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Rosen AD, Javanbakht M, Shoptaw SJ, Seamans MJ, Gorbach PM. Associations of Sleep Deficiency With Sexual Risk Behaviors and HIV Treatment Outcomes Among Men Who Have Sex With Men Living With or at High Risk of Acquiring HIV. J Acquir Immune Defic Syndr 2024; 96:326-333. [PMID: 38916426 PMCID: PMC11207189 DOI: 10.1097/qai.0000000000003444] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Accepted: 04/11/2024] [Indexed: 06/26/2024]
Abstract
BACKGROUND Associations of sleep deficiency and methamphetamine use with sexual health and HIV treatment outcomes are poorly understood. SETTING A longitudinal cohort of men who have sex with men at risk for or living with HIV (the mSTUDY) was analyzed. This analysis included 1445 study visits among 382 participants. Data were collected from June 2018 to February 2022. METHODS Semiannual study visits included self-interviews for sleep deficiency, sexual behaviors, substance use, and HIV treatment. Sleep deficiency was measured using the Pittsburgh Sleep Quality Index. Participants provided specimens for HIV viral load and sexually transmitted infection (STI) testing (chlamydia, gonorrhea, syphilis). Associations between sleep deficiency and STI/HIV outcomes were estimated using multiple logistic regression. RESULTS Across visits, the prevalence of sleep deficiency was 56%, with 33% reporting methamphetamine use and 55% living with HIV. Sleep deficiency was associated with reporting at least 1 new anal sex partner (aOR = 1.62, 95% CI: 1.21 to 2.15), exchange sex (aOR = 2.71, 95% CI: 1.15 to 6.39), sex party attendance (aOR = 2.60, 95% CI: 1.68 to 4.04), and missing HIV medications (aOR = 1.91, 95% CI: 1.16 to 3.14). The association between sleep deficiency and exchange sex differed for participants who did and did not report the use of methamphetamine (P = 0.09). CONCLUSION Sleep deficiency was associated with sexual health and HIV treatment behaviors after accounting for methamphetamine use. Sleep health should be considered in STI/HIV prevention, particularly for those who use methamphetamine.
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Affiliation(s)
- Allison D. Rosen
- Department of Epidemiology, Fielding School of Public Health, University of California Los Angeles, Los Angeles, CA, USA
- Department of Family Medicine, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA
| | - Marjan Javanbakht
- Department of Epidemiology, Fielding School of Public Health, University of California Los Angeles, Los Angeles, CA, USA
| | - Steven J. Shoptaw
- Department of Family Medicine, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA
- Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA
| | - Marissa J. Seamans
- Department of Epidemiology, Fielding School of Public Health, University of California Los Angeles, Los Angeles, CA, USA
| | - Pamina M. Gorbach
- Department of Epidemiology, Fielding School of Public Health, University of California Los Angeles, Los Angeles, CA, USA
- Division of Infectious Diseases, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, USA
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Melese M, Mengistie BA, Delie AM, Limenh LW, Worku NK, Fenta ET, Hailu M, Abie A, Mehari MG, Eseyneh T, Esubalew D, Abuhay HW. Poor sleep quality and its associated factors among HIV/ADIS patients living in sub-Saharan African countries: a systematic review and meta-analysis. Sci Rep 2024; 14:16955. [PMID: 39043922 PMCID: PMC11266486 DOI: 10.1038/s41598-024-68074-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2024] [Accepted: 07/19/2024] [Indexed: 07/25/2024] Open
Abstract
Good-quality sleep is defined by its ability to minimize disturbances, provide adequate duration, and maintain a balanced progression through sleep stages. Sleep disturbance is a common complaint in people living with HIV/AIDS. Despite the influence of sleep disturbance on treatment adherence, quality of life, work productivity, risk of chronic illness. Studies have reported sleep disturbances among HIV/AIDS patients in sub-Saharan African countries (SSA), yielding varied results at the country level. Therefore, conducting a systematic review and meta-analysis is essential. This systematic review and meta-analysis aimed to evaluate the prevalence of poor sleep quality and identify associated factors among HIV/AIDS patients in sub-Saharan African countries. We systematically searched across various databases, including PubMed, African Journals Online, Scopus, Cochrane Library, HINARI, and Science Direct. Additionally, we conducted searches using Google and Google Scholar search engines. Microsoft Excel was used for data extraction, and the data were analysed using STAT version 17.0. We assessed heterogeneity using Cochran's Q test and I2 test and checked for small study effects using funnel plot symmetry and Egger's test. Pooled prevalence and associated factors were estimated using a random-effects model at a 95% confidence interval (CI) and significance level of p < 0.05. To identify factors associated with poor sleep quality among individuals living with HIV/AIDS, odds ratios (ORs) and their corresponding 95% CI were calculated. This analysis combined data from 15 separate studies involving a total sample size of 5176 participants. The pooled prevalence of poor sleep quality among HIV/AIDS patients in SSA countries was 49.32% (95% CI 41.32-56.8%). Factors significantly associated with poor sleep quality included depression (OR 2.78; 95% CI 1.21-6.40) and CD4 count < 200 cells/mm3 (AOR 3.15; 95% CI 2.41-4.15). In this study the prevalence of poor sleep quality among HIV/AIDS patients in SSA was higher and differs across the countries, ranging from 21.7 to 73.7%. The findings underscore the urgent necessity for programs aimed at improving sleep quality, particularly in addressing factors such as participant income and depression that are linked to poor sleep quality in HIV/AIDS patients.Systematic review registration: PROSPERO CRD42024517229.
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Affiliation(s)
- Mihret Melese
- Department of Human Physiology, School of Medicine, College of Medicine and Health Science, University of Gondar, Gondar, Ethiopia.
| | - Berihun Agegn Mengistie
- Department of General Midwifery, School of Midwifery, College of Medicine and Health Science, University of Gondar, Gondar, Ethiopia
| | - Amare Mebrat Delie
- Department of Public Health, College of Medicine and Health Sciences, Injibara University, Injibara, Ethiopia
| | - Liknaw Workie Limenh
- Department of Pharmaceutics, School of Pharmacy, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Nigus Kassie Worku
- Department of Public Health, College of Medicine and Health Sciences, Injibara University, Injibara, Ethiopia
- Department of Public Health, College of Medicine and Health Science, Dire Dawa University, Dire Dawa, Ethiopia
| | - Eneyew Talie Fenta
- Department of Public Health, College of Medicine and Health Sciences, Injibara University, Injibara, Ethiopia
| | - Mickiale Hailu
- Department of Midwifery, College of Medicine and Health Science, Dire Dawa University, Dire Dawa, Ethiopia
| | - Alemwork Abie
- Department of Midwifery, College of Medicine and Health Science, Bahir Dar University, Bahir Dar, Ethiopia
| | - Molla Getie Mehari
- Department of Medical Laboratory Science, College of Medicine and Health Sciences, Injibara University, Injibara, Ethiopia
| | - Tenagnework Eseyneh
- Department of Public Health, College of Medicine and Health Sciences, Injibara University, Injibara, Ethiopia
| | - Dereje Esubalew
- Department of Human Physiology, College of Medicine and Health Science, Ambo University, Ambo, Ethiopia
| | - Habtamu Wagnew Abuhay
- Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Science, University of Gondar, Gondar, Ethiopia
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Chen YC, Chen CC, Lin WK, Toh HS, Ko NY, Lin CY. Variations in the sleep-related breathing disorder index on polysomnography between men with HIV and controls: a matched case-control study. BMC Infect Dis 2024; 24:456. [PMID: 38689220 PMCID: PMC11062006 DOI: 10.1186/s12879-024-09322-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2023] [Accepted: 04/15/2024] [Indexed: 05/02/2024] Open
Abstract
BACKGROUND Both sleep-related breathing disorders (SRBDs) and HIV infection can interfere with normal sleep architecture, and also cause physical and psychological distress. We aimed to understand the differences in the obstructive patterns, sleep architecture, physical and psychological distress when compared between people living with HIV (PLWH) and matched the severity of SRBDs controls. METHODS A comparative study using matched case-control design was conducted. Men with HIV infection (case group) were enrolled from 2016 to 2019. A control group with HIV seronegative men were matched for SRBDs severity, and were selected from sleep medicine center database for comparison. RESULTS The mean age of the 108 men (including 54 cases and 54 matched controls) was 33.75 years. Central-apnea index (CI) was higher in the case group rather than matched controls (mean CI, 0.34 vs. 0.17, p = 0.049). PLWH had a lower mean percentage of stage 3 sleep (10.26% vs. 13.94%, p = 0.034) and a higher percentage of rapid eye movement sleep (20.59% vs. 17.85%, p = 0.011) compared to matched controls. Nocturnal enuresis and sleepiness causing traffic accidents were more frequent complaint in PLWH compared to controls. CONCLUSIONS Early detected SRBDs and subtypes in PLWH to begin treatment for the underlying cause could reduce the risk of sleepiness-related traffic accidents.
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Affiliation(s)
- Yen-Chin Chen
- College of Medicine, National Sun Yat-sen University, Tainan, Taiwan.
- Department of Nursing, College of Medicine, National Cheng Kung University, Tainan, Taiwan.
- Research and Development Committee, Taiwan AIDS Nurse Association, Taipei, Taiwan.
- , No. 70, Lianhai Road, Gushan District, 80424, Kaohsiung City, Taiwan.
| | - Chang-Chun Chen
- Department of Electrical and Computer Engineering, University of Arizona, Tucson, United States
| | - Wen-Kuei Lin
- Sleep Medicine Center, College of Medicine, National Cheng Kung University Hospital, National Cheng Kung University, Tainan, Taiwan
| | - Han Siong Toh
- Department of Intensive Care Medicine, Chi Mei Medical Center, Tainan, Taiwan
- Institute of Clinical Medicine, College of Medicine, National Cheng Kung University, Tainan, Taiwan
- Department of Health and Nutrition, Chia Nan University of Pharmacy & Science, Tainan, Taiwan
| | - Nai-Ying Ko
- Department of Nursing, College of Medicine, National Cheng Kung University, Tainan, Taiwan
- Research and Development Committee, Taiwan AIDS Nurse Association, Taipei, Taiwan
| | - Cheng-Yu Lin
- Sleep Medicine Center, College of Medicine, National Cheng Kung University Hospital, National Cheng Kung University, Tainan, Taiwan.
- Department of Otolaryngology, College of Medicine, National Cheng Kung University Hospital, National Cheng Kung University, Tainan, Taiwan.
- , No. 70, Lianhai Road, Gushan District, 80424, Kaohsiung City, Taiwan.
