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.
DabaghzadehFKhaliliHGhaeliP, et al.Sleep quality and its correlates in hiv positive patients who are candidates for initiation of antiretroviral therapy. Iran J Psychiatry2013; 8(4): 160–164.
2.
ReidSDwyerJ. Insomnia in HIV infection: a systematic review of prevalence, correlates, and management. Psychosom Med2005; 67(2): 260–269.
3.
UstinovYLichsteinKLWalG, et al.Association between report of insomnia and daytime functioning. Sleep Med2010; 11: 65–68.
4.
DrakeCRoehrsTBreslauN, et al.The 10 year risk of verified motor vehicle crashes in relation to physiologic sleepiness. Sleep2010; 33: 745–752.
5.
CappuccioFPD'EliaLStrazzulloP, et al.Quantity and quality of sleep and incidence of type 2 diabetes: a systematic review and meta-analysis. Diabetes Care2010; 33: 414–420.
6.
SchubertCRCruickshanksKJDaltonDS, et al.Prevalence of sleep problems and quality of life in an older population. Sleep2002; 25: 889–893.
7.
RidkerPMHennekensCHRoitman-JohnsonB, et al.Plasma concentration of soluble intercellular adhesion molecule 1 and risks of future myocardial infarction in apparently healthy men. Lancet1998; 351: 88–92.
8.
NormanSEResnickLCohnMA, et al.Sleep disturbances in HIV-seropositive patients. JAMA1988; 260(7): 922.
9.
LeyroTMBabsonKABonn-MillerMO. Anxiety sensitivity in relation to sleep quality among HIV-infected individuals. J Assoc Nurses AIDS Care2014; 25(6): 638–645.
10.
HandGAPhilipsKDDudgeonWD. Perceived stress in HIV-infected individuals: physiological and psychological correlates. AIDS Care2006; 18: 1011–1017.
11.
RobbinsJLPhillipsKDDudgeonWD, et al.Physiological and psychological correlates of sleep in HIV infection. Clin Nurs Res2004; 13(1): 33–52.
12.
WuJWuHLuC, et al.Self-reported sleep disturbances in HIV-infected people: a meta-analysis of prevalence and moderators. Sleep Med2015; 16(8): 901–907.
13.
BabsonKAHeinzAJBonn-MillerMO. HIV medication adherence and HIV symptom severity: the roles of sleep quality and memory. AIDS Patient Care and STDs2013; 27: 44–52.
14.
NokesKMKendrewJ. Correlates of sleep quality in persons with HIV disease. J Assoc Nurses AIDS Care2001; 12: 17–22.
15.
OmonuwaTSGoforthHWPreud'hommeX, et al.The pharmacologic management of insomnia in patients with HIV. J Clin Sleep Med2009; 5(3): 251–262.
16.
WiegandMMollerAASchreiberW, et al.Nocturnal sleep EEG in patients with HIV infection. Eur Arch Psychiatry Clin Neurosci1991; 240: 153–158.
17.
ChenYCChenCCStrolloPJJr, et al.Differences in sleep disorders between HIV-infected persons and matched controls with sleep problems: a matched-cohort study based on laboratory and survey data. J Clin Med2021; 10(21): 5206.
18.
SoldatosCRDikeosDGPaparrigopoulosTJ. Athens insomnia scale: validation of an instrument based on ICD-10 criteria. J Psychosom Res2000; 48(6): 555–560.
19.
AllenRPPicchiettiDHeningWA, et al.Restless legs syndrome: diagnostic criteria, special considerations, and epidemiology: a report from the restless legs syndrome diagnosis and epidemiology workshop at the national institutes of health. Sleep Med Mar2003; 4(2): 101–119.
20.
WaltersASLeBrocqCDharA, et al.Validation of the international restless legs syndrome study group rating scale for restless legs syndrome. Sleep Med Mar2003; 4(2): 121–132.
21.
MiskedakiABacopoulouFVlachakisD, et al.Validation of the STOP-bang questionnaire in greek patients suffering from obstructive sleep apnea. Adv Exp Med Biol2021; 1337: 77–82.
22.
BakalidouDSkordilisEKGiannopoulosS, et al.Validity and reliability of the FSS in greek MS patients. Springerplus2013; 2(1): 304.
23.
BougiaMKOikonomouNTNtafouliM, et al.AB023. investigation of the reliability of the medical outcomes study (MOS) sleep scale in greek patients with sleep-related breathing disorders. Ann Transl Med2016; 4(22): AB023.
24.
TsaraVSerasliEAmfilochiouA, et al.Greek version of the Epworth sleepiness scale. Sleep Breath2004; 8(2): 91–95.
25.
MichopoulosIDouzenisAKalkavouraC, et al.Hospital anxiety and depression scale (HADS): validation in a Greek general hospital sample. Ann Gen Psychiatry2008; 7: 4.
26.
KotronoulasGCPapadopoulouCNPapapetrouA, et al.Psychometric evaluation and feasibility of the Greek Pittsburgh sleep quality index (GR-PSQI) in patients with cancer receiving chemotherapy. Support Care Cancer2011; 19(11): 1831–1840.
27.
PapathanasiouGGeorgoudisGPapandreouM, et al.Reliability measures of the short International physical activity questionnaire (IPAQ) in Greek young adults. Hellenic J Cardiol2009; 50(4): 283–294.
28.
