Sleep Apnea Risk May Be Elevated in Men With HIV

By Linda Carroll

July 29, 2020

(Reuters Health) - Risk of sleep apnea may be elevated in men with HIV, a new study suggests.

An analysis of one night of data on the sleep patterns of 54 HIV-infected men who had complained of difficulties sleeping, found that 63% had at least mild sleep apnea, according to the report published in Sleep Medicine.

The findings revealed higher rates of untreated sleep-related breathing disorder (SRBD) in HIV-infected persons, compared to the general population, conclude the researchers, led by Chang-Chun Chen, a Ph.D. student in the International Doctoral Program in Nursing at National Cheng Kung University in Tainan, Taiwan. "Healthcare professionals should pay attention to HIV-infected people with sleep complaints to detect (sleep apnea) early," they write.

To look at the prevalence of SRBD - defined as Apnea-Hypopnea Index (AHI) over 5 events/hour by full channel home-based polysomnography - in people infected with HIV, the researchers recruited HIV-positive patients who had reported difficulty sleeping from a medical center in southern Taiwan. Of the 230 eligible patients, 140 said they were willing to participate in the study and 54 men ultimately completed one night of home polysomnography.

The participants' height, weight, blood pressure and neck, waist and hip circumferences were measured. Demographic factors, including age, educational level, and substance use in the past year, were gathered through questionnaires.

The researchers used the AHI to categorize each participant's nighttime breathing status.

A score of 5 to 15 is categorized as mild sleep apnea, a score of 15 to 30 is designated as moderate and a score of 30 and above is considered to be severe, according to the American Sleep Apnea Association. A score less than 5 is considered normal.

Among the 54 men who completed the overnight polysomnography, 20 were in the normal range, 18 fell into the mild category and 16 had scores of 15 or higher.

Patients diagnosed as having moderate to severe sleep apnea tended to be older. The proportion of participants with BMI greater than or equal to 24 was higher among those diagnosed with moderate to severe sleep apnea compared to those without apneas. And the waist-to-hip ratio of the moderate to severe group was higher than that of the other groups.

When the researchers scrutinized sleep architecture, they found that the arousal index was the only parameter that separated the moderate to severe apnea group from the others.

The researchers note that there are several limitations to the study. "First, the small sample size might be difficult to detect important associations related to our study outcomes," they write. "Second, this study only covered men and thus cannot be generalized to female HIV-infected population. Third, SRBD prevalence in this study may be overestimated due to the selection bias of subjects with poor sleep quality or sleep problems."

Using the AHI definition leads to large numbers of people being classified as having sleep apnea, whether they have HIV or not, said Dr. Andrew Varga, a sleep specialist and an assistant professor of medicine at the Icahn School of Medicine at Mount Sinai in New York City, who wasn't involved in the study.

"Big epidemiological studies with thousands of people have found that if you set the cutoff at 5, the majority of people will be categorized as having sleep apnea," Dr. Varga said. "Even if you use a number like 15 there will still be tons of people who are categorized as having apnea, one in two, for example, of people who are 60 and older."

"The paper is trying to make the case that there is an unexpectedly high incidence of sleep apnea in the HIV-infected population," Dr. Varga said. "I'm not sure I'd say unexpectedly high. I think it's high in the same way it would be in the general population."

One big issue for the new paper is the lack of a control group, Dr. Varga said. "My sense is that if you looked at age- and sex-matched controls you'd see similar numbers," he added.

SOURCE: Sleep Medicine, online July 2020.