title: Prevalence and factors associated with sleep disturbances among early-treated HIV-infected persons.
abstract: BACKGROUND
  Sleep disturbances are reportedly common among persons infected with human immunodeficiency virus (HIV), but recent data, including comparisons with HIV-uninfected persons, are limited.
  
  
  METHODS
  We performed a cross-sectional study among early-treated HIV-infected military beneficiaries (n = 193) to determine the prevalence and factors associated with insomnia (Pittsburgh Sleep Quality Index [PSQI]) and daytime sleepiness (Epworth Sleepiness Scale [ESS]). Data were compared with HIV-uninfected persons (n = 50) matched by age, sex, race or ethnicity, and military rank.
  
  
  RESULTS
  Forty-six percent of HIV-infected persons had insomnia (PSQI >5), and 30% reported daytime drowsiness (ESS ≥10). The prevalence of insomnia and daytime sleepiness was not significantly higher compared with the HIV-uninfected group (38% [P = .30] and 20% [P = .18], respectively). In the multivariate model, factors associated with insomnia among HIV infected patients included depression (odds ratio [OR], 16.8; 95% confidence interval [CI], 2.0-142.1; P = .01), increased waist size (OR, 2.7; 95% CI, 1.4-5.1; P = .002), and fewer years of education (OR, 0.8; 95% CI, .7-.95; P = .006). Neurocognitive impairment (diagnosed in 19% of HIV-infected participants) was not associated with insomnia; however, HIV-infected persons with insomnia were 3.1-fold more likely to have a decline in activities of daily living than those without insomnia (23% vs 9%; P = .01). Only 18% of HIV-infected persons reported using a sleep medication at least weekly.
  
  
  CONCLUSIONS
  HIV-infected persons have a high prevalence of insomnia, but among an early-treated cohort this rate was not significantly higher compared with HIV-uninfected persons. Factors associated with insomnia among HIV-infected patients include depression and increased waist size. Prompt diagnosis and treatment of sleep disturbances are advocated and may improve quality of life.
authors.affiliation: Infectious Disease Clinical Research Program, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA. nancy.crum@med.navy.mil
authors.forename: Nancy F
authors.initials: NF
authors.lastname: Crum-Cianflone
authors.forename: Mollie Poehlman
authors.initials: MP
authors.lastname: Roediger
authors.forename: David J
authors.initials: DJ
authors.lastname: Moore
authors.forename: Braden
authors.initials: B
authors.lastname: Hale
authors.forename: Amy
authors.initials: A
authors.lastname: Weintrob
authors.forename: Anuradha
authors.initials: A
authors.lastname: Ganesan
authors.forename: Lynn E
authors.initials: LE
authors.lastname: Eberly
authors.forename: Erica
authors.initials: E
authors.lastname: Johnson
authors.forename: Brian K
authors.initials: BK
authors.lastname: Agan
authors.forename: Scott
authors.initials: S
authors.lastname: Letendre
mesh_terms: D000293:Adolescent; D000328:Adult; D019380:Anti-HIV Agents / Q000008:administration & dosage*; D003430:Cross-Sectional Studies; D005260:Female; D015658:HIV Infections / Q000150:complications* / Q000188:drug therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D012307:Risk Factors; D007319:Sleep Initiation and Maintenance Disorders / Q000453:epidemiology*; D055815:Young Adult
chemical_list: D019380:Anti-HIV Agents