WeirCBJanA. BMI classification percentile and cut off points. Orlando, FL, USA: StatPearls Publishing, 2022. [Updated 2022 Jun 27]. In: StatPearls [Internet]. Treasure Island (FL)Available from: https://www.ncbi.nlm.nih.gov/books/NBK541070/?report=classic
29.
RossRNeelandIJYamashitaS, et al.Waist circumference as a vital sign in clinical practice: a consensus statement from the IAS and ICCR working group on visceral obesity. Nat Rev Endocrinol2020; 16(3): 177–189.
30.
PhillipsKDSkeltonWD. Effects of individualized acupuncture on sleep quality in HIV disease. J Assoc Nurses AIDS Care2001; 12(1): 27–39.
31.
WibbelerTReicheltDHusstedtIW, et al.Sleepiness and sleep quality in patients with HIV infection. J Psychosom Res2012; 72: 439–442.
32.
RubinsteinMLSelwynPA. High prevalence of insomnia in an outpatient population with HIV infection. J Acquir Immune Defic Syndr1998; 19: 260–266.
33.
BrownSMitlerMAtkinsonH, et al.Correlation of subjective sleep complaints absolute T-4 cell number and anxiety in HIV illness. Sleep Res1991; 20: 363–368.
34.
DarkoDFMcCutchanJAKripkeDF, et al.Fatigue, sleep disturbance, disability, and indices of progression of HIV infection. Am J Psych1992; 149: 514–520.
35.
PaparrigopoulosTTzavaraCTheleritisC, et al.Insomnia and its correlates in a representative sample of the Greek population. BMC Public Health2010; 10: 531.
36.
HuangXLiHMeyersK, et al.Burden of sleep disturbances and associated risk factors: a cross-sectional survey among HIV-infected persons on antiretroviral therapy across China. Sci Rep2017; 7(1): 3657.
37.
ZhangCLiXLiuY, et al.Emotional, physical and financial burdens of stigma against people living with HIV/AIDS in China. AIDS Care2016; 28(Suppl 1): 124–131.
38.
PetrakisVPanagopoulosPMaltsanT, et al.Late presenters of HIV infection in an HIV unit of a tertiary university hospital in a rural region of Greece. AIDS Res Hum Retroviruses2020; 36(7): 601–605.
39.
FarautBMalmartelAGhosnJ, et al.Sleep disturbance and total sleep time in persons living with HIV: a cross-sectional study. AIDS Behav2018; 22(9): 2877–2887.
40.
WallaceDMAlcaideMLWohlgemuthWK, et al.Prevalence and correlates of restless legs syndrome in men living with HIV. PLoS One2021; 16(10): e0258139.
41.
KunisakiKMDeFrancescoDSabinCA, et al.Sleep disorders in HIV: a substudy of the pharmacokinetics and clinical observations in people over fifty (POPPY) study. Open Forum Infect Dis2020; 8.
42.
DoanTTKooBBOgilvieRP, et al.Restless legs syndrome and periodic limb movements during sleep in the multi-ethnic study of atherosclerosis. Sleep2018; 41(8): zsy106.
43.
KooBBBagaiKWaltersAS. Restless legs syndrome: current concepts about disease pathophysiology. Tremor Other Hyperkinet Mov (N Y)2016; 6: 401.
44.
AllenRP. Restless leg syndrome/willis-ekbom disease pathophysiology. Sleep Med Clin2015; 10(3): 207–214.
45.
KooBBBlackwellTLeeHB, et al.Restless legs syndrome and depression: effect mediation by disturbed sleep and periodic limb movements. Am J Geriatr Psychiatry2016; 24(11): 1105–1116.
46.
KunisakiKMAkgunKMFiellinDA, et al.Prevalence and correlates of obstructive sleep apnoea among patients with and without HIV infection. HIV Med2015; 16(2): 105–113.
47.
BrownTTPatilSPJacobsonLP, et al.Anthropometry in the prediction of sleep disordered breathing in HIV-positive and HIV-negative men. Antivir Ther2010; 15(4): 651–659.
48.
GallegoLBarreiroPdel RíoR, et al.Analyzing sleep abnormalities in HIV-infected patients treated with Efavirenz. Clin Infect Dis2004; 38(3): 430–432.
49.
BlanchJMartinezERousaudA, et al.Preliminary data of a prospective study on neuropsychiatric side effects after initiation of efavirenz. J Acquir Immune Defic Syndr2001; 27: 336–343.
50.
NunezMGonzalez de RequenaDGallegoL, et al.Higher efavirenz plasma levels correlate with the development of insomnia. J Acquir Immune Defic Syndr2001; 28: 399–400.
51.
CahnPPozniakALMingroneH, et al.Dolutegravir versus raltegravir in antiretroviral-experienced, integrase-inhibitor-naive adults with HIV: week 48 results from the randomised, double-blind, non-inferiority SAILING study. Lancet2013; 382: 700–708.
52.
HoffmannCWelzTSabranskiM, et al.Higher rates of neuropsychiatric adverse events leading to dolutegravir discontinuation in women and older patients. HIV Med2017; 18: 56–63.
53.
de BoerMvan den BerkGvan HoltenN, et al.Intolerance of dolutegravir-containing combination antiretroviral therapy regimens in real-life clinical practice. AIDS (London, England)2016; 30: 2831–2834.
54.
VoitsidisPGliatasIBairachtariV, et al.Insomnia during the COVID-19 pandemic in a Greek population. Psychiatry Res2020; 289: 113076.
