Sleep Disorders and Challenges in People Living with Human Immunodeficiency Virus: A Narrative Literature Review

Purpose of Review Understanding the prevalence, presentation, and outcomes of the contribution of sleep disorders to sleep disruption and quality of life of persons living with human immunodeficiency virus (HIV) infection (PLWH) is crucial for planning comprehensive patient care and management strategies. This review focuses on the presence of sleep disorders in PLWH and identifies possible challenges and treatment options. Recent Findings The prevalence of insomnia among PLWH is significantly higher than in the general population (29–97%), due to complex and multifactorial mechanisms. A multidisciplinary approach that incorporates behavioral therapies and, when appropriate, pharmacological interventions, while closely monitoring for potential drug interactions, should be carried out. Men with HIV may have an increased frequency of sleep disordered breathing, possibly associated to inflammatory markers which can be counteracted by adequate ventilation at night. Also, restless legs syndrome (RLS) seems to be frequent in PLWH with a possible main involvement of iron metabolism and dopaminergic dysfunction. HIV directly affects the suprachiasmatic nucleus, with the potential contribution of specific genetic factors, potentially resulting in circadian rhythm sleep-wake disorders. Also, narcolepsy might be hypothesized to be favored by HIV infection. Summary Sleep disorders, such as insomnia, OSA, and RLS are common in PLWH, but other less common disorders, such as narcolepsy and circadian rhythm sleep-wake disorders, can also be present. Although there is literature on the complexity of the pathophysiology in these disorders, evidence is lacking on the effectiveness of treatment options and on the specific effects of sleep disorders in all populations affected by HIV.