Sleep disordered breathing, fatigue, and sleepiness in HIV-infected and -uninfected men

Abstract

Study objectives: We investigated the association of HIV infection and highly active antiretroviral therapy (HAART) with sleep disordered breathing (SDB), fatigue, and sleepiness.

Methods: HIV-uninfected men (HIV-; n = 60), HIV-infected men using HAART (HIV+/HAART+; n = 58), and HIV-infected men not using HAART (HIV+/HAART-; n = 41) recruited from two sites of the Multicenter AIDS cohort study (MACS) underwent a nocturnal sleep study, anthropometric assessment, and questionnaires for fatigue and the Epworth Sleepiness Scale. The prevalence of SDB in HIV- men was compared to that in men matched from the Sleep Heart Health Study (SHHS).

Results: The prevalence of SDB was unexpectedly high in all groups: 86.7% for HIV-, 70.7% for HIV+/HAART+, and 73.2% for HIV+/HAART-, despite lower body-mass indices (BMI) in HIV+ groups. The higher prevalence in the HIV- men was significant in univariate analyses but not after adjustment for BMI and other variables. SDB was significantly more common in HIV- men in this study than those in SHHS, and was common in participants with BMIs <25 kg/m2. HIV+ men reported fatigue more frequently than HIV- men (25.5% vs. 6.7%; p = 0.003), but self-reported sleepiness did not differ among the three groups. Sleepiness, but not fatigue, was significantly associated with SDB.

Conclusions: SDB was highly prevalent in HIV- and HIV+ men, despite a normal or slightly elevated BMI. The high rate of SDB in men who have sex with men deserves further investigation. Sleepiness, but not fatigue, was related to the presence of SDB. Clinicians caring for HIV-infected patients should distinguish between fatigue and sleepiness when considering those at risk for SDB, especially in non-obese men.

Figure 1. Severity of sleep disordered breathing for all study participants and study participants with BMI <25 kg/m².

Boxplots of RDI severity (median; 25^th–75^th percentile) stratified by HIV infection and HAART status for A) all study participants and B) study participants with BMI <25 kg/m². Among all participants (panel A), HIV− men (21.0; 7.9–30.9 events/h) had higher RDIs than HIV+men (11.9; 4.1–24.1 events/h; * indicates p = 0.02). In men with BMI <25 kg/m² (panel B), HIV+/HAART− men (15.5; 4.7–25.4 events/h) had higher RDIs than HIV+/HAART+ men (7.7; 2.4–15.0 events/h; * indicates p = 0.02). The dashed line represents an RDI of 5 events/h. Boxes depict the 25^th, 50^th, and 75^th percentiles of the distributions; whiskers represent the 5^th and 95^th percentiles, and outliers are represented by solid circles beyond the whiskers. Outliers with an RDI >80 events/h are represented by an X (HIV− group: RDI 120.8 events/h; HIV+/HAART+ group: 86.5 and 88.5 events/h).

Figure 2. Prevalence of sleep disordered breathing by HAART exposure status.

The HIV+/HAART− men were stratified by prior HAART (but had not taken HAART in the year prior to study enrollment) vs. no prior HAART exposure. Men with prior HAART exposure had a significantly higher prevalence of SDB than those that had no prior HAART exposure (90.0% vs. 57.1%, respectively; p = 0.02), despite a lower BMI.