Sukumaran Luxsena, Sabin Caroline A, Kunisaki Ken M, Doyle Nicki, Post Frank A, Vera Jaime, Mallon Patrick W G, Sachikonye Memory, Boffito Marta, Anderson Jane, Winston Alan
Institute for Global Health, University College London.
National Institute for Health Research (NIHR) Health Protection Research Unit (HPRU) in Blood-borne and Sexually Transmitted Infections at University College London, London, UK.
AIDS. 2025 Mar 15;39(4):424-433. doi: 10.1097/QAD.0000000000004073. Epub 2024 Nov 28.
We aimed to provide insights into the effects of comorbidities on sleep health in people with HIV by assessing associations between multimorbidity patterns and sleep outcomes in the Pharmacokinetic and clinical Observations in PeoPle over fiftY (POPPY) sub-study.
Principal component analysis identified six multimorbidity patterns among participants with HIV ( n = 1073) at baseline: cardiovascular diseases (CVDs), sexually transmitted diseases, metabolic, mental/joint, neurological and cancer/other. Burden z scores were calculated for each individual/pattern. A subset of 478 participants completed sleep assessments at follow-up, including questionnaires [Insomnia Severity Index (ISI), Patient-Reported Outcomes Measurement Information System (PROMIS) Sleep Disturbance (SD) and Sleep Related Impairment (SRI)] and overnight oximetry [4% oxygen desaturation index (ODI) and percentage of time with oxygen saturation (SpO 2 ) <90%). Multivariable regression assessed associations between burden z scores and sleep measures.
Amongst 309 participants [median (interquartile range) age 53 (47-59) years], 21% had insomnia (ISI ≥15). Higher Mental/Joint z scores were associated with increased odds of insomnia [aOR 1.06 (95% CI 1.03-1.09)] and worse PROMIS-SRI [1.34 (1.22-1.48)] and PROMIS-SD [1.27 (1.16-1.39)] scores. Higher metabolic and neurological z scores were associated with worse PROMIS-SRI scores ( P < 0.01). Higher CVDs z scores were associated with worse ISI and PROMIS-SRI scores, and a higher percentage of time with SpO 2 below 90% (all P 's < 0.01).
This study is among the first to describe specific multimorbidity patterns linked to poorer sleep outcomes in people with HIV. Findings suggest the need for targeted sleep interventions based on multimorbidity profiles, which may mitigate broader health risks associated with poor sleep.
我们旨在通过评估五十岁以上人群药代动力学和临床观察（POPPY）子研究中多种疾病模式与睡眠结果之间的关联，深入了解合并症对HIV感染者睡眠健康的影响。
主成分分析确定了基线时HIV感染者（n = 1073）中的六种多种疾病模式：心血管疾病（CVD）、性传播疾病、代谢性疾病、精神/关节疾病、神经疾病和癌症/其他疾病。计算每个个体/模式的负担z评分。478名参与者的子集在随访时完成了睡眠评估，包括问卷调查[失眠严重程度指数（ISI）、患者报告结果测量信息系统（PROMIS）睡眠障碍（SD）和睡眠相关损害（SRI）]以及夜间血氧饱和度测定[4%氧去饱和指数（ODI）和血氧饱和度（SpO2）<90%的时间百分比]。多变量回归评估了负担z评分与睡眠指标之间的关联。
在309名参与者[年龄中位数（四分位间距）为53（47 - 59）岁]中，21%患有失眠（ISI≥15）。较高的精神/关节z评分与失眠几率增加[aOR 1.06（95%CI 1.03 - 1.09）]以及更差的PROMIS - SRI[1.34（1.22 - 1.48）]和PROMIS - SD[1.27（1.16 - 1.39）]评分相关。较高的代谢和神经z评分与更差的PROMIS - SRI评分相关（P < 0.01）。较高的CVD z评分与更差的ISI和PROMIS - SRI评分以及SpO2低于90%的时间百分比更高相关（所有P值<0.01）。
本研究是首批描述与HIV感染者较差睡眠结果相关的特定多种疾病模式的研究之一。研究结果表明需要基于多种疾病概况进行有针对性的睡眠干预，这可能减轻与睡眠不佳相关的更广泛健康风险。
