March 30, 2012
Insomnia Common, but not Necessarily More So, in HIV
by Tim Horn
Insomnia and daytime drowsiness are common among people living with HIV, but not necessarily more so than HIV-negative individuals, according to a U.S. military study published online ahead of print by Clinical Infectious Diseases.
Insomnia among people living with HIV is considered common, though much of what is known about its prevalence comes from studies conducted in the early years of the epidemic, before combination antiretroviral (ARV) therapy became the standard of care. And while one of the more recent studies found that 73 percent of people living with HIV suffer from insomnia, it was conducted 15 years ago and lacked a comparison group consisting of those not living with HIV.
To make a comparison, Nancy Crum-Cianflone, MD, MPH, of the Naval Medical Center in San Diego and her colleagues turned to a cohort of 193 HIV-positive individuals and 50 HIV-negative volunteers matched for age, sex, race/ethnicity and military rank. All subjects were military beneficiaries—active duty members, retirees and dependents.
Cohort subjects averaged 36 years old, 95 percent were male, and 50 percent were white. The mean body mass index among the people living with HIV was 27.5, and 25 percent were obese—a known risk factor for sleep disorders. Lipodystrophy, another sleep disorder risk factor, was noted in 52 percent of the study volunteers. Depression was documented in 7 percent.
Those living with HIV had been diagnosed, on average, seven years before study enrollment. Six percent had a prior AIDS-defining condition, and 15 percent had a lowest-ever CD4 count below 200. Of those living with HIV, 66 percent were receiving ARV therapy, 55 percent had undetectable viral loads, and the mean CD4 count at enrollment was 587.
Of the cohort subjects living with HIV, 46 percent had insomnia and 30 percent reported daytime drowsiness, Crum-Cianflone and her colleagues reported.
The prevalence of insomnia and daytime sleepiness was not, however, significantly higher compared with those in the HIV-negative control group. Among those not living with HIV included in the analysis, insomnia was documented in 38 percent and daytime sleepiness was documented in 20 percent.
Factors found to be associated with insomnia among those living with HIV included depression, increased waist size and fewer years of education.
Neurocognitive impairment—potentially related to HIV infection and diagnosed in 19 percent of the study subjects living with HIV—was not associated with insomnia. However, HIV-positive study volunteers with insomnia were significantly more likely to have a decline in activities of daily living—a symptom of neurocognitive impairment—than those without insomnia.
Of note, Crum-Cianflone and her colleagues did not find an association between insomnia and ARV therapy use, including regimens containing efavirenz (found in Sustiva and Atripla). Efavirenz has been tied to sleep disturbances in various clinical trials and cohorts.
Only 18 percent of those living with HIV in the study reported using a sleep medication at least weekly.
“In summary,” the authors write, “insomnia and daytime sleepiness are common among HIV-infected persons, but in the setting of early HIV diagnosis and management, the prevalence of these disorders does not seem higher than matched HIV-uninfected persons. Among HIV-infected persons, depression and increased waist size were significantly associated with insomnia.”
The authors caution, however, that “because our study was conducted among a cohort of military beneficiaries with early diagnosed, early managed HIV infection, results may not be generalizable to other HIV populations.”
Still, the authors conclude: “Prompt diagnosis and treatment of sleep disturbances are advocated and may improve quality of life.”
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