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Mohammadnejhad S, Najafi A, Earnshaw VA, Mousavi ME, Fotouhi A, Akbarpour S. Sleep traits and associated factors among people living with HIV/AIDS in Iran: a two-step clustering analysis. Sci Rep 2024; 14:5076. [PMID: 38429283 PMCID: PMC10907632 DOI: 10.1038/s41598-024-53140-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Accepted: 01/29/2024] [Indexed: 03/03/2024] Open
Abstract
Sleep plays an essential role in improving the quality of life of people living with HIV (PLWH); however, sleep traits in this population are not well studied. This study aims to evaluate the sleep traits and related associated factors among PLWH in Iran. A nationwide cross-sectional study was conducted with 1185 PLWH who attended Voluntary Counseling and Testing centers in 15 provinces in Iran between April 2021 and March 2022. The Berlin Obstructive Sleep Apnea questionnaire, Pittsburgh Sleep Quality Index, Epworth Sleepiness Scale and Insomnia Severity Index were used. A two-step clustering method was employed to identify the number of sleep clusters in PLWH. Prevalence of poor sleep quality, sleepiness and insomnia were 49.6%, 21.15% and 42.7% respectively. Three sleep trait clusters were identified: I. minor sleep problems (45.6%); II. Snoring & sleep apnea (27.8%), and III. poor sleep quality and insomnia (26.7%). Age (Odds Ratio (OR) 1.033, 95% Confidence Interval (CI) 1.017-1.050), academic education (OR 0.542, 95% CI 0.294-0.998) and HIV duration were associated with being in Snoring & sleep apnea cluster, while age (OR = 1.027, 95% CI 1.009-1.040) was associated with being in Poor sleep quality and insomnia cluster. PLWH with depression had higher odds of being in Poor sleep quality and insomnia cluster, and those with anxiety had higher odds of being in Snoring & sleep apnea cluster and Poor sleep quality and insomnia cluster. A significant proportion of PLWH have poor sleep quality, sleepiness, and insomnia. The identification of three distinct sleep trait clusters underscores the need for increased attention and tailored interventions to address the specific sleep issues experienced by PLWH.
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Affiliation(s)
- Safieh Mohammadnejhad
- Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Arezu Najafi
- Occupational Sleep Research Center, Baharloo Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Valerie A Earnshaw
- Department of Human Development and Family Sciences, University of Delaware, Newark, DE, USA
| | - Mohammad Ebrahimzadeh Mousavi
- Department of Human Development and Family Sciences, University of Delaware, Newark, DE, USA
- Department of Clinical Psychology, Faculty of Behavioral Science, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Akbar Fotouhi
- Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran.
| | - Samaneh Akbarpour
- Sleep Breathing Disorders Research Center (SBDRC), Tehran University of Medical Sciences, Tehran, Iran.
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Bourne K, Croston M, Hurt E, Galbraith N, Hayter M. What is known from the existing literature about how sleep is measured in HIV care? A scoping review. BRITISH JOURNAL OF NURSING (MARK ALLEN PUBLISHING) 2024; 33:S10-V. [PMID: 38194326 DOI: 10.12968/bjon.2024.33.1.s10] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/10/2024]
Abstract
The HIV care landscape has significantly altered over the past 30 years with advances in HIV medical treatment. Despite these medical advances, people living with HIV experience a significant number of issues that affect their health-related quality of life, including sleep. Although poor sleep quality is common, there remains a lack of understanding of how to identify sleep issues in order to improve outcomes for people living with HIV. A scoping review of three databases as well as the grey literature yielded 2932 articles, of which 60 met the inclusion criteria. The following themes were identified: range of methods used to assess sleep, self-reported sleep measures and objective measures of sleep. The review found that a number of different measures of sleep were used within the research, the most commonly used being the Pittsburgh Sleep Quality Index. Due to the variety of approaches being used to measure sleep (n=18) there was a lack of consistency in what aspects of sleep were being explored, and in many cases why the measure of sleep was chosen. Furthermore, there was a lack of meaningful clinical recommendations as to how these findings could be used to improve outcomes for people living with HIV.
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Affiliation(s)
- Kathryn Bourne
- Clinical Psychologist, Department of Infectious Diseases, Manchester University NHS Foundation Trust, and Lecturer in Clinical Psychology, Faculty of Health and Medicine, Lancaster University
| | - Michelle Croston
- Associate Professor of Nursing, School of Health Sciences, University of Nottingham, Nottingham
| | - Emily Hurt
- Research Assistant, Manchester Metropolitan University
| | | | - Mark Hayter
- Professor and Head of Nursing, Manchester Metropolitan University
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Reisert H, Miner B, Farhadian S. Sleep deficiency among people living with human immunodeficiency virus: A growing challenge. HIV Med 2024; 25:5-15. [PMID: 37485570 PMCID: PMC10803648 DOI: 10.1111/hiv.13526] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Accepted: 07/04/2023] [Indexed: 07/25/2023]
Abstract
PURPOSE OF REVIEW The purpose of this narrative review is to consolidate and summarize the existing literature on sleep deficiency among people living with human immunodeficiency virus (HIV; PLWH), to discuss the potential impact of antiretroviral therapy on sleep deficiency and to identify priorities for future research in this area. RECENT FINDINGS Three important domains of sleep deficiency include alterations in sleep quality (including sleep disorders), duration and timing. The existing HIV and sleep deficiency literature, which is robust for sleep quality but sparser for sleep duration or sleep timing, has identified epidemiological correlates and outcomes associated with sleep deficiency including sociodemographic factors, HIV-specific factors, aspects of physical and mental health and cognition. SUMMARY Sleep deficiency is a common problem among PLWH and is likely underdiagnosed, although more high-quality research is needed in this area. Sleep quality has received the most attention in the literature via methodologies that assess subjective/self-reported sleep quality, objective sleep quality or both. There is significantly less research on sleep duration and minimal research on sleep timing. Use of certain antiretroviral therapy drugs may be associated with sleep deficiency for some individuals. Future research should utilize larger, longitudinal studies with consistent, comprehensive and validated methods to assess both subjective and objective measures of sleep deficiency to better understand the prevalence, correlates and clinical implications of sleep deficiency in PLWH.
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Affiliation(s)
- Hailey Reisert
- Yale School of Medicine, Section of Infectious Diseases, New Haven, CT, USA
| | - Brienne Miner
- Yale School of Medicine, Section of Geriatrics, New Haven, CT, USA
| | - Shelli Farhadian
- Yale School of Medicine, Section of Infectious Diseases, New Haven, CT, USA
- Yale School of Medicine, Department of Neurology, New Haven, CT, USA
- Yale School of Public Health, Department of Epidemiology of Microbial Diseases, New Haven, CT, USA
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Mazzitelli M, Trunfio M, Milinkovic A, Castelli E, Sasset L, Leoni D, Salvucci M, Cazzaro R, Calcinoni I, Balducci P, Ribeiro GCQ, Filagrana G, Scaglione V, Cattelan AM. Sleep disturbances and their correlation with cardiovascular risk, obesity, and mood disorders in people with HIV. AIDS 2023; 37:925-934. [PMID: 36723511 DOI: 10.1097/qad.0000000000003493] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
BACKGROUND The relationship between sleep disorders (SDs), cardiovascular risk (CVR), and mood disorders (MDs) has been studied in detail in the general population, but far less in people with HIV (PWH). METHODS Cross-sectional analysis in single centre cohort of PWH. Sleep quality was assessed using by Epworth Sleepiness Scale (ESS), Insomnia Severity Index (ISI), Berlin Questionnaire (BQ), Pittsburgh Sleep Quality Index (PSQI); anxiety and depression were evaluated by the Generalized Anxiety Disorder-7 and Patient Health Questionnaire-9. Demographic, clinical and HIV-related data were collected, and Framingham and Data collection on Adverse effects of anti-HIV Drugs (DAD)-10 scores were computed in modelling associations with each SDs scale. RESULTS Data were collected for 721 PWH on stable combination antiretroviral therapy (cART) (median age of 53 years, 71.8% males, 96% with undetectable HIV RNA, 50.3% on cART potentially affecting sleep, and 20.4% on hypno-inducing drugs), 76.9% had SDs 60.3, 31.3, 31.1, and 7.9% at PSQI, BQ, ISI, and ESS, respectively. Anxiety and depression were detected in 28.3 and 16.1% participants, respectively. BQ score was independently associated with high BMI ( P < 0.001), Framingham risk >10% ( P < 0.001), and both DAD-10R and -10F score >10% ( P < 0.001 and P = 0.031). PSQI and ISI scores were independently associated with depression and anxiety ( P < 0.001). No association between SDs and specific antiretroviral regimens, nor HIV-related parameters was detected. CONCLUSIONS In our cohort of PWH on stable ART, despite the alarmingly higher prevalence, SDs were associated with the same determinants (cardiovascular risk factors and MDs) observed in the general population.
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Affiliation(s)
- Maria Mazzitelli
- Department of Molecular Medicine, Infectious and Tropical Diseases Unit, Department of Medical Sciences, Padua University Hospital, Padua
| | - Mattia Trunfio
- Infectious Diseases Unit, Department of Medical Sciences, University of Turin at Amedeo di Savoia Hospital, Turin, Italy
- HIV Neurobehavioral Research Program and Departments of Neurosciences and Psychiatry, School of Medicine, University of California, San Diego, California, USA
| | - Ana Milinkovic
- Chelsea and Westminster Foundation Trust
- Imperial College London, London, UK
| | - Eleonora Castelli
- Department of Molecular Medicine, Infectious and Tropical Diseases Unit, Department of Medical Sciences, Padua University Hospital, Padua
| | - Lolita Sasset
- Department of Molecular Medicine, Infectious and Tropical Diseases Unit, Department of Medical Sciences, Padua University Hospital, Padua
| | - Davide Leoni
- Department of Molecular Medicine, Infectious and Tropical Diseases Unit, Department of Medical Sciences, Padua University Hospital, Padua
| | | | | | | | | | | | | | - Vincenzo Scaglione
- Department of Molecular Medicine, Infectious and Tropical Diseases Unit, Department of Medical Sciences, Padua University Hospital, Padua
| | - Anna M Cattelan
- Department of Molecular Medicine, Infectious and Tropical Diseases Unit, Department of Medical Sciences, Padua University Hospital, Padua
- Student at University of Padua, Padua University Hospital
- University of Padua, Padua, Italy
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GebreEyesus FA, Degu FS, Yohanes YB, Azagew AW. Sleep quality and associated factors among adult people living with HIV on follow-up at Dessie Town Governmental Health Facilities Antiretroviral Therapy Clinics, Northeast, Ethiopia, 2020, a multicenter cross-sectional study. BMC Psychiatry 2023; 23:132. [PMID: 36864404 PMCID: PMC9983252 DOI: 10.1186/s12888-023-04619-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Accepted: 02/20/2023] [Indexed: 03/04/2023] Open
Abstract
BACKGROUND Poor sleep quality is an important health problem in people living with HIV. The exact cause of sleep disturbance is not well known, but it may relate to HIV itself, antiretroviral drug side effects, and other HIV-related disorders. As a result, the purpose of this study was to assess sleep quality and associated factors among adult HIV patients on follow-up at Dessie Town governmental health facilities' antiretroviral therapy clinics in Northeast Ethiopia in 2020. METHODS A multi-center cross-sectional study was conducted among 419 adult people living with HIV/AIDS from February 1/2020 to April 22/2020 in Dessie Town governmental antiretroviral therapy clinics. A systematic random sampling method was used to select the study participants. An interviewer-administered method of data collection with a chart review was used. The Pittsburgh Sleep Quality Index was used to evaluate sleep disruption. A binary logistic regression was conducted to see the relationship between a dependent variable and independent variables. Variables with a p-value of < 0.05 and a 95% confidence interval were used to declare an association between factors and a dependent variable. RESULTS A total of 419 study participants were enrolled in this study, with a response rate of 100%. The mean age of the study participants was 36 ± 6.5 SD years and 63.7% of the participants were female. The prevalence of poor sleep quality was found to be 36% (95% CI, 31-41%). Being female (AOR = 3.45, 95% CI: 1.52-7.79), viral loads 1000 copies/ml (AOR = 6.88, 95% CI: 2.79-16.9), CD4 cell count 200 cells/mm3 (AOR = 6.85, 95% CI: 2.42-19.39), WHO stage II and III (AOR = 4.29, 95% CI: 1.05-17.53), having anxiety (AOR = 10, 95% CI: 4.21-23.9. CONCLUSION The findings of this study showed that more than one-third of the study participants had poor-quality sleep at the Dessie Town Health Facility ART clinic. Being female, low CD4 cell counts, viral load ≥1000 copies/ml, WHO stage II and III, depression, anxiety, sleeping in a communal bedroom, and living alone were predictors of poor sleep quality.
