Faculty of Health and Medical Sciences, University of Surrey, Guildford, GU2 7XH, UK.
MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), University of the Witwatersrand, Johannesburg, South Africa; School of Public Health, University of the Witwatersrand, Johannesburg, South Africa.
Sleep Med Rev. 2022 Oct;65:101571. doi: 10.1016/j.smrv.2021.101571. Epub 2021 Nov 20.
Antiretroviral therapy has significantly reduced morbidity and mortality in people living with HIV (PLWH). However, a direct consequence of higher survival is the development of ageing-related co-morbidities that have considerable potential to affect quality of life. Sleep disturbances in PLWH are a significant source of morbidity. A meta-analysis has estimated the prevalence of self-reported sleep disturbances in PLWH to be 58%, with commonly identified disturbances including insomnia, obstructive sleep apnoea and poor sleep quality. Not only do sleep disturbances impair daytime functioning, but chronic sleep disruption also associates with metabolic dysregulation and cardiometabolic disease. Therefore, an understanding of the pathogenesis of sleep disturbances in PLWH is important for reducing morbidity and improving quality of life. Several pathophysiological processes in HIV infection may cause sleep-wake dysregulation. In early infection stages, immunological changes such as expression of sleep-promoting cytokines could mediate sleep disturbances. Long term, chronic immune activation, in addition to side effects of antiretroviral therapy, may impact sleep homeostasis more severely, for example through increasing the risk of obstructive sleep apnoea. These sleep disturbances may further contribute to an inflammatory state, due to the bi-directional relationship between sleep and immunity. In summary, further elucidating the link between HIV, immune activation, and sleep is an underexplored avenue for minimising population morbidity and mortality.
抗逆转录病毒疗法显著降低了艾滋病毒感染者（PLWH）的发病率和死亡率。然而，更高存活率的直接后果是与衰老相关的合并症的发展，这些合并症有可能极大地影响生活质量。PLWH 的睡眠障碍是发病率的一个重要来源。一项荟萃分析估计，PLWH 自我报告的睡眠障碍患病率为 58%，常见的睡眠障碍包括失眠、阻塞性睡眠呼吸暂停和睡眠质量差。睡眠障碍不仅会损害白天的功能，而且慢性睡眠中断还与代谢失调和心血管代谢疾病有关。因此，了解 HIV 感染者睡眠障碍的发病机制对于降低发病率和提高生活质量非常重要。HIV 感染中的几个病理生理过程可能导致睡眠-觉醒失调。在早期感染阶段，免疫变化，如促进睡眠的细胞因子的表达，可能介导睡眠障碍。长期慢性免疫激活，加上抗逆转录病毒治疗的副作用，可能会更严重地影响睡眠稳态，例如通过增加阻塞性睡眠呼吸暂停的风险。这些睡眠障碍可能由于睡眠和免疫之间的双向关系而进一步导致炎症状态。总之，进一步阐明 HIV、免疫激活和睡眠之间的联系是减少人群发病率和死亡率的一个未被充分探索的途径。
