Obstructive sleep apnea (OSA), characterized by the repetitive collapse of the upper airway during sleep, results in transient hypoxemia and sleep disturbances. Additionally, OSA can contribute to greater health complications if left untreated. In people living with HIV (PLWH), OSA may be a common issue that is largely undiagnosed, further complicating the patient’s clinical course, according to a paper in Clinical Infectious Diseases.
“OSA is one of the few reversible causes of fatigue,” author Robert L. Owens, MD, of the University of California, San Diego, told Contagion®. “Diagnosis and treatment of OSA in patients with HIV are not common, yet doing so could improve these patients’ quality of life.”
According to Dr Owens, the exact prevalence of OSA in the HIV population is unknown. “But in some cohorts, as many as 70% of men with HIV have OSA,” he explained. “Untreated OSA might contribute to fatigue, increased cardiovascular risk, and ongoing inflammation that are likely to be important symptoms predictive of the disorder, even in those with well-controlled HIV.”
In PLWH, the most common OSA-related symptoms reported include fatigue and disturbed sleep. Despite these symptoms, many patients with HIV do not receive the care they need for their potential sleep disorder. The traditional risk factors for OSA, including older age and obesity, may not be reliable or highly prevalent in PLWH, making a diagnosis in this patient population difficult. Prior or current use of antiretroviral therapy has been associated with OSA in PLWH and may represent a possible predictor, yet little data are available to understand the mechanisms underlying this association.
Witnessed sleep apnea is the most common predictor of fatigue in PLWH, even in patients who have achieved suppression of HIV replication and restoration of normal CD4 cell counts. Therefore, further investigation into OSA among PLWH who report fatigue may be warranted. Additionally, ongoing inflammation, which is attributable to OSA in HIV, may increase the likelihood of elevated C-reactive protein >3.0 mg/dL and higher tumor necrosis factor α levels, findings which necessitate OSA screening in HIV patients for potentially improving the clinical course.
Dr Owens and colleagues suggest that clinical researchers should consider OSA not as a separate comorbidity in HIV, but as a contributor to some of the comorbidities commonly experienced by PLWH. The authors also indicate that OSA diagnosis and treatment in HIV patients may help control some of these comorbidities (e.g., hypertension and diabetes) while having a substantial impact on patients’ mental and emotional wellbeing.
Screening tools for OSA, although primarily focused on obesity as a primary predictive factor, may represent an initial starting point where clinicians can assess an HIV patient’s OSA status. Once OSA is confirmed in PLWH, standard treatment with continuous positive airway pressure may be the best option for managing both sleep disturbances and, consequently, accompanying comorbidities.
Considering both OSA and HIV contribute to cardiovascular and inflammatory health complications, identifying this sleep disorder in HIV patients could further reduce the potential risk for additional comorbidities in HIV patients, thereby improving both prognosis and life quality. “HIV providers may not think about looking for OSA,” Dr Owens added. “Getting the word out with this article is designed to address that gap, but more research needs to be performed.”
By Brandon May