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Affiliation(s)
- Fisha Alebel GebreEyesus
- Department of Nursing, College of Medicine and Health Sciences, Wolkite University, PO Box 07, Wolkite, Ethiopia.
| | - Fatuma Seid Degu
- Department of Adult Health Nursing, Wollo University, Dessie, Ethiopia.
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Petrakis V, Steiropoulos P, Papanas N, Trypsianis G, Papazoglou D, Panagopoulos P. Quality of sleep in people living with HIV in the era of highly active antiretroviral treatment. Int J STD AIDS 2023; 34:191-202. [PMID: 36542510 DOI: 10.1177/09564624221146608] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
PURPOSE Although HIV infection has become a chronic disease, people living with HIV (PLWHIV) often develop disorders that affect their quality of life. Sleep disturbances could occur in all stages of infection and lead to fatigue, increased risk for comorbidities and reduced adherence to treatment. The aim of the present study is to evaluate the quality of sleep in PLWHIV monitored at the HIV Unit of the University General Hospital of Evros (Greece). METHODS Patients completed self-reported questionnaires including restless legs syndrome (RLS) questionnaire, the Epworth Scale, the Athens Insomnia Scale, the Fatigue Severity Scale (FSS), the Hospital Anxiety and Depression Scale - HADS, the SleepF Quality Scale MOS, the STOP BANG questionnaire for obstructive sleep apnoea (OSA), the Pittsburgh Sleep Quality Index and the International Physical Activity Questionnaire. Sociodemographic and anthropometric characteristics, data of HIV infection and clinical factors were recorded. RESULTS A total of 154 patients, 120 males, were included in the study. The percentage of patients diagnosed with RLS was 26.6% and the corresponding percentage of insomnia 55.2%. OSA was documented in 35% of patients. High prevalence of depression (46.1%) and anxiety (54.54%) was reported. Detectable viral load, low CD4 cell count and limited physical activity (p < 0.001) were significant risk factors for increased incidence rate of sleep disturbances. Sleep disorders were not proven to be associated with newer antiretroviral regimens. CONCLUSIONS Sleep disturbances were reported in high frequency in PLWHIV affecting their quality of life and increasing symptoms of depression and anxiety. It is vital to add sleep assessment into routine care and find efficient interventions in order to improve quality of life, mental health and adherence to antiretroviral treatment.
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Affiliation(s)
- Vasileios Petrakis
- Department of Infectious Diseases, 2nd Department of Internal Medicine, University General Hospital Alexandroupolis, 387479Democritus University of Thrace, Alexandroupoli, Greece
| | - Paschalis Steiropoulos
- University Pneumonology Department, University General Hospital Alexandroupolis, 387479Democritus University of Thrace, Alexandroupoli, Greece
| | - Nikolaos Papanas
- Department of Infectious Diseases, 2nd Department of Internal Medicine, University General Hospital Alexandroupolis, 387479Democritus University of Thrace, Alexandroupoli, Greece
| | - Grigorios Trypsianis
- Department of Medical Statistics, Medical School, 387479Democritus University of Thrace, Alexandroupoli, Greece
| | - Dimitrios Papazoglou
- Department of Infectious Diseases, 2nd Department of Internal Medicine, University General Hospital Alexandroupolis, 387479Democritus University of Thrace, Alexandroupoli, Greece
| | - Periklis Panagopoulos
- Department of Infectious Diseases, 2nd Department of Internal Medicine, University General Hospital Alexandroupolis, 387479Democritus University of Thrace, Alexandroupoli, Greece
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Yu X, Lobo JD, Sundermann E, Baker DJ, Tracy RP, Kuchel GA, Stephenson KE, Letendre SL, Brew B, Cysique LA, Dale SK, Wallen C, Kunisaki KM, Guaraldi G, Milic J, Winston A, Moore DJ, Margolick JB, Erlandson KM. Current Challenges and Solutions for Clinical Management and Care of People with HIV: Findings from the 12th Annual International HIV and Aging Workshop. AIDS Res Hum Retroviruses 2023; 39:1-12. [PMID: 36322713 PMCID: PMC9889016 DOI: 10.1089/aid.2022.0079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
People with HIV on combination antiretroviral therapy (ART) have longer life expectancy and are increasingly experiencing age-related comorbidities. Thus, aging with HIV has become a central issue in clinical care and research, which has been particularly challenging with the intersection of the ongoing coronavirus (COVID)-19 pandemic. Since 2009, the International Workshop on HIV and Aging has served as a multidisciplinary platform to share research findings from cross-disciplinary fields along with community advocates to address critical issues in HIV and aging. In this article, we summarize the key oral presentations from the 12th Annual International Workshop on HIV and Aging, held virtually on September 23rd and 24th, 2021. The topics ranged from basic science research on biological mechanisms of aging to quality of life and delivery of care under the COVID-19 pandemic. This workshop enriched our understanding of HIV and aging under the COVID-19 pandemic, identified challenges and opportunities to combat the impact of COVID-19 on HIV communities, and also provided updated research and future directions of the field to move HIV and aging research forward, with the ultimate goal of successful aging for older people with HIV.
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Affiliation(s)
- Xiaoying Yu
- Department of Biostatistics and Data Science, University of Texas Medical Branch, Galveston, Texas, USA
| | - Judith D. Lobo
- Department of Psychiatry, University of California San Diego, San Diego, California, USA
| | - Erin Sundermann
- Department of Psychiatry, University of California San Diego, San Diego, California, USA
| | - Darren J. Baker
- Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Russell P. Tracy
- Department of Pathology and Laboratory Medicine, Larner College of Medicine, University of Vermont, Colchester, Vermont, USA
- Department of Biochemistry, Larner College of Medicine, University of Vermont, Colchester, Vermont, USA
| | - George A. Kuchel
- UConn Center on Aging, Department of Medicine, University of Connecticut School of Medicine, Farmington, Connecticut, USA
| | - Kathryn E. Stephenson
- Center for Virology and Vaccine Research, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
- Department of Medicine, Harvard Medical School, Boston, Massachusetts, USA
| | - Scott L. Letendre
- Department of Psychiatry, University of California San Diego, San Diego, California, USA
- Department of Medicine, University of California San Diego, San Diego, California, USA
| | - Bruce Brew
- Department of Neurology and HIV Medicine, St. Vincent's Hospital, Sydney, Australia
- Department of Neurology, Peter Duncan Neurosciences Unit, St. Vincent's Centre for Applied Medical Research, Sydney, Australia
- Faculty of Medicine, Department of Neurology, University of New South Wales Sydney, Sydney, Australia
- University of Notre Dame Australia, Sydney, Australia
| | - Lucette A. Cysique
- Faculty of Science, Department of Psychology, School of Psychology, University of New South Wales Sydney, Sydney, Australia
- MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Canada
- Neuroscience Unit, St. Vincent's Hospital Centre for Applied Medical Research, Sydney, Australia
| | - Sannisha K. Dale
- Department of Psychology, University of Miami, Coral Gables, Florida, USA
| | - Chelsie Wallen
- Department of Psychology, University of Miami, Coral Gables, Florida, USA
| | - Ken M. Kunisaki
- Section of Pulmonary, Allergy, Critical Care, and Sleep Medicine, Minneapolis VA Health Care System, Minneapolis, Minnesota, USA
- Department of Medicine; Division of Pulmonary, Allergy, Critical Care and Sleep Medicine, University of Minnesota, Minneapolis, Minnesota, USA
| | - Giovanni Guaraldi
- Department of Surgical, Medical, Dental and Morphological Sciences, Modena HIV Metabolic Clinic (MHMC), University of Modena and Reggio Emilia, Modena, Italy
| | - Jovana Milic
- Department of Surgical, Medical, Dental and Morphological Sciences, Modena HIV Metabolic Clinic (MHMC), University of Modena and Reggio Emilia, Modena, Italy
| | - Alan Winston
- Department of Infectious Disease, Faculty of Medicine, Imperial College London, London, United Kingdom
| | - David J. Moore
- Department of Psychiatry, University of California San Diego, San Diego, California, USA
| | - Joseph B. Margolick
- W. Harry Feinstone Department of Molecular Microbiology and Immunology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Kristine M. Erlandson
- Divisions of Infectious Diseases, Department of Medicine, University of Colorado Denver-Anschutz Medical Campus, Aurora, Colorado, USA
- Divisions of Geriatric Medicine, Department of Medicine, University of Colorado Denver-Anschutz Medical Campus, Aurora, Colorado, USA
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11
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Etzkorn LH, Liu F, Urbanek JK, Heravi AS, Magnani JW, Plankey MW, Margolich JB, Witt MD, Palella FJ, Haberlen SA, Wu KC, Post WS, Schrack JA, Crainiceanu CM. Patterns of objectively measured physical activity differ between men living with and without HIV. AIDS 2022; 36:1553-1562. [PMID: 35979829 PMCID: PMC9395149 DOI: 10.1097/qad.0000000000003274] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
OBJECTIVE To use accelerometers to quantify differences in physical activity (PA) by HIV serostatus and HIV viral load (VL) in the Multicenter AIDS Cohort Study (MACS). METHODS MACS participants living with (PLWH, n = 631) and without (PWOH, n = 578) HIV wore an ambulatory electrocardiogram monitor containing an accelerometer for 1-14 days. PA was summarized as cumulative mean absolute deviation (MAD) during the 10 most active consecutive hours (M10), cumulative MAD during the six least active consecutive hours (L6), and daily time recumbent (DTR). PA summaries were compared by HIV serostatus and by detectability of VL (>20 vs. ≤20 copies/ml) using linear mixed models adjusted for sociodemographics, weight, height, substance use, physical function, and clinical factors. RESULTS In sociodemographic-adjusted models, PLWH with a detectable VL had higher L6 (β = 0.58 mg, P = 0.027) and spent more time recumbent (β = 53 min/day, P = 0.003) than PWOH. PLWH had lower M10 than PWOH (undetectable VL β = -1.62 mg, P = 0.027; detectable VL β = -1.93 mg, P = 0.12). A joint test indicated differences in average PA measurements by HIV serostatus and VL (P = 0.001). However, differences by HIV serostatus in M10 and DTR were attenuated and no longer significant after adjustment for renal function, serum lipids, and depressive symptoms. CONCLUSIONS Physical activity measures differed significantly by HIV serostatus and VL. Higher L6 among PLWH with detectable VL may indicate reduced amount or quality of sleep compared to PLWH without detectable VL and PWOH. Lower M10 among PLWH indicates lower amounts of physical activity compared to PWOH.
