Kunisaki Ken M, De Francesco Davide, Sabin Caroline A, Winston Alan, Mallon Patrick W G, Anderson Jane, Bagkeris Emmanouil, Boffito Marta, Doyle Nicki, Haddow Lewis, Post Frank A, Sachikonye Memory, Vera Jaime, Khalil Wajahat, Redline Susan
Minneapolis Veterans Affairs Health Care System, Minneapolis, Minnesota, USA.
University of Minnesota, Minneapolis, Minnesota, USA.
Open Forum Infect Dis. 2020 Nov 18;8(1):ofaa561. doi: 10.1093/ofid/ofaa561. eCollection 2021 Jan.
Self-reported sleep quality is poor in persons with human immunodeficiency virus (PWH), but prior studies commonly used nonspecific questionnaires, investigated only single sleep disorders, or lacked human immunodeficiency virus (HIV)-negative controls. We addressed these limitations in the Pharmacokinetics and Clinical Observations in People Over Fifty (POPPY) Sleep Substudy by assessing PWH and HIV-negative controls for insomnia, restless legs syndrome (RLS), and sleep apnea (SA).
Previously enrolled POPPY participants coenrolled in this substudy without regard to sleep symptoms. Participants completed validated sleep assessments including the Insomnia Severity Index questionnaire, International Restless Legs Syndrome Study Group questionnaire, and in-home, wrist-worn overnight oximetry. They also completed health-related quality of life questionnaires including 36-item Short Form (SF-36) and Patient-Reported Outcomes Measurement Information System (PROMIS) sleep questionnaires.
We enrolled 357 PWH (246 >50 years of age; 111 between 18 and 50 years) and 126 HIV-negative controls >50 years of age. Among PWH, criteria were met by 21% for insomnia, 13% for RLS, and 6% for SA. Compared with HIV-negative controls, PWH had a higher risk of insomnia (adjusted odds ratio, 5.3; 95% confidence interval, 2.2-12.9) but not RLS or SA. Compared with PWH without insomnia, those with insomnia reported significantly worse scores on all SF-36 and PROMIS components; fewer than 30% reported previous diagnosis or treatment for insomnia.
Insomnia was more common in PWH, associated with worse health-related quality of life, and frequently undiagnosed. Further research should focus on the pathogenesis of insomnia in PWH and the development of effective screening and intervention strategies for this unique population.
人类免疫缺陷病毒感染者（PWH）自我报告的睡眠质量较差，但既往研究通常使用非特异性问卷，仅调查单一睡眠障碍，或缺乏人类免疫缺陷病毒（HIV）阴性对照。我们在五十岁以上人群的药代动力学和临床观察（POPPY）睡眠子研究中解决了这些局限性，通过评估PWH和HIV阴性对照的失眠、不安腿综合征（RLS）和睡眠呼吸暂停（SA）情况。
先前入组的POPPY参与者无需考虑睡眠症状即可共同入组本亚研究。参与者完成了经过验证的睡眠评估，包括失眠严重程度指数问卷、国际不安腿综合征研究组问卷，以及在家中进行的腕部夜间血氧饱和度监测。他们还完成了与健康相关的生活质量问卷，包括36项简短形式（SF-36）和患者报告结局测量信息系统（PROMIS）睡眠问卷。
我们纳入了357名PWH（246名年龄大于50岁；111名年龄在18至50岁之间）和126名年龄大于50岁的HIV阴性对照。在PWH中，失眠符合标准的占21%，RLS符合标准的占13%，SA符合标准的占6%。与HIV阴性对照相比，PWH患失眠的风险更高（调整后的优势比为5.3；95%置信区间为2.2-12.9），但患RLS或SA的风险并不更高。与没有失眠的PWH相比，患有失眠的PWH在所有SF-36和PROMIS分量表上的得分明显更差；不到30%的人报告曾被诊断或治疗过失眠。
失眠在PWH中更为常见，与较差的健康相关生活质量相关，且经常未被诊断。进一步的研究应聚焦于PWH失眠的发病机制以及针对这一独特人群的有效筛查和干预策略的开发。
