Severe sleep-disordered breathing linked to disturbed sleep in men with HIV

Men with HIV and severe sleep-disordered breathing (SDB) experience the most disrupted sleep, with lower efficiency, more light sleep, and greater stage instability than other groups. These study results were published in Sleep.

Researchers examined whether HIV status independently affected sleep stages and whether SDB, as assessed by the apnea-hypopnea index, modified these associations. A population-based cohort study was conducted within the Multicenter AIDS Cohort Study (MACS), now integrated into the MACS-WIHS Combined Cohort Study. Between March 2018 and June 2019, participants underwent home-based polysomnography.

The analysis included 447 (56.2%) men living with HIV and 349 (43.8%) men who did not have HIV. Those with and without HIV were mostly White (56.4% and 77.1%, respectively). Participants with HIV were younger (median age 56.0 vs 63.0 years) and were more likely to be current smokers (22.9% vs 12.2%). Body mass index (BMI) and SDB severity were similar between groups. Among men with HIV, 93.8% were receiving antiretroviral therapy, with 92.6% achieving viral suppression.

In unadjusted comparisons, men with HIV had shorter total sleep time (364.7 vs 382.5 minutes; P =.006), less time in bed (411.9 vs 427.5 minutes; P =.02), and longer sleep onset latency (20.9 vs 16.9 minutes; P =.03) compared with those without HIV. Between the 2 groups, there were no significant differences in unadjusted sleep stage percentages, arousal index, or wake time after sleep onset.

Compared with participants without SDB or those with mild to moderate SDB, those with severe SDB exhibited significantly lower sleep efficiency and total sleep time, along with significantly higher wake time after sleep onset. This pattern was observed only in men with HIV.

Men with HIV and severe SDB demonstrated the lowest percentages of stage N3 and rapid eye movement (REM) sleep, the highest proportion of stage N1 sleep, and fewer transitions between non-REM and REM sleep stages compared with all other subgroups. These findings persisted after adjustment for age, race, and BMI.

Further, the combination of HIV and severe SDB was uniquely associated with lower total sleep time, reduced sleep efficiency, and greater sleep fragmentation. In contrast, HIV status alone was not significantly associated with altered percentages of N2, N3, or REM sleep, suggesting that the interaction between HIV and severe SDB drives the most pronounced changes in sleep architecture.

Study limitations include an exclusively male population, a cross-sectional design, and data collected more than five years ago.

“Fundamentally, this study shows differences in sleep architecture between men with and without HIV that indicate impaired sleep quality in the former but only with the co-occurrence of severe SDB,” the study authors concluded.

Disclosures: This research was supported by the National Heart, Lung, and Blood Institute.

By Hibah Khaja, PharmD

References:

Punjabi NM, Brown TT, Stefanovski D, et al. Differences in sleep architecture between men living with and without HIV. Sleep. Published online September 11, 2025. doi:10.1093/sleep/zsaf274