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Affiliation(s)
| | - Fangyu Liu
- Johns Hopkins Bloomberg School of Public Health
| | | | | | | | | | - Joseph B Margolich
- Johns Hopkins Bloomberg School of Public Health
- Johns Hopkins School of Medicine, Baltimore, MD
| | | | - Frank J Palella
- Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | | | | | - Wendy S Post
- Johns Hopkins Bloomberg School of Public Health
- Johns Hopkins School of Medicine, Baltimore, MD
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12
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Bell BJ, Hollinger KR, Deme P, Sakamoto S, Hasegawa Y, Volsky D, Kamiya A, Haughey N, Zhu X, Slusher BS. Glutamine antagonist JHU083 improves psychosocial behavior and sleep deficits in EcoHIV-infected mice. Brain Behav Immun Health 2022; 23:100478. [PMID: 35734753 PMCID: PMC9207540 DOI: 10.1016/j.bbih.2022.100478] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Revised: 05/02/2022] [Accepted: 05/30/2022] [Indexed: 10/31/2022] Open
Abstract
Combined antiretroviral therapy ushered an era of survivable HIV infection in which people living with HIV (PLH) conduct normal life activities and enjoy measurably extended lifespans. However, despite viral control, PLH often experience a variety of cognitive, emotional, and physical phenotypes that diminish their quality of life, including cognitive impairment, depression, and sleep disruption. Recently, accumulating evidence has linked persistent CNS immune activation to the overproduction of glutamate and upregulation of glutaminase (GLS) activity, particularly in microglial cells, driving glutamatergic imbalance with neurological consequences. Our lab has developed a brain-penetrant prodrug of the glutamine antagonist 6-diazo-5-oxo-L-norleucine (DON), JHU083, that potently inhibits brain GLS activity in mice following oral administration. To assess the therapeutic potential of JHU083, we infected mice with EcoHIV and characterized their neurobehavioral phenotypes. EcoHIV-infected mice exhibited decreased social interaction, suppressed sucrose preference, disrupted sleep during the early rest period, and increased sleep fragmentation, similar to what has been reported in PLH but not yet observed in murine models. At doses shown to inhibit microglial GLS, JHU083 treatment ameliorated all of the abnormal neurobehavioral phenotypes. To explore potential mechanisms underlying this effect, hippocampal microglia were isolated for RNA sequencing. The dysregulated genes and pathways in EcoHIV-infected hippocampal microglia pointed to disruptions in immune functions of these cells, which were partially restored by JHU083 treatment. These findings suggest that upregulation of microglial GLS may affect immune functions of these cells. Thus, brain-penetrable GLS inhibitors like JHU083 could act as a potential therapeutic modality for both glutamate excitotoxicity and aberrant immune activation in microglia in chronic HIV infection.
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13
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Yoshino Y, Wakabayashi Y, Kitazawa T. Relationship of sleep disorders with long-term complications and health-related quality of life in people with well-controlled human immunodeficiency virus. Medicine (Baltimore) 2022; 101:e29070. [PMID: 35356931 PMCID: PMC10684212 DOI: 10.1097/md.0000000000029070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Accepted: 02/24/2022] [Indexed: 11/27/2022] Open
Abstract
ABSTRACT Although sleep disorders are common in patients with human immunodeficiency virus (HIV) infection, they have not been adequately evaluated under currently advanced treatments, mainly with integrase strand transfer inhibitors. However, the relationship of sleep disorders with long-term complications and quality of life (QOL) status in patients infected with HIV is still poorly understood. Such associations are important in the management of outpatients with HIV. Hence, this study aimed to evaluate these associations.This cross-sectional observational study assessed the QOL changes of patients with HIV before and after the treatment regimen change. Male patients with well-controlled HIV who attended our hospital and changed HIV medications for reasons other than treatment failure between October 2019 and September 2021 were included. At the time of regimen change, sleep disorder status was assessed according to the Pittsburgh sleep quality index (PSQI), and health-related QOL (HRQOL) was assessed using the medical outcomes study 8-item short form health survey. In addition, we collected information on age, blood tests, and long-term comorbid conditions present during the evaluation. The HIV treatment regimen was also reviewed.Out of 45 male Japanese patients with HIV that were included in this study, 24 (53.3%) and 21 (46.7%) were classified into the sleep disorder group and nonsleep disorder group, respectively, according to their PSQI scores. The sleep disorder group had a significantly lower HRQOL mental component summary (P = .0222) than the nonsleep disorder group. The prevalence rates of hypertension, dyslipidemia, and diabetes mellitus were not significantly different between the 2 groups. In addition, a significant correlation was observed between PSQI scores and the HRQOL status (mental component summary, P = .0450; physical component summary, P = .0350).Sleep disorders remain common in patients with well-controlled HIV infection receiving current treatment. Sleep disorder is significantly associated with a low HRQOL in these patients. Hence, sleep status evaluation is necessary to improve HIV management.
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Affiliation(s)
- Yusuke Yoshino
- Department of Microbiology, Teikyo University School of Medicine, 2-11-1, Kaga, Itabashi, Tokyo, Japan,Department of Internal Medicine, Teikyo University School of Medicine, 2-11-1, Kaga, Itabashi, Tokyo, Japan
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14
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Sun-Suslow N, Balon E, Montoya JL, Saloner R, Campbell LM, Serrano V, Ellis RJ, Moore DJ. Frailty Syndrome Is Associated with Poorer Self-Reported Sleep Quality Among Older Persons with Human Immunodeficiency Virus. AIDS Res Hum Retroviruses 2022; 38:87-96. [PMID: 34779233 PMCID: PMC8861916 DOI: 10.1089/aid.2020.0158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
Older people with HIV (PWH) experience heightened risk for the acquisition of cumulative, multisystem decline, that is, frailty syndrome. Frailty relates to poorer sleep quality in the general older adult population; however, this association has yet to be explored among PWH. A cross-sectional analysis of 285 PWH ≥50 years of age (mean age 60.5 ± 7.0) examined the relationship between frailty (Fried frailty phenotype) and self-reported sleep quality [Pittsburgh Sleep Quality Index (PSQI)]. Three separate multivariable linear regression models examined global PSQI as a function of (1) frailty phenotype, (2) total number of frailty symptoms, or (3) specific individual frailty symptoms. Models covaried for demographic and biopsychosocial risk factors, including age, sex, race/ethnicity, education, premorbid verbal IQ estimate, current depressive symptoms, and diagnosis of a substance abuse disorder. Compared to nonfrail (B = 0.151; p = .021) and prefrail (B = 0.144; p = .021), frail phenotype was related to poorer sleep quality (increased global PSQI; F(5,278) = 11.34, p < .001; R2 = 0.17). Increased number of frailty symptoms (B = 0.144; p = .019; F(4,276) = 12.719, p < .001; R2 = 0.16) and exhaustion was associated with increased global PSQI scores (B = 0.218, p < .001; F(6,247) = 10.436, p < .001; R2 = 0.19). In all models, older age, female sex, and elevated current depressive symptoms were associated with poorer sleep quality. In older PWH, greater frailty symptoms related to poorer sleep quality, independent of psychosocial risk factors for poor sleep. Frailty and poor sleep individually have adverse effects on health and everyday functioning; thus, establishing this association may better aid providers to screen for and treat problems with sleep quality and/or frailty among PWH.
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Affiliation(s)
- Ni Sun-Suslow
- Department of Psychiatry, University of California San Diego, San Diego, California, USA
| | - Emily Balon
- University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Jessica L. Montoya
- Department of Psychiatry, University of California San Diego, San Diego, California, USA
| | - Rowan Saloner
- San Diego State University/University of California San Diego Joint Doctoral Program in Clinical Psychology, San Diego, California, USA
| | - Laura M. Campbell
- San Diego State University/University of California San Diego Joint Doctoral Program in Clinical Psychology, San Diego, California, USA
| | - Vanessa Serrano
- San Diego State University/University of California San Diego Joint Doctoral Program in Clinical Psychology, San Diego, California, USA
| | - Ronald J. Ellis
- University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - David J. Moore
- University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
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15
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Chen CC, Liu HY, Chen YC, Ko NY. Relationships Among Trajectories of Sleep Disturbance, Depression, and Antiretroviral Therapy in Persons Newly Diagnosed with HIV: A One-and-a-Half-Year Observational Longitudinal Study. Nat Sci Sleep 2022; 14:2133-2142. [PMID: 36483983 PMCID: PMC9724576 DOI: 10.2147/nss.s377464] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2022] [Accepted: 11/14/2022] [Indexed: 12/05/2022] Open
Abstract
PURPOSE Sleep disturbance is one of the most prevalent symptoms among persons living with HIV (PLWH). However, the trajectory of sleep patterns in persons newly diagnosed with HIV remains underrecognized. The current study aimed to estimate the trajectory of sleep quality and its associated factors among newly diagnosed PLWH. PATIENTS AND METHODS A prospective study was conducted in the outpatient clinic of a medical center in southern Taiwan from January 2015 to December 2017. Our primary outcome was sleep quality using the Chinese version of the Pittsburgh Sleep Quality Index (CPSQI). Participants completed the questionnaire at baseline and at four follow-up interval visits: at 3-6, 6-9, 9-12 and 12-15 months. A generalized equation estimation (GEE) model was applied to analyze the relationships among poor sleep quality, depression and antiretroviral therapy among persons newly diagnosed with HIV. RESULTS A total of 217 PLWH were included. The mean age of the sample was 29.3 years, and males (98.6%) were predominant. A total of 56.2% of HIV-infected persons were considered to have poor sleep quality at baseline. After controlling for the confounding effects of demographic characteristics, the following factors increased the risk of poor sleep quality: older age (ß= 0.07, CI: 0.03-0.11, p=0.001), level of depression (ß= 0.32, CI: 0.27-0.37, p<0.001) and detectable viral load (ß= 0.61, CI: 0.04 - 1.18, p= 0.037). However, there was no significant difference in BMI, CD4 counts, HIV viral load, disclosure status, or highly active antiretroviral therapy (HAART) regimen. CONCLUSION Our results demonstrate that one in two persons with newly diagnosed HIV had poor sleep quality. Being older, having higher levels of depression, and having detectable HIV viral loads were identified as risk factors for developing poor sleep quality in persons living with HIV.
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Affiliation(s)
- Chang-Chun Chen
- Department of Nursing, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Hsiao-Ying Liu
- Department of Nursing, National Cheng Kung University Hospital, Tainan, Taiwan
| | - Yen-Chin Chen
- Department of Nursing, College of Medicine, National Cheng Kung University, Tainan, Taiwan.,Department of Nursing, National Cheng Kung University Hospital, Tainan, Taiwan.,Research and Development Committee, Taiwan AIDS Nurse Association, Taipei, Taiwan
| | - Nai-Ying Ko
- Department of Nursing, College of Medicine, National Cheng Kung University, Tainan, Taiwan.,Department of Nursing, National Cheng Kung University Hospital, Tainan, Taiwan.,Research and Development Committee, Taiwan AIDS Nurse Association, Taipei, Taiwan
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16
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Use of digital health technologies to examine subjective and objective sleep with next-day cognition and daily indicators of health in persons with and without HIV. J Behav Med 2021; 45:62-75. [PMID: 34370189 PMCID: PMC8818628 DOI: 10.1007/s10865-021-00233-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Accepted: 05/27/2021] [Indexed: 01/08/2023]
Abstract
Most previous studies investigating sleep's association with health outcomes have relied on averaged sleep quality and laboratory-based health measures. This study examines the dynamic within-person relationships between subjective (Ecological Momentary Assessment) and objective sleep (actigraphy) on next-day cognition (subjective and objective), mood, and engagement in daily activities using linear mixed-effects regression modeling. Participants included 94 individuals (59 people with HIV, 35 HIV-) aged 50-74, assessed daily for 14 consecutive days/nights. Subjective and objective sleep were well correlated and were both associated with subjective ratings of cognition, but not objective cognition. Worse subjective sleep was associated with next-day lower happiness and higher depressed mood, and more pain, but was not related to next-day daily activities. Objective sleep was associated with next-day depressed mood and feelings of worry, and was positively associated with next-day television watching. Results provide evidence to support the utility of real-time assessment for sleep and functional outcomes that may lead to potential personalized interventions for individuals with and without HIV.
