Sleep, Sleep Apnea, and Fatigue in People Living with HIV

People living with HIV (PLWH) often report fatigue even when viral load is suppressed. Obstructive sleep apnea (OSA), which is often associated with fatigue, is common in PLWH, but whether OSA explains fatigue in this population is unknown. Academic university-affiliated HIV and Sleep Medicine Clinics. PLWH age 18-65 years, body mass index 20-35kg/m2 and with viral suppression (RNA <200copies per mL) were recruited to undergo daytime questionnaires including the Functional Assessment of Chronic Illness Therapy Fatigue Scale (FACIT-F) and Epworth Sleepiness Scale (ESS), seven days of actigraphy (to determine daily sleep duration and activity amplitude and rhythms) and an in-laboratory polysomnography to assess for presence and severity of OSA. Of 120 participants with evaluable data, 90 (75%) had OSA using the American Academy of Sleep Medicine 3% desaturation or arousal criteria with apnea-hypopnea index >5/hour. There was no difference in FACIT scores between those with and without OSA, although those with OSA did report more daytime sleepiness by ESS. In a multivariable model, predictors of fatigue included more variable daily sleep durations as well as decreased mean activity counts. Sleepiness was predicted by the presence of OSA. OSA was very common in our cohort of PLWH, with those with OSA reporting more sleepiness but not more fatigue. Variability in sleep duration was associated with increased fatigue. Further study is needed to determine if treatment of OSA, or an emphasis on sleep consistency and timing, improves symptoms of fatigue in PLWH.