Many HIV-positive patients have insomnia or
daytime sleepiness, investigators from the US military report in the online
edition of Clinical Infectious Diseases.
However, the prevalence of sleep disorders was no higher in HIV-positive
patients than in matched controls. Risk factors for insomnia included
depression and increased waist size. There was no evidence that HIV treatment
of any kind increased the risk of insomnia.
“We found that HIV-infected persons have a
high prevalence of sleep disturbances,” comment the authors. “Despite the high
prevalence of insomnia, HIV-infected persons did not have a statistically
significant higher rate compared with matched HIV-uninfected persons. These data suggest that in the HAART [highly
active antiretroviral therapy] era, patients with early-diagnosed,
early-treated HIV infection may have similar rates of sleep disturbances as the
It has long been recognised that insomnia is
common in patients with HIV. However, most of the studies exploring the
prevalence of sleep disturbances in patients with HIV were conducted before
combination antiretroviral therapy became available.
Research conducted since then has tended to
focus on the association of treatment with efavirenz (Sustiva, also in Atripla)
and sleep quality. Moreover, much of the research is limited because it did not
include an HIV-negative comparator group.
Investigators from the US military
therefore designed a study assessing the prevalence and causes of insomnia and
daytime sleepiness in a cohort of HIV-positive patients, who were matched with
All the patients were aged between 18 and
50 years. They completed validated questionnaires enquiring about insomnia and
sleepiness during the day.
A total of 193 HIV-positive patients and 50
HIV-negative controls were included in study. The participants had a mean age
of 36 years, 95% were male and 50% were white.
The mean body mass index (BMI) for the
HIV-positive patients was 27.5 kg2 and 25% were assessed as obese.
Lipodystrophy was noted in 52% of patients and 7% were depressed. The mean CD4
cell count at enrollment was 587 cells/mm3. Two-thirds of patients
were taking antiretroviral therapy and 55% had an undetectable viral load.
Insomnia was reported by 46% of
HIV-positive patients. The mean amount of sleep per night was 6.5 hours and 46%
reported less than seven hours sleep. Just under a quarter (23%) of
HIV-positive patients rated the quality of their sleep as “bad.”
Daytime dysfunction caused by sleepiness
was reported by 53% of patients, and 30% of individuals with HIV had evidence
of drowsiness during the day.
Use of sleep medication at least once a
week was reported by 18% of patients.
The prevalence of insomnia among the
HIV-negative controls was 38%. This was not significantly different to the 46%
prevalence reported by patients with HIV. Nor did the proportion of
HIV-negative controls who reported sleepiness during the day differ significantly.
Moreover, similar proportions of HIV-positive and HIV-negative patients
reported the regular use of sleep medication (18% vs. 16%).
The investigators then undertook a series
of analyses to establish the factors associated with sleep disturbances in the
Univariate analysis showed a significant
association with fewer years of education (p
= 0.005), obesity (p = 0.04), increased waist size (p < 0.001),
smoking (p = 0.01), a history of serious head trauma (p = 0.006), depression (p
= 0.006) and peripheral neuropathy (p = 0.02). Patients of officer rank had a
lower risk of insomnia compared to personnel in enlisted ranks (p = 0.04).
Subsequent multivariate analysis that
controlled for potential confounders showed that only depression (p = 0.01),
waist size (p = 0.002) and fewer years of education (p = 0.006) increased the
risk of insomnia.
“The strongest factor associated with insomnia
among HIV-infected in our study was depression,” observe the investigators. “This
finding is consistent with other studies, and exemplifies that psychological
morbidity is a major factor in insomnia among HIV-infected persons.”
The authors believe this finding has
implications for patient care: “treating depression might improve sleep
quality, and the treatment of sleep disturbances may decrease the incidence of
There was no evidence that HIV therapy or
the use of any individual antiretroviral drugs were associated with insomnia.
Follow-up showed that patients with
insomnia were more likely to report a decline in measures of neurocognitive function
than patients without insomnia (p = 0.01).
“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,” conclude the authors. “Prompt diagnosis and management
of sleep disturbances are advocated and may improve quality of life.”