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17
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Danti R, Gayatri D. Relationship of psychological discomforts of stress, depression, and anxiety to sleep quality in HIV/AIDS patients. ENFERMERIA CLINICA 2021. [PMID: 33849216 DOI: 10.1016/j.enfcli.2020.09.039] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
HIV/AIDS remains a chronic disease that is ubiquitous in the community. People with HIV/AIDS can experience psychological problems because of the influence of internal and external stress. This study aimed to determine the relationship of psychological discomforts of stress, depression, and anxiety to sleep quality in HIV/AIDS patients. This study employed a descriptive-correlational research design with a cross-sectional approach and consecutive sampling technique. The Depression Anxiety Stress Scale-21 and Pittsburgh Sleep Quality Index were used as research instruments on 110 respondents. This study found that there was a significant relationship between psychological discomforts of stress, depression, and anxiety and sleep quality in patients with HIV/AIDS (p<α=0.05). The results of this study indicate the importance of health services, especially those of HIV/AIDS polyclinics, to be more concerned with the psychological discomfort experienced by patients to improve the sleep quality of patients with HIV/AIDS.
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Affiliation(s)
- Raden Danti
- Faculty of Nursing Universitas Indonesia, Depok, West Java, Indonesia
| | - Dewi Gayatri
- Faculty of Nursing Universitas Indonesia, Depok, West Java, Indonesia.
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18
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Prevalence and Correlates of Insomnia in People Living With HIV in Indonesia: A Descriptive, Cross-sectional Study. J Assoc Nurses AIDS Care 2021; 31:606-614. [PMID: 32639267 DOI: 10.1097/jnc.0000000000000192] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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19
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CD4+ T Cell Count, Sleep, Depression, and Anxiety in People Living With HIV: A Growth Curve Mixture Modeling. J Assoc Nurses AIDS Care 2021; 31:535-543. [PMID: 31335460 PMCID: PMC7497416 DOI: 10.1097/jnc.0000000000000112] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
We investigated changes in CD4+ T cell counts related to sleep quality, depression, anxiety, and sociodemographic variables in heterogeneous groups of people living with HIV in a 6-month prospective study. Our longitudinal study involved 247 ambulatory patients living with HIV and using antiretroviral therapy. Sleep quality, anxiety, depression, and CD4+ T cell counts were assessed three times at 3-month intervals. Growth curve mixture modeling was conducted to explore changes over time. A two-class mixture model with logarithmic change pattern fit the data best. For the majority of the sample (89.1%), anxiety, depression, and sleep quality did not change when CD4+ T cells increased. For a small proportion of the sample (11.9%), sleep quality, anxiety, and depression deteriorated when CD4+ T cells decreased. Marital status and alcohol use affected the classification significantly. Health care professionals should provide relevant services to people living with HIV with decreasing CD4+ T cell counts.
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20
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Venkataraman A, Zhuang Y, Marsella J, Tivarus ME, Qiu X, Wang L, Zhong J, Schifitto G. Functional MRI Correlates of Sleep Quality in HIV. Nat Sci Sleep 2021; 13:291-301. [PMID: 33688288 PMCID: PMC7936696 DOI: 10.2147/nss.s291544] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2020] [Accepted: 01/19/2021] [Indexed: 12/23/2022] Open
Abstract
OBJECTIVE To examine resting-state functional MRI (rs-fMRI) networks related to sleep in the context of HIV infection. METHODS rs-fMRI data were collected in 40 HIV-infected (HIV+) individuals at baseline (treatment-naive), 12 week (post-treatment) and one year timepoints. A group of 50 age-matched HIV-negative (HIV-) individuals were also imaged at baseline and one year timepoints. The Pittsburgh Sleep Quality Index (PSQI) questionnaire was administered at all timepoints. Using group independent component analysis (ICA), maps of functional networks were generated from fMRI data; from these, sleep-related networks were selected. A generalized linear model (GLM) was used to analyze if these networks were significantly associated with the PSQI score, and if this relationship was influenced by HIV status/treatment or timepoint. RESULTS HIV+ individuals had significantly lower PSQI score after treatment (p=0.022). Networks extracted from group ICA analysis included the anterior and posterior default mode network (DMN), central executive network (CEN), bilateral frontoparietal networks (FPNs), and the anterior cingulate cortex salience network (ACC SN). We found the posterior DMN, right FPN, and ACC SN GLMs showed significantly higher goodness-of-fit after incorporating PSQI data (p = 0.0204, 0.044, 0.044, respectively). Furthermore, the correlation between ACC SN and posterior DMN connectivity was significantly decreased in the HIV+ cohort. CONCLUSION Functional networks such as the DMN, FPN, CEN, and ACC SN are altered in poor sleep, as measured by the PSQI score. Furthermore, the relationship between these networks and PSQI is different in the HIV+ and HIV- populations.
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Affiliation(s)
- Arun Venkataraman
- Department of Physics and Astronomy, University of Rochester, Rochester, NY, USA
| | - Yuchuan Zhuang
- Department of Electrical and Computer Engineering, University of Rochester, Rochester, NY, USA
| | - Jennifer Marsella
- Department of Neurology, University of Rochester Medical Center, Rochester, NY, USA
| | - Madalina E Tivarus
- Department of Imaging Sciences, University of Rochester Medical Center, Rochester, NY, USA.,Department of Neuroscience, University of Rochester Medical Center, Rochester, NY, USA
| | - Xing Qiu
- Department of Biostatistics and Computational Biology, University of Rochester, Rochester, NY, USA
| | - Lu Wang
- Department of Biostatistics and Computational Biology, University of Rochester, Rochester, NY, USA
| | - Jianhui Zhong
- Department of Physics and Astronomy, University of Rochester, Rochester, NY, USA.,Department of Imaging Sciences, University of Rochester Medical Center, Rochester, NY, USA
| | - Giovanni Schifitto
- Department of Neurology, University of Rochester Medical Center, Rochester, NY, USA.,Department of Imaging Sciences, University of Rochester Medical Center, Rochester, NY, USA
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21
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Abdu Z, Dule A. Poor Quality of Sleep Among HIV-Positive Persons in Ethiopia. HIV AIDS (Auckl) 2020; 12:621-628. [PMID: 33116924 PMCID: PMC7588272 DOI: 10.2147/hiv.s279372] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Accepted: 10/05/2020] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND In comparison to the general population, persons living with HIV show a higher prevalence of poor quality of sleep, with estimates from 24.1-100% vs in the normal population 10-40%. There are not enough data on the poor quality of sleep among HIV-infected persons in Ethiopia. METHODS Hospital-based cross-sectional study design was conducted among 336 HIV-infected persons in Mettu Karl Referral Hospital. Pittsburgh sleep quality index (PSQI), social phobia inventory (SPIN), changes in sexual functioning questionnaire short-form (CSFQ-14), Fagerstrom test for nicotine dependence (FTND), severity of dependence scale (SDS), and CAGE questionnaire (cut down, annoyed, guilty, eye opener) was used. Data were analyzed by SPSS 20 version. Bivariate and multivariable regressions were computed, and a significance level was declared at a point P-value of <0.05. RESULTS A total of 336 respondents completed all questionnaires with response rate 98.53%. A total of 192 participants (57.1%) had poor sleep quality. Concerning associated factors; positive for social phobia, sexual dysfunction, living alone, poor antiretroviral (ARV) treatment adherence, and drunken alcohol had a positive association with poor sleep quality. CONCLUSION Of the persons living with HIV (PLWH) in Mettu Karl Referral Hospital, 57.1% experienced poor sleep quality. Social phobia, living arrangement, sexual dysfunction, poor ARV treatment adherence, and use of alcohol showed a significant association with poor quality of sleep. The findings suggest that a longitudinal study will be needed to elucidate the causal relationship of variables, and routine screening of poor sleep quality among PLWH is highly recommended. Furthermore, integrating and launching mental health services at ART clinic is greatly important.
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Affiliation(s)
- Zakir Abdu
- Department of Psychiatry, Faculty of Health and Medical Sciences, Mettu University, Mettu, Ethiopia
| | - Aman Dule
- Department of Psychiatry, Faculty of Health and Medical Sciences, Mettu University, Mettu, Ethiopia
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22
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Balthazar M, Diallo I, Pak VM. Metabolomics of sleep disorders in HIV: a narrative review. Sleep Breath 2020; 24:1333-1337. [PMID: 32198720 DOI: 10.1007/s11325-019-01993-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2019] [Revised: 11/25/2019] [Accepted: 12/03/2019] [Indexed: 11/26/2022]
Abstract
PURPOSE Sleep disturbances are prevalent among patients with human immunodeficiency virus (HIV), even those who are being treated on antiretroviral therapy. It is important to understand the metabolomic mechanisms underlying sleep disturbances among people living with HIV (PLWH). METHODS A review of recent literature was performed to explore the use of metabolomics in understanding sleep among PLWH. RESULTS We found only two studies that used metabolomics to explore sleep health among PLWH. CONCLUSION This paper reviews common sleep disorders in HIV, the existing metabolomic studies that may explain the relationship, and implications for future research. The use of metabolomics in exploring sleep disorders among PLWH will help to elucidate mechanistic links to improve patient outcomes.
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Affiliation(s)
- Monique Balthazar
- Nell Hodgson Woodruff School of Nursing, Emory University, 1520 Clifton Rd, Atlanta, GA, 30322, USA
| | - Idiatou Diallo
- Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Victoria M Pak
- Nell Hodgson Woodruff School of Nursing, Emory University, 1520 Clifton Rd, Atlanta, GA, 30322, USA.
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23
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Kadkhoda Mezerji F, Moharreri F, Mohammadpour AH, Elyasi S. Preventive effect of cyproheptadine on sleep and appetite disorders induced by methylphenidate: an exploratory randomised, double-blinded, placebo-controlled clinical trial. Int J Psychiatry Clin Pract 2019; 23:72-79. [PMID: 30261781 DOI: 10.1080/13651501.2018.1509095] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
OBJECTIVES Insomnia and loss of appetite are the most common side effects of methylphenidate in patients with attention deficit/hyperactivity disorder (ADHD). The adverse effects may limit optimal dosing and patients' compliance with treatment leading to the discontinuation of treatment. This research evaluates the preventive effects of cyproheptadine on sleeping and appetite disorders induced by methylphenidate in ADHD children. METHODS During this exploratory, randomised, double-blinded, placebo-controlled clinical trial, forty patients with ADHD diagnosis who had received methylphenidate randomly were assigned to participate in the cyproheptadine or the placebo group. Patients' weight and Pittsburgh Sleep Quality Index (PSQI) score were recorded at baseline, after four, six and eight weeks of treatment. The ADHD Parent Rating Scale-V score was also defined at the beginning and the end of study for each patient. RESULTS There was no significant difference between the cyproheptadine and the placebo groups regarding their weight, rate of growth and PSQI score in the monthly assessment. In addition, there was no significant difference in response to the therapy between the two groups. CONCLUSIONS Based on our findings, cyproheptadine does not have any considerable preventive effect on sleeping and appetite disorders induced by methylphenidate in ADHD children.
