1; P=0.05).

Conclusions: BMI, WC and NC had a better predictive value for moderate-severe SDB in HIV-positive men compared with HIV-positive [corrected] men, and had no value among HIV-positive/no HAART men. Among this latter group, systemic inflammation might contribute to the pathogenesis of SDB.

Figure 1

Receiver Operating Characteristic (ROC) Curves Demonstrating the Discriminatory Performance of Anthropometric Measures (BMI, waist circumference, neck circumference) to Predict Significant Sleep Disordered Breathing (Respiratory Disturbance Index (RDI) ≥ 15 events/hour) in HIV-seronegative men (a), HIV-infected, HAART-treated men (b), and HIV-infected, not receiving HAART (c)

Figure 2

Respiratory Disturbance Index (apneic or hypopneic events/hour) in HIV-infected Men Not Receiving Highly Active Antiretroviral Therapy (n=41), stratified by HIV RNA ≤ or > 10,000 copies/mL (line represents median RDI in each group).