title: High prevalence of insomnia in an outpatient population with HIV infection.
abstract: OBJECTIVE
  To determine the prevalence, characteristics, and clinical recognition of insomnia in HIV-seropositive outpatients.
  
  
  METHODS
  Systematic sample of patients attending an outpatient HIV/AIDS clinic at an urban teaching hospital.
  
  
  METHODS
  Patients were recruited for standard interviews including Pittsburgh Sleep Quality Index (PSQI); Mini Mental State Exam (MMSE); Trail Making Test A and B, and Hospital Anxiety and Depression Scale. Abstraction of medical records was used to assess clinician identification of insomnia.
  
  
  RESULTS
  115 of 127 (91%) patients who were approached agreed to be interviewed for the study. Of these, 79 (69%) were male, 36 (31%) female; 38 (33%) black, 64 (56%) white, 12 (10%) Hispanic, 1 (1%) native American; 45 (39%) were injection drug users. Eighty-four (73%) respondents were classified as having a sleep disturbance according to the PSQI. Patients with cognitive impairment had a higher prevalence of insomnia (100% versus 70%; p = .034). A trend was shown for drug-using patients to report a higher prevalence of insomnia than nondrug users (86% versus 69%; p < .07). Using multivariate analysis, cognitive impairment (odds ratio [OR] = 1.4) as defined by the neuropsychiatric test battery and depression (OR = 1.2) were the best predictors of insomnia (p < .05). Only 28 (33%) patients with insomnia had any documentation of sleep disturbance in their clinical medical records.
  
  
  CONCLUSIONS
  Insomnia is widespread and underdiagnosed in HIV-seropositive ambulatory patients. Insomnia is especially prevalent among those with cognitive impairment. These findings suggest the importance for clinicians to inquire specifically about sleep disorders in HIV-seropositive patients. Prompt diagnosis and treatment may improve the quality of life in patients living with HIV.
authors.affiliation: AIDS Program, Yale School of Medicine, New Haven, Connecticut 06510, USA.
authors.forename: M L
authors.initials: ML
authors.lastname: Rubinstein
authors.forename: P A
authors.initials: PA
authors.lastname: Selwyn
mesh_terms: D000328:Adult; D001008:Anxiety Disorders / Q000150:complications; D003072:Cognition Disorders / Q000150:complications; D003430:Cross-Sectional Studies; D003863:Depression / Q000150:complications; D005260:Female; D006679:HIV Seropositivity / Q000150:complications* / Q000188:drug therapy; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D010045:Outpatients / Q000706:statistics & numerical data*; D015995:Prevalence; D007319:Sleep Initiation and Maintenance Disorders / Q000150:complications / Q000188:drug therapy / Q000453:epidemiology*; D015819:Substance Abuse, Intravenous / Q000150:complications