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Affiliation(s)
- Faezeh Kadkhoda Mezerji
- a Department of Clinical Pharmacy, School of Pharmacy , Mashhad University of Medical Sciences , Mashhad , Iran
| | - Fatemeh Moharreri
- b Psychiatry and Behavioral Sciences Research Center, Mashhad University of Medical Sciences , Mashhad , Iran
| | | | - Sepideh Elyasi
- a Department of Clinical Pharmacy, School of Pharmacy , Mashhad University of Medical Sciences , Mashhad , Iran
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24
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Cody SL, Fazeli PL, Crowe M, Kempf MC, Moneyham L, Stavrinos D, Vance DE, Heaton K. Effects of speed of processing training and transcranial direct current stimulation on global sleep quality and speed of processing in older adults with and without HIV: A pilot study. APPLIED NEUROPSYCHOLOGY-ADULT 2019; 27:267-278. [PMID: 30652949 DOI: 10.1080/23279095.2018.1534736] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Some older adults with human immunodeficiency virus (HIV) experience poor sleep which can worsen cognition. Transcranial direct current stimulation (tDCS) and cognitive training have improved sleep and cognition in studies of older adults; yet, their combined influence is unknown in adults with HIV. Older adults with HIV (n = 33) and without HIV (n = 33) were randomized to receive 10 one-hour sessions of speed of processing (SOP) training with tDCS or sham tDCS over approximately 5 weeks. tDCS with SOP training did not improve sleep. Omitting correction of multiple comparisons for this exploratory pilot study, main effects for HIV (F[1, 59] = 5.26, p = .03, ηp2 = .082) and tDCS (F[1, 59] = 5.16, p = .03, ηp2 = .080) on the Digit Copy Test were detected. A HIV × tDCS interaction was detected on the Letter Comparison Test (F[1, 59] = 5.50, p = .02, ηp2 = .085). Useful Field of View scores improved across all four groups (F[1, 59] = 64.76, p < .001, ηp2 = .523). No significant effects for HIV (F[1, 59] = 1.82, p = .18) and tDCS (F[1, 59] = .01, p = .94) were detected on the Useful Field of View test. While the current study did not show effects of combined tDCS and SOP training on sleep quality, future studies are needed to examine the effects of such interventions on sleep-related cognitive functions among cognitively impaired adults with HIV.
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Affiliation(s)
- Shameka L Cody
- Capstone College of Nursing, The University of Alabama, Tuscaloosa, Alabama, USA
| | - Pariya L Fazeli
- School of Nursing, University of Alabama at Birmingham, Birmingham, Alabama, USA.,Edward R. Roybal Center for Translational Research in Aging and Mobility, Birmingham, Alabama, USA
| | - Michael Crowe
- Edward R. Roybal Center for Translational Research in Aging and Mobility, Birmingham, Alabama, USA
| | - Mirjam-Colette Kempf
- School of Nursing, University of Alabama at Birmingham, Birmingham, Alabama, USA.,School of Public Health and Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Linda Moneyham
- School of Nursing, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Despina Stavrinos
- Edward R. Roybal Center for Translational Research in Aging and Mobility, Birmingham, Alabama, USA
| | - David E Vance
- School of Nursing, University of Alabama at Birmingham, Birmingham, Alabama, USA.,Edward R. Roybal Center for Translational Research in Aging and Mobility, Birmingham, Alabama, USA
| | - Karen Heaton
- School of Nursing, University of Alabama at Birmingham, Birmingham, Alabama, USA
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25
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Mahmood Z, Hammond A, Nunez RA, Irwin MR, Thames AD. Effects of Sleep Health on Cognitive Function in HIV+ and HIV- Adults. J Int Neuropsychol Soc 2018; 24:1038-1046. [PMID: 30165914 PMCID: PMC6237632 DOI: 10.1017/s1355617718000607] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
OBJECTIVES People living with HIV (PLWH) are more likely to report sleep difficulties and cognitive deficits. While cognitive impairment associated with sleep problems have been found in healthy and medical populations, less is known about the effects of poor sleep health (SH) on cognition among PLWH. This study examined differences in cognitive performance among participants classified based upon their HIV status and reported SH. METHODS One hundred sixteen (N=116) adults recruited from the Greater Los Angeles community were administered a comprehensive cognitive test battery and completed a questionnaire about SH. Participants were classified into the following HIV/SH groups: [HIV+/good sleep health (SH+; n=34); HIV-/SH+ (n=32); HIV-/poor sleep health (SH-; n=18) and HIV+/SH- (n=32)]. RESULTS For both HIV+ and HIV- individuals, poor SH was associated with lower cognitive performance, with the domains of learning and memory driving the overall relationship. The HIV+/SH- group had poorer scores in domains of learning and memory compared to the SH+ groups. Additionally, the HIV-/SH- group demonstrated poorer learning compared to the HIV-/SH+ group. CONCLUSIONS Our findings suggest that sleep problems within medical populations are relevant to cognitive functioning, highlighting the clinical and scientific importance of monitoring sleep health and cognition to help identify individuals at greatest risk of poor health outcomes. Longitudinal investigations using both objective and subjective measures of sleep are needed to determine the robustness of the current findings and the enduring effects of poor SH in the context of chronic disease. (JINS, 2018, 24, 1038-1046).
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Affiliation(s)
- Zanjbeel Mahmood
- Department of Psychiatry and Biobehavioral Sciences, University of California Los Angeles, 740 Westwood Plaza 28-263, Los Angeles, CA 90095
| | - Andrea Hammond
- Department of Psychiatry and Biobehavioral Sciences, University of California Los Angeles, 740 Westwood Plaza 28-263, Los Angeles, CA 90095
| | - Rodolfo A. Nunez
- Department of Psychiatry and Biobehavioral Sciences, University of California Los Angeles, 740 Westwood Plaza 28-263, Los Angeles, CA 90095
- Department of Psychology, University of California Los Angeles, Franz Hall, 502 Portola Plaza Los Angeles, CA 90095
| | - Michael R. Irwin
- Department of Psychiatry and Biobehavioral Sciences, University of California Los Angeles, 740 Westwood Plaza 28-263, Los Angeles, CA 90095
| | - April D. Thames
- Department of Psychiatry and Biobehavioral Sciences, University of California Los Angeles, 740 Westwood Plaza 28-263, Los Angeles, CA 90095
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26
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Santos IKD, Azevedo KPMD, Melo FCM, Lima KKFD, Pinto RS, Dantas PMS, Medeiros HJD, Knackfuss MI. Lifestyle and sleep patterns among people living with and without HIV/AIDS. Rev Soc Bras Med Trop 2018; 51:513-517. [PMID: 30133636 DOI: 10.1590/0037-8682-0235-2017] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2017] [Accepted: 01/25/2018] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION Negative lifestyles affect the health and quality of sleep of those living with and without HIV/AIDS. METHODS Individuals were divided into two groups based on whether or not they were living with HIV/AIDS. RESULTS Among the 20 participants, 95% displayed a poor lifestyle, and both groups demonstrated low-quality sleep with significant differences between groups in the early sleep variables, total sleep time, and sleep patterns. CONCLUSIONS Both groups demonstrated similar behavior with unsatisfactory lifestyles, poor sleep quality, and irregular sleep patterns.
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Affiliation(s)
- Isis Kelly Dos Santos
- Programa de Pós-Graduação em Saúde e Sociedade, Universidade do Estado do Rio Grande do Norte, Mossoró, RN, Brasil
| | | | | | - Kátia Kamila Felix de Lima
- Programa de Pós-Graduação em Saúde e Sociedade, Universidade do Estado do Rio Grande do Norte, Mossoró, RN, Brasil
| | - Rianne Soares Pinto
- Programa de Pós-Graduação em Saúde e Sociedade, Universidade do Estado do Rio Grande do Norte, Mossoró, RN, Brasil
| | | | | | - Maria Irany Knackfuss
- Departamento de Educação Física, Universidade Estadual do Rio Grande do Norte, Mossoró, RN, Brasil
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Faraut B, Malmartel A, Ghosn J, Duracinsky M, Leger D, Grabar S, Viard JP. Sleep Disturbance and Total Sleep Time in Persons Living with HIV: A Cross-Sectional Study. AIDS Behav 2018; 22:2877-2887. [PMID: 29855973 DOI: 10.1007/s10461-018-2179-1] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Abstract
Short and long sleep durations have been associated with inflammation and chronic diseases. To study the association between sleep duration/quality and HIV disease severity, a cross-sectional study was conducted in patients living with HIV (PLWHs) using self-administered questionnaires assessing total sleep time, insomnia (ICSD-3 criteria), and poor sleep quality (PSQI > 5). Multivariable logistic regression identified the factors associated with sleep disorders and with HIV features. 640 Parisian ambulatory PLWHs were included. The prevalence of insomnia was 50 and 68% of patients had a PSQI > 5. Patients with CD4 count < 500 cells/mm3 were more likely to be long sleepers (> 8 h/day) (OR 1.49; 95% CI [1.10-1.99]: p < 0.01), and less likely to be short sleepers (< 6 h/day) (OR 0.69; 95% CI[0.50-0.96]; p = 0.04) or to experience insomnia (OR 0.59; 95% CI[0.40-0.86]; p < 0.01). HIV features were not associated with a PSQI > 5. Thus, insomnia and impaired sleep quality were highly prevalent in well-controlled PLWHs and the severity of HIV infection was associated with long sleep times.
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28
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Buchanan DT, McCurry SM, Eilers K, Applin S, Williams ET, Voss JG. Brief Behavioral Treatment for Insomnia in Persons Living with HIV. Behav Sleep Med 2018; 16:244-258. [PMID: 27362814 DOI: 10.1080/15402002.2016.1188392] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
This study examined the feasibility and preliminary efficacy of brief behavioral treatment for insomnia (BBTI) for persons living with HIV (PLWH). Of the 22 persons enrolled, 9 were lost before starting treatment, and one dropped out after starting BBTI. Acceptability was rated favorably by those completing the treatment (n = 12). The most common problems pertained to sleep hygiene: variable bedtimes and rise times, watching television, or consuming caffeine. Improvements on sleep outcomes at posttreatment were clinically and statistically significant on questionnaire and sleep diary outcomes. This study supports the overall feasibility of BBTI in PLWH, and the preliminary evidence supports further research on this treatment for PLWH who have insomnia, but dropouts indicate that some individuals may have difficulty initiating treatment.
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Affiliation(s)
- Diana Taibi Buchanan
- a Department of Biobehavioral Nursing and Health Systems, School of Nursing , University of Washington , Seattle , Washington , USA
| | - Susan M McCurry
- b Department of Psychosocial and Community Health, School of Nursing , University of Washington , Seattle , Washington , USA
| | - Kristi Eilers
- c Winder Clinic , Madigan Army Medical Center , Tacoma , Washington , USA
| | - Shauna Applin
- d Hilltop Family Medical Clinic , Community Health Care , Tacoma , Washington , USA
| | - Ellita T Williams
- a Department of Biobehavioral Nursing and Health Systems, School of Nursing , University of Washington , Seattle , Washington , USA
| | - Joachim G Voss
- e Frances Payne Bolton School of Nursing , Case Western Reserve University , Cleveland , Ohio , USA
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29
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Redman KN, Karstaedt AS, Scheuermaier K. Increased CD4 counts, pain and depression are correlates of lower sleep quality in treated HIV positive patients with low baseline CD4 counts. Brain Behav Immun 2018; 69:548-555. [PMID: 29452219 DOI: 10.1016/j.bbi.2018.02.002] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2017] [Revised: 01/12/2018] [Accepted: 02/12/2018] [Indexed: 12/17/2022] Open
Abstract
Poor sleep quality leads to increased immune activation and immune activation leads to worse sleep quality. South African HIV positive patients typically have delayed start of treatment, which has been associated with CD4+ effector T cells being more spontaneously activated in chronically treated patients. This cross-sectional study investigated whether subjective sleep quality was associated with CD4+ T lymphocyte reconstitution in treated South African HIV+ patients. One hundred and thirty-nine treated HIV+ patients (109 F, age average (SD) = 43 (9)) were recruited from Chris Hani Baragwanath Academic Hospital in Soweto, Johannesburg, South Africa. Participants completed questionnaires evaluating their subjective sleep quality (Pittsburgh Sleep Quality Index), daytime sleepiness (Epworth sleepiness scale), pain, and depression severity (Beck Depression Inventory). Univariate and multivariate analyses were run to determine the correlates of sleep quality in this population. Patients had been on antiretroviral treatment for about 4 years and had increased their CD4 counts from a median at baseline of 82 to 467 cells/µL. They had overall poor sleep quality (average (SD) PSQI = 7.7 (±5), 61% reporting PSQI > 5, a marker of lower sleep quality), 41% had clinical depression (average (SD) BDI = 17 (±12)) and 55% reported pain. In two separate multivariate analyses, both the overall CD4 count increase from baseline (p = 0.0006) and higher current CD4 counts (p = 0.0007) were associated with worse sleep quality, when adjusting for depression severity (p < 0.001), daytime sleepiness (p = 0.01) and the presence of pain (p < 0.01). In this cohort of treated South African HIV positive patients, poor sleep quality was associated with higher current CD4 counts, when adjusting for depression severity, daytime sleepiness and pain. Further studies should investigate the temporal relationship between HIV-related poor sleep quality and underlying immune activation.
