Prevalence and Predictors of Sleep-Disordered Breathing in Men Participating in the Multicenter AIDS Cohort Study

Abstract

Background: Data on the prevalence of sleep-disordered breathing (SDB) in people with HIV are limited. Moreover, whether the associations between SDB and age or BMI differ by HIV status is unknown.

Research question: Is SDB more prevalent in men with HIV than those without HIV, and do the predictors of SDB differ between the two groups?

Study design and methods: Home polysomnography was used in the Multicenter AIDS Cohort Study to assess SDB prevalence in men with (n = 466; 92% virologically suppressed) and without (n = 370) HIV. SDB was defined using the oxygen desaturation index (ODI) and the apnea-hypopnea index (AHI), using four definitions: ≥ 5 events/h based on an ODI with a 3% (ODI₃) or 4% (ODI₄) oxygen desaturation, or an AHI with a 3% oxygen desaturation or EEG arousal (AHI_3a) or with a 4% oxygen desaturation (AHI₄).

Results: SDB prevalence was similar in men with and without HIV using the ODI₃ and AHI_3a definitions. However, SDB prevalence was higher in men with than without HIV using the ODI₄ (55.9% vs 47.8%; P = .04) and the AHI₄ definitions (57.9% vs 50.4%; P = .06). Mild and moderate SDB were more common in men with than without HIV. Associations between SDB prevalence and age, race, and BMI were similar in men with and without HIV. Among men with HIV, viral load, CD4 cell count, and use of antiretroviral medications were not associated with SDB prevalence.

Interpretation: SDB prevalence was high overall but greater in men with than without HIV using the ODI₄ threshold definition. Efforts to diagnose SDB are warranted in people with HIV, given that SDB is associated with daytime sleepiness and impaired quality of life.

Keywords: HIV; prevalence; sleep apnea; sleep-disordered breathing.