Table 4.
Comparison of our results with the most representative epidemiologic studies of sleep disorders in HIV-infected patients in the last 10 years.
| Study | Location | Study design | n | Mean age (range) | Sex % male race/ethnicity | Obesity rate or BMI | CD4 count | Assessment instruments | Depression rate | Sleep outcome(s) | Major findings |
|---|---|---|---|---|---|---|---|---|---|---|---|
| Crum-Cianflone et al.3 | Multi-center, USA | CS | 193 HIV+, 50 matched controls | 36 (18–54) | 95% male, 50% White | Mean BMI kg/m2 (SD) 27.5 (4.5) |
CD4 count mean (SD) 587 (230) |
PSQI, ESS | 7% (HIV+) and 0% (Control) | Insomnia (PSQI > 5), daytime drowsiness (ESS ⩾ 10) | 46% insomnia in HIV-patients vs 38% (p = 0.3) in controls. Depression (OR:16.8), increased in waist size (OR:2.7), and fewer years of education (OR:0.8) were associated with insomnia |
| Jean-Louis et al.28 | Brooklyn, USA | CS | 1161 HIV+, 521 controls | 20–70 years | 0% male, 63% Black, 24% Hispanic | Obesity rate (BMI > 30) 40% |
CD4 < 500 cells/mL (44% vs 46%, control vs HIV+) |
insomnia survey, CES-D | 27.6% vs 9.6% in patients with insomnia vs no insomnia | Insomnia diagnosis | Prevalence of insomnia symptoms did not vary significantly by HIV status except in younger women. Depression was the most significant predictor for insomnia. |
| Avellana et al.36 | “Pays de la Loire,” France | CS | 1354 HIV+ | 47 (40–54) | 73.5% male, race not reporteda | Mean BMI kg/m2
(range) 23.5 (21–26.1) |
CD4 count mean (range) 604 (434–784) |
PHQI, BDI-II, WHO QOL | 19.70% | Poor sleep quality (PSQI > 5) |
47% poor sleep quality, poor sleep was associated with depression, male gender, active smoking, nevirapine, or efavirenz in ART |
| Byun et al.11 | San Francisco, USA | CS | 268 HIV+ | 44.8 (27.8–61.5) | 67% male, 42% White | Mean BMI kg/m2
(range) 27 (21.4–32.6) |
CD4 count ⩾ 200 (83%) | PSQI, MOS, LFS, Actigraphy | b | Poor sleep quality (PSQI > 5), TST, WASO | 63% poor sleep quality. Lower self-reported cognitive functional scores were associated with poorer sleep quality, total sleep time (low or high), and greater fatigue |
| Gutierrez et al.47 | Philadelphia, USA | CS | 176 HIV+ | 49 (43–55) | 44% male, 75% Black, 12% Hispanic | Mean BMI kg/m2 (range) 29.5 (16.9–55.2) |
CD4 count mean (range) 559 (359–848) |
PSQI, ESS, ISQ, PHQ-9, STOP-BANG and sleep hygiene survey | 48% | Poor sleep quality (PSQI > 5), Insomnia diagnosis, OSA risk |
73% poor sleep quality, 52% met insomnia diagnosis, 59% mod-high risk of OSA. Self-reported sleep disturbances, Black race, and obesity were associated with poor sleep. |
n: number of patients; SD: standard deviation; BMI: body mass index; CS: cross-sectional; PSQI: Pittsburgh Sleep Quality Index; ESS: Epworth Sleepiness Scale; OR: odds ratios; CES-D: Center for Epidemiological Studies Depression; ART: Anti-Retroviral Therapy; BDI-II: Beck Depression Inventory-II; WHO QOL: World Health Organization quality of life assessment HIV BREF questionnaire; MOS: Medical Outcome Study Cognitive Functional Scale; LFS: Lee Fatigue Scale; TST: Actigraphy-based total sleep time; WASO: wake after sleep onset; ISQ: Insomnia Symptoms Questionnaire; PHQ9: Patient Health Questionnaire for depression; OSA: obstructive sleep apnea.
race/ethnicity were not reported. Country of birth was France for 82.9%, Africa 14.7%.
Depression rate not reported. Antidepressant rate use was 35%. Participants were excluded if reported schizophrenia, bipolar disorder, or dementia.