High Insomnia Rate in US HIV Group Tied to Depression and Girth

Almost half of a small cohort of treated, HIV-positive military beneficiaries had insomnia, and almost one third had daytime sleepiness. Depression and higher waist size were associated with a higher insomnia risk.

Depression has been studied often in people with HIV, but insomnia and daytime sleepiness have not. This cross-sectional study involved 193 HIV-positive military personnel who began early treatment for their infection. Researchers rated insomnia by the Pittsburgh Sleep Quality Index (PSQI) and daytime sleepiness by the Epworth Sleepiness Scale (ESS). A control group of 50 HIV-negative people matched the HIV group in age, gender, race or ethnicity, and military rank.

While 46% of HIV-positive people had insomnia (PSQI > 5), 30% had daytime drowsiness (ESS > 10). Rates of these sleep disturbances were not significantly different in the HIV-negative group, of whom 38% had insomnia (P = 0.30) and 20% had daytime drowsiness (P = 0.18).

In people with HIV, multivariate analysis identified three factors associated with insomnia, at the following odds ratios (OR) (and 95% confidence intervals):

• Depression: OR 16.8 (2.0 to 142.1), P = 0.01
• Increased waist size: OR 2.7 (1.4 to 5.1), P = 0.002
• Fewer years of education: OR 0.8 (0.7 to 0.95) P = 0.006

Neurocognitive impairment was diagnosed in 19% of HIV-positive people and was not associated with insomnia. But HIV-positive people with insomnia were 3.1 times more likely to have a decline in activities of daily living than people without insomnia (23% versus 9%, P = 0.01).

Only 18% of HIV-positive cohort members used a sleep medication at least weekly.

The researchers advocate prompt diagnosis and treatment of sleep disturbances in people with HIV to improve quality of life.

Source: Nancy F. Crum-Cianflone, Mollie Poehlman Roediger, David J. Moore, Braden Hale, Amy Weintrob, Anuradha Ganesan, Lynn E. Eberly, Erica Johnson, Brian K. Agan, Scott Letendre. Prevalence and factors associated with sleep disturbances among early-treated HIV-infected persons. Clinical Infectious Diseases. 2012 54: 1485-1494

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Written by Mark Mascolini on behalf of the International AIDS Society