Identifying Sleep Biomarkers to Evaluate Cognition in HIV

What is known from the existing literature about how sleep is measured in HIV care? A scoping review

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.

Poor subjective sleep reported by people living with HIV is associated with impaired working memory

Poor sleep can undermine health and may be especially disruptive to those with chronic conditions including HIV infection. Here, clinically well-described people living with HIV [PLWH] (74 men, 35 women) and healthy control (38 men, 35 women) participants were administered the Pittsburgh Sleep Quality Index (PSQI), a validated measure of subjective sleep with a global score ≥5 able to distinguish good from poor sleepers. In addition, participants completed a battery of neuropsychological tests. PLWH (6.8 ± 3.7) had higher global PSQI scores than healthy controls (4.1 ± 2.8): 39.7 % of uninfected controls and 68.8 % of PLWH had a PSQI≥5 indicative of poor sleep. There were no relations between the global PSQI score and any evaluated variables among uninfected individuals or with demographic or HIV-related variables in PLWH. Instead, a higher global PSQI score among PLWH was associated with worse "Quality of Life" scores [Global Assessment of Functioning (GAF, p=0.0007), Medical Outcomes Study survey (21-item short form, SF-21, p<0.0001), and Activities of Daily Living-Instrumental (ADL-I, p=0.0041)] and higher Beck Depression Index (BDI, p<0.0001) depressive symptoms. Further, in PLWH, higher global PSQI scores were associated with poor performance on a working memory task, the digit backward span (p=0.0036). In PLWH, the 5 variables together explained 32.3 % of the global PSQI score variance; only 3 variables - the SF-21, BDI, and digit backward scores - explained 30.6 % of the variance. To the extent that poor subjective sleep contributes to impaired working memory in HIV, we speculate that this impairment may be ameliorated by improved sleep health.

Sleep Disturbances and Chronic Pain in People with HIV: Implications for HIV-Associated Neurocognitive Disorders

Purpose of Review

Antiretroviral therapy has significantly reduced morbidity and mortality in people with HIV. Despite being virally suppressed, sleep disturbances, chronic pain, and neurocognitive impairments persist which can negatively impact quality of life for people with HIV. This article presents relevant literature related to sleep disturbances and chronic pain in people with HIV. The potential impact of these comorbidities on cognition is discussed with implications for managing HIV-associated neurocognitive disorder (HAND).

Recent Findings

People with HIV and chronic pain report greater insomnia and depressive symptoms compared to those without chronic pain. The neurotoxic effects of HIV itself and sleep and chronic pain induced inflammation can contribute to poorer cognitive outcomes.

Summary

Sleep disturbances and chronic pain are prevalent conditions in people with HIV that may perpetuate the development and exacerbation of HAND. Sleep and pain interventions may preserve cognitive function and improve quality of life for people aging with HIV.

Sleep Disturbance in the Context of HIV: A Concept Analysis

Due to the differing definitions of the concept of sleep disturbance among people living with human immunodeficiency virus (HIV), reviewers in this area have not reached any firm conclusions. The study aimed to clarify and provide a stronger foundation for the definition of sleep disturbance in the context of HIV to enhance the concept’s development. Following Beth Rodgers’ concept analysis guidelines, two leading databases were searched, and 73 articles were used for this concept analysis. The attributes, surrogate terms, antecedents, and consequences of sleep disturbance have been identified using thematic analysis. In this analysis, two main attributes of sleep disturbance in the context of HIV were identified: a) subjective measures, including reduced total sleep time, difficulty falling asleep, nighttime and early morning awakenings, feeling sleepy and poorly rested after a night’s sleep, frequent arousals, and irritability, and b) objective measures, including changes in sleep architecture and sleep continuity. Five antecedents of sleep disturbance in the context of HIV were identified.

Meanwhile, the consequences of sleep disturbance in HIV are listed based on the frequency the points occur within the reviewed articles. The list is as follows: fatigue and pain; reduced neurocognitive functions; reduced health outcome and quality of life; poor anti-retroviral (ARV) therapy adherence; daytime sleepiness; depression, anxiety, and maladaptive coping; increased disease progression and cardiovascular mortality; and social phobia, living arrangement and sexual dysfunction. An improved understanding of sleep disturbance in the context of HIV will be beneficial in directing analysts to develop research plans. At the same time, the knowledge gaps identified in the analysis provided a solid basis for further study intending to fill in these gaps.