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Affiliation(s)
- K N Redman
- Wits Sleep Laboratory, Brain Function Research Group, School of Physiology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, Gauteng, South Africa
| | - A S Karstaedt
- Division of Infectious Diseases, Department of Medicine, Chris Hani Baragwanath Academic Hospital, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, Gauteng, South Africa
| | - K Scheuermaier
- Wits Sleep Laboratory, Brain Function Research Group, School of Physiology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, Gauteng, South Africa.
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30
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Huang X, Li H, Meyers K, Xia W, Meng Z, Li C, Bai J, He S, Cai W, Huang C, Liu S, Wang H, Ling X, Ma P, Tan D, Wang F, Ruan L, Zhao H, Wei H, Liu Y, Yu J, Lu H, Wang M, Zhang T, Chen H, Wu H. Burden of sleep disturbances and associated risk factors: A cross-sectional survey among HIV-infected persons on antiretroviral therapy across China. Sci Rep 2017. [PMID: 28623361 PMCID: PMC5473875 DOI: 10.1038/s41598-017-03968-3] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
This study evaluated the prevalence and factors associated with sleep disturbance in a large cohort of HIV-infected patients across China. A cross-sectional study was conducted among HIV-infected patients on antiretroviral therapy at 20 AIDS clinics. The Pittsburgh Sleep Quality Index was self-administered by subjects. Socio-demographic characteristics, medical history and HIV-related clinical data were collected. 4103 patients had complete data for analysis. Sleep disturbances were observed in 43.1% of patients. Associated factors in multivariable analysis included psychological factors: anxiety (odds ratio [OR], 3.13; 95% confidence interval [CI], 2.44–4.00; P < 0.001), depression (OR, 2.09; 95% CI, 1.70–2.57; P < 0.001), and both anxiety and depression (OR, 5.90; 95% CI, 4.86–7.16; P < 0.001); sociodemographic factors: MSM (OR, 1.26; 95% CI, 1.04–1.52; P = 0.018), being single (OR, 1.45; 95%CI 1.21–1.74; P < 0.001), higher education (OR, 1.25; 95% CI, 1.03–1.53; P = 0.025); and clinical factors: suboptimal adherence (OR,1.51; 95% CI,1.23–1.85; P < 0.001), regimen-switching (OR, 1.94; 95% CI, 1.12–3.35; P = 0.018), and antidepressant use (OR, 1.98; 95% CI, 1.47–2.67; P = 0.044). Prevalence of sleep disturbance is high in this large Chinese cohort. Associated factors appear related to psychological and social-demographic factors. Health workers may consider routinely assessing sleep disturbances among HIV-infected patients, especially in the first three months after HIV diagnosis, and referring for mental health services, which may positively impact adherence to treatment.
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Affiliation(s)
- Xiaojie Huang
- Center for Infectious Diseases, Beijing You'an Hospital, Capital Medical University, Beijing, 100069, China
| | - Huiqin Li
- Infectious Diseases Department, Yunnan AIDS Caring Center, Kunming, Yunnan, 650301, China
| | - Kathrine Meyers
- The Aaron Diamond AIDS Research Center, New York, NY, 10016, United States
| | - Wei Xia
- Center for Infectious Diseases, Beijing You'an Hospital, Capital Medical University, Beijing, 100069, China
| | - Zhihao Meng
- Infectious Diseases Department, Longtan Hospital of Guangxi, Liuzhou, Guangxi, 545005, China
| | - Chongxi Li
- Infectious Diseases Department, the Third People's Hospital of Kunming, Kunming, Yunnan, 650041, China
| | - Jinsong Bai
- Infectious Diseases Department, the Third People's Hospital of Kunming, Kunming, Yunnan, 650041, China
| | - Shenghua He
- Infectious Diseases Department, the Infectious Diseases Hospital of Chengdu, Chengdu, Sichuan, 610061, China
| | - Weiping Cai
- Institute of Infectious Diseases, the Eighth People's Hospital of Guangzhou, Guangzhou, Guangdong, 510060, China
| | - Chengyu Huang
- Department of AIDS, Chongqing Infectious Disease Medical Center, Chongqing, 400039, China
| | - Shuiqing Liu
- Department of Infectious Diseases, the Fifth People's Hospital of Guiyang, Guiyang, Guizhou, 550004, China
| | - Hui Wang
- Department of Clinical AIDS Research, the Third People's Hospital of Shenzhen, Shenzhen, Guangdong, 518020, China
| | - Xuemei Ling
- Department of Hematology, the Third People's Hospital of Hengyang, Hengyang, Hunan, 421000, China
| | - Ping Ma
- Department of Infectious Diseases, the Second People's Hospital of Tianjin, Tianjin, 300193, China
| | - Daling Tan
- Department of Infectious Diseases, the People's Hospital of Luzhai, Liuzhou, Guangxi, 545600, China
| | - Fuxiang Wang
- Department of Infectious Diseases, the First Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang, 150001, China
| | - Lianguo Ruan
- Department of Infectious Diseases, Wuhan Medical Treatment Center, Wuhan, Hubei, 430023, China
| | - Hongxin Zhao
- Department of Infectious Diseases, Beijing Ditan Hospital, Capital Medical University, Beijing, 100015, China
| | - Hongxia Wei
- Department of Infectious Diseases, the Second Hospital of Nanjing Affiliated to Southeast University Medical College, Nanjing, Jiangsu, 210003, China
| | - Yanfen Liu
- Department of Infectious Diseases, the Fourth People's Hospital of Nanning, Nanning, Guangxi, 530023, China
| | - Jianhua Yu
- Department of Infectious Diseases, the Sixth People's Hospital of Hangzhou, Hangzhou, Jiangsu, 310023, China
| | - Hongzhou Lu
- Department of Infectious Diseases, Shanghai Public Health Clinical Center Affiliated to Fudan University, Shanghai, 200083, China
| | - Min Wang
- Department of Infectious Diseases, the First People's Hospital of Changsha, Changsha, Hunan, 410005, China
| | - Tong Zhang
- Center for Infectious Diseases, Beijing You'an Hospital, Capital Medical University, Beijing, 100069, China
| | - Hui Chen
- School of Biomedical Engineering, Capital Medical University, Beijing, 100069, China.
| | - Hao Wu
- Center for Infectious Diseases, Beijing You'an Hospital, Capital Medical University, Beijing, 100069, China.
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Perazzo JD, Webel AR, Voss JG, Prince-Paul M. Fatigue Symptom Management in People Living With Human Immunodeficiency Virus. J Hosp Palliat Nurs 2017; 19:122-127. [PMID: 29398974 PMCID: PMC5793939 DOI: 10.1097/njh.0000000000000329] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Fatigue is a subjective, unpleasant, potentially disabling symptom rooted in physiological, psychological, and behavioral causes. People living with HIV are a population highly affected by fatigue due to risk factors associated with HIV-infection, treatment, and psychosocial disease burden. People with HIV are living longer, and are facing the challenge of a longer disease trajectory. Palliative nurses with expertise in symptom management can play a crucial role in helping people with HIV to engage in health behaviors that prevent or mitigate fatigue. In this paper we present a definition and overview of fatigue, describe the problem of fatigue in people living with HIV, and present a case study that illustrates the role of the palliative nurse in helping a person with HIV to cope with fatigue.
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Affiliation(s)
- Joseph D Perazzo
- Frances Payne Bolton School of Nursing; Case Western Reserve University; Cleveland, OH
| | - Allison R Webel
- Frances Payne Bolton School of Nursing; Case Western Reserve University; Cleveland, OH
| | - Joachim G Voss
- Frances Payne Bolton School of Nursing; Case Western Reserve University; Cleveland, OH
| | - Maryjo Prince-Paul
- Frances Payne Bolton School of Nursing; Case Western Reserve University; Cleveland, OH
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Ahmadi M, Khalili H, Abbasian L, Ghaeli P. Effect of Valerian in Preventing Neuropsychiatric Adverse Effects of Efavirenz in HIV-Positive Patients: A Pilot Randomized, Placebo-Controlled Clinical Trial. Ann Pharmacother 2017; 51:457-464. [PMID: 28478716 DOI: 10.1177/1060028017696105] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Several neuropsychiatric adverse effects of efavirenz are known. Preventing these adverse effects may improve patients' adherence to antiretroviral therapy (ART). OBJECTIVES To evaluate the efficacy and safety of valerian in preventing neuropsychiatric adverse effects of efavirenz in HIV-positive patients. METHOD In this pilot randomized, double-blinded, placebo-controlled, clinical trial, 51 HIV-positive patients who were receiving efavirenz were recruited into the valerian (n = 25) or placebo (n = 26) group. Patients received valerian (530 mg) or placebo nightly 1 hour before sleep for 4 weeks. The neuropsychiatric status (sleep, anxiety, depression, suicidal thought, and psychosis) of patients was assessed at baseline and week 4 using validated questionnaires. RESULTS Sleep ( P ≤ 0.001) and anxiety ( P = 0.001) significantly improved in the valerian group compared with the placebo group. Dizziness was the most common complaint of patients in first days of the intervention. In the valerian and placebo groups, 92% and 84.6% of patients experienced dizziness, respectively ( P = 0.35). Nausea was the second common adverse effect that 84% and 76.9% of patients in the valerian and placebo groups experienced ( P = 0.39). CONCLUSION In the first 4 weeks of ART including efavirenz, valerian significantly improved sleep and anxiety in HIV-positive patients. Valerian may be considered as a potential option in preventing neuropsychiatric adverse effects of efavirenz in HIV-positive patients.
