Anthropometry in the prediction of sleep disordered breathing in HIV-positive and HIV-negative men.
BACKGROUND
Body mass index (BMI), waist circumference (WC) and neck circumference (NC) are important screening tools for sleep disordered breathing (SDB); however, the utility of anthropometry for this purpose has not been evaluated among HIV-positive patients.


METHODS
HIV-negative men (n=60), HIV-positive men receiving highly active antiretroviral therapy (HIV-positive/HAART; n=58) and HIV-positive men not receiving HAART (HIV-positive/no HAART; n=41) from the Multicenter AIDS Cohort Study underwent a nocturnal sleep study and anthropomorphic assessment. Moderate-severe SDB was defined as an apnea/hypopnea event rate > or =15 episodes/h. Receiver operating characteristic (ROC) curves were used to compare the ability of different anthropometric measurements to predict SDB within each group.


RESULTS
Moderate-severe SDB was found in 48% of men (HIV-negative [57%], HIV-positive/HAART [41%] and HIV-positive/no HAART [44%]). The performance of BMI, WC and NC to predict SDB was excellent among the HIV-negative men (ROC areas under the curve [AUCs] 0.83, 0.88 and 0.88, respectively) and fair among the HIV-positive/HAART group (AUC 0.71, 0.77 and 0.77, respectively). By contrast, these measurements had no predictive value in the HIV-positive/no HAART group (AUC 0.43, 0.41 and 0.45, respectively). Moreover, in the HIV-positive/no HAART group, moderate-severe SDB was independently associated with serum C-reactive protein > or =3.0 mg/l (odds ratio 6.9; P=0.04) and HIV RNA>10,000 copies/ml (odds ratio 7.1; P=0.05).


CONCLUSIONS
BMI, WC and NC had a better predictive value for moderate-severe SDB in HIV-positive men compared with HIV-positive [corrected] men, and had no value among HIV-positive/no HAART men. Among this latter group, systemic inflammation might contribute to the pathogenesis of SDB.
Brown
Todd T
TT
Division of Endocrinology and Metabolism, Johns Hopkins School of Medicine, Baltimore, MD, USA. tbrown27@jhmi.edu.
Patil
Susheel P
SP
Jacobson
Lisa P
LP
Margolick
Joseph B
JB
Laffan
Alison M
AM
Godfrey
Rebecca J
RJ
Johnson
Jacquett R
JR
Johnson-Hill
Lisette M
LM
Reynolds
Sandra M
SM
Schwartz
Alan R
AR
Smith
Philip L
PL
D000328:Adult; D000886:Anthropometry / Q000379:methods*; D023241:Antiretroviral Therapy, Highly Active; D001823:Body Composition / Q000502:physiology; D050218:Body Fat Distribution; D015992:Body Mass Index; D015331:Cohort Studies; D015658:HIV Infections / Q000150:complications* / Q000188:drug therapy; D018023:HIV Seronegativity / Q000502:physiology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D012891:Sleep Apnea Syndromes / Q000150:complications / Q000175:diagnosis* / Q000453:epidemiology; D055105:Waist Circumference; D049629:Waist-Hip Ratio