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Affiliation(s)
- Joanne Potterton
- Department of Physiotherapy, University of the Witwatersrand, Johannesburg, South Africa
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34
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Tello-Velásquez JR, Díaz-Llanes BE, Mezones-Holguín E, Rodríguez-Morales AJ, Huamaní C, Hernández AV, Arévalo-Abanto J. [Poor quality of sleep associated with low adherence to highly active antiretroviral therapy in Peruvian patients with HIV/AIDS]. CAD SAUDE PUBLICA 2015; 31:989-1002. [PMID: 26083174 DOI: 10.1590/0102-311x00010014] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2014] [Accepted: 12/01/2014] [Indexed: 01/25/2023] Open
Abstract
This cross-sectional study analyzed the association between poor quality of sleep and adherence to highly active antiretroviral therapy (HAART) in 389 Peruvian patients with HIV/AIDS. Poor quality of sleep was measured with the Pittsburgh Sleep Quality Index (PSQI) and adherence with the CEAT-VIH (Peruvian adaptation). A Poisson generalized linear model with robust standard errors was used to estimate prevalence ratios and 95%CI. A crude model showed that mild, moderate, and severe poor quality of sleep were associated with inadequate treatment adherence. In the adjusted model for variables associated in the bivariate analysis or variables theoretically associated with adherence, only moderate/severe poor quality of sleep remained associated (PR = 1.34, 95%CI: 1.17-1.54; and PR = 1.34, 95%CI: 1.16-1.57, respectively). The study concluded that moderate/severe poor quality of sleep was independently associated with adherence to HAART. Assessing quality of sleep may be helpful in the comprehensive evaluation of HIV patients.
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Affiliation(s)
| | | | | | | | - Charles Huamaní
- Centro Nacional de Salud Pública, Instituto Nacional de Salud, Lima, Perú
| | - Adrián V Hernández
- Escuela de Medicina, Universidad Peruana de Ciencias Aplicadas, Lima, Perú
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35
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George Dalmida S, McDonnell Holstad M, Fox R, Mara Delaney A. Depressive symptoms and fatigue as mediators of relationship between poor sleep factors and medication adherence in HIV-positive women. J Res Nurs 2015. [DOI: 10.1177/1744987115601464] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
Patients living with HIV commonly experience sleep disturbances, depression, excessive daytime sleepiness and fatigue, which negatively affect antiretroviral medication adherence. Few studies have examined relationships between these symptoms and medication adherence in women living with HIV or examine the mechanisms through which these symptoms affect adherence. The purpose of this study was to examine the associations between sleep quality, excessive daytime sleepiness and medication adherence, and energy/fatigue and depression as mediators of these relationships among 206 women living with HIV. Correlations, t-tests and hierarchical regression analysis were utilised. The majority of participants (93.2%) were African American or Black. The average age of participants was 43.3 years and average years infected was 9.6. More than half of the women reported poor sleep quality and, on average, participants reported moderate daytime sleepiness, high depressive symptoms and moderate levels of fatigue. Additionally, both depression and low energy/fatigue were identified as significant mediators of the relationship between sleep quality and medication adherence. Depression also significantly mediated the relationship between excessive daytime sleepiness and medication adherence. The findings from this study highlight the impact of sleep on medication adherence and associated mechanisms and emphasise the need for healthcare providers to assess and address sleep factors when providing care for patients living with HIV.
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Affiliation(s)
| | | | - Rodney Fox
- Nurse Practitioner, Pride Medical, GA USA
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Jabbari F, Dabaghzadeh F, Khalili H, Abbasian L. Associated factors of sleep quality in HIV-positive individuals. Future Virol 2015. [DOI: 10.2217/fvl.14.107] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
ABSTRACT Objective: In the present study, sleep quality and associated factors have been evaluated in HIV-positive individuals. Methods: 150 HIV-positive and 50 non-HIV-positive people were included. Pittsburgh Sleep Quality Index, Hospital Anxiety and Depression Scale, somatization subscale of Symptom Checklist-90 were used for evaluation of sleep quality, anxiety, depression and physiological factors respectively. Results: Statistically significant differences were found regarding sleep quality (p < 0.001) between the HIV-positive and control group. There was significant direct correlation between sleep quality and each of somatization subscale of Symptom Checklist-90, depression and anxiety scores in HIV-positive individuals. Conclusion: Depression, anxiety and physical morbidity were detected as main factors that affect sleep quality in the HIV-positive individuals.
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Affiliation(s)
- Fatemeh Jabbari
- Department of Clinical Pharmacy, Faculty of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran
| | - Fatemeh Dabaghzadeh
- Department of Clinical Pharmacy, Faculty of Pharmacy, Kerman University of Medical Sciences, Kerman, Iran
| | - Hossein Khalili
- Department of Clinical Pharmacy, Faculty of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran
| | - Ladan Abbasian
- Iranian Research Center for HIV/AIDS, Tehran University of Medical Sciences, Tehran, Iran
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Seay JS, McIntosh R, Fekete EM, Fletcher MA, Kumar M, Schneiderman N, Antoni MH. Self-reported sleep disturbance is associated with lower CD4 count and 24-h urinary dopamine levels in ethnic minority women living with HIV. Psychoneuroendocrinology 2013; 38:2647-53. [PMID: 23850225 PMCID: PMC3812316 DOI: 10.1016/j.psyneuen.2013.06.022] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2013] [Revised: 06/12/2013] [Accepted: 06/17/2013] [Indexed: 11/24/2022]
Abstract
BACKGROUND Sleep disturbance is associated with dopamine dysregulation, which can negatively impact immune status. Individuals living with HIV experience more sleep difficulties, and poor sleep may compound immune decrements associated with HIV infection. Little research has examined associations between sleep, dopamine, and immune status (CD4 count) in individuals with HIV. As ethnic minority women living with HIV (WLWH) are at heightened risk for HIV disease progression, we related sleep reports to both CD4 count and dopamine levels in a cohort of ethnic minority WLWH. METHODS Participants were 139 low-income WLWH (ages 20-62; 78.3% African-American or Caribbean) who reported both overall sleep quality and sleep disturbance on the Pittsburgh sleep quality index (PSQI). CD4 count and HIV viral load were measured via morning peripheral venous blood samples, and concentrations of dopamine were measured via 24-h urine collection. Covariates included HIV viral load, length of time since HIV diagnosis, HAART adherence, perceived stress and depression. RESULTS After controlling for all covariates, greater sleep disturbance was associated with significantly lower CD4 count (β=-.20, p=.03) and lower levels of dopamine (β=-.25, p=.04). Poorer overall sleep quality was marginally associated with lower CD4 count (β=-.16, p=.08), and was not associated with dopamine. CONCLUSION Our analyses suggest that sleep disturbance is independently related with immune status and dopamine levels in WLWH. Lower levels of dopamine may indicate neuroendocrine dysregulation and may impact immune and health status. Results highlight sleep disturbance rather than overall sleep quality as potentially salient to neuroendocrine and immune status in ethnic minority WLWH.
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Affiliation(s)
- Julia S. Seay
- Department of Psychology, University of Miami, Coral Gables, FL, USA,Corresponding Author: Julia Seay, M.S.; 5665 Ponce de Leon Blvd. Coral Gables, FL 33146; ; Phone: 305-284-8532; Fax: 305-284-1700
| | - Roger McIntosh
- Department of Psychology, University of Miami, Coral Gables, FL, USA
| | - Erin M. Fekete
- School of Psychological Sciences, University of Indianapolis, Indianapolis, IN, USA
| | | | - Mahendra Kumar
- Department of Psychiatry, University of Miami, Miami, FL, USA
| | - Neil Schneiderman
- Department of Psychology, University of Miami, Coral Gables, FL, USA
| | - Michael H. Antoni
- Department of Psychology, University of Miami, Coral Gables, FL, USA
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Fekete EM, Seay J, Antoni MH, Mendez AJ, Fletcher MA, Szeto A, Schneiderman N. Oxytocin, social support, and sleep quality in low-income minority women living with HIV. Behav Sleep Med 2013; 12:207-21. [PMID: 23799864 PMCID: PMC4533907 DOI: 10.1080/15402002.2013.791297] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Sleep disturbances are highly prevalent in women with HIV, and few studies examine potential protective factors that may reduce risk for sleep disturbances in this high-risk population. This study predicted that HIV-specific social support from various sources (i.e., friends, family members, and spouses), as well as oxytocin (OT), would explain sleep quality in 71 low-income minority women living with HIV. Social support from family members was associated with better sleep quality in women. For women with high OT, support from friends was associated with better sleep quality, whereas for women with low OT, support from friends was associated with poorer sleep quality. Women with low OT may not effectively interpret and utilize available support resources, which may be associated with sleep disturbances.
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Affiliation(s)
- Erin M Fekete
- a School of Psychological Sciences University of Indianapolis
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Taibi DM. Sleep disturbances in persons living with HIV. J Assoc Nurses AIDS Care 2013; 24:S72-85. [PMID: 23290379 DOI: 10.1016/j.jana.2012.10.006] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2012] [Accepted: 10/27/2012] [Indexed: 12/16/2022]
Abstract
Up to 70% of persons living with HIV (PLWH) experience sleep disturbances. Insomnia and obstructive sleep apnea syndrome (OSAS) are common disorders seen in the primary care of PLWH. This paper reviews the current evidence and practice recommendations for treating these conditions. Insomnia is evaluated by clinical interview, questionnaires, and sleep diaries. The recommended first-line treatment is cognitive-behavioral therapy for insomnia (CBT-I) delivered by a trained therapist. Certain sedative medications may be useful, but over-the-counter treatments (particularly those containing antihistamines) are not recommended. OSAS is diagnosed by overnight sleep study but can be screened for in primary care. The STOP-BANG is a useful eight-item screening tool. The gold standard of treatment for OSAS is the use of a continuous positive airway pressure device. Treatment of insomnia and OSAS is important for improving quality of life and preventing associated health problems (especially cardiovascular disease in OSAS) in PLWH.
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Affiliation(s)
- Diana M Taibi
- Biobehavioral Nursing and Health Systems, University of Washington, Seattle, Washington, USA
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Dabaghzadeh F, Ghaeli P, Khalili H, Alimadadi A, Jafari S, Akhondzadeh S, Khazaeipour Z. Cyproheptadine for prevention of neuropsychiatric adverse effects of efavirenz: a randomized clinical trial. AIDS Patient Care STDS 2013; 27:146-54. [PMID: 23442031 DOI: 10.1089/apc.2012.0410] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Abstract
Cyproheptadine prevention of the neuropsychiatric adverse effects of an antiretroviral regimen including efavirenz has been evaluated in a randomized clinical trial. Twenty-five patients (16 males and 9 females with mean±SD ages of 36±9 years) in a cyproheptadine group, and 26 patients (17 males and 9 females with mean±SD ages of 34±7 years) in a control group completed the trial. Sexual contact and injection drug use were the main routs of HIV infection in both groups. The patients' neuropsychiatric adverse effects were evaluated based on the Hamilton Depression Rating Scale, Hamilton Anxiety Rating Scale, Positive and Negative Syndrome Scale, Beck Depression Scale, Pittsburgh Sleep Quality Inventory, Positive and Negative Suicide Ideation, and Somatization Subscale of Symptom Checklist 90 at baseline and 4 weeks after treatment. Cyproheptadine significantly decreased the scores of Hamilton Depression Rating Scale, Hamilton Anxiety Rating Scale, Positive and Negative Syndrome Scale, Beck Depression Scale, Pittsburgh Sleep Quality Inventory, Positive and Negative Suicide Ideation of the patients after 4 weeks in comparison with control group. All of the scores increased in control group following antiretroviral therapy. Although short duration of the patients' follow-up was a major limitation of the study, the results of the study showed that cyprohepradine is effective in prevention of depression, anxiety, hallucination, aggressive behaviors, emotional withdrawal, poor rapport, poor impulse control, active social avoidance, suicidal ideation, and improved sleep quality of HIV-positive patients after initiation of antiretroviral therapy including efavirenz.
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Affiliation(s)
- Fatemeh Dabaghzadeh
- Department of Clinical Pharmacy, Faculty of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran
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