Sleep disorders associated with frailty among middle-aged, older people with HIV

• Sleep disorders such as insomnia and poor sleep quality were associated with physical frailty in middle-aged and older people with HIV.
• Depression mediated the relation between insomnia and physical frailty.

Sleep disorders including insomnia, poor sleep quality and short and long sleep duration were associated with physical frailty among middle-aged and older patients with HIV, researchers found.

“Sleep disorders are common and serious problems among middle-aged and older HIV-positive and HIV-negative individuals,” Qionggui Zhou, PhD, of the Yi-Wu Research Institute at Fudan University, and colleagues wrote.

“Previous studies have found that sleep disorders including poor sleep quality, insomnia, nap duration, and either short or long sleep duration were significantly associated with physical frailty among HIV-negative participants. However, studies on the association between sleep disorders and physical frailty remained scarce in middle-aged and older people living with HIV,” they wrote.

To investigate the association of different sleep disorder symptoms — including insomnia, poor sleep quality and sleep duration — with physical frailty and examine whether depression mediated the association between sleep disorders and physical frailty, the researchers conducted a population-based study of age-sex-matched middle-aged and older patients with HIV and those without HIV aged 40 and older. According to the study, patients were matched in a 1:2 ratio by sex and age categories. The researchers then used logistic regression models to estimate the OR of the association between sleep disorders and physical frailty.

In total, 1,526 people with HIV and 3,052 people without were included in the study. Overall, the study showed that insomnia (OR = 3.05, 95% CI, 1.63-5.72) and poor sleep quality (OR = 2.32; 95% CI, 1.21-4.45) were significantly associated with physical frailty in middle-aged and older people with HIV. This association between insomnia and poor sleep quality and frailty was also more pronounced among patients with current CD4+ T-cell counts of less than 350 cells/L (OR = 5.1; 95% CI, 2.21-11.79 and OR = 4.79; 95% CI, 1.95-11.75, respectively), although not in patients without HIV.

The study found that shorter and longer sleep duration was associated with an increased risk of physical frailty in people with HIV. However, only longer sleep duration was associated with physical frailty in study participants who did not have HIV.

The researchers added that depression mediated the relation between insomnia and physical frailty, with a significant indirect effect (OR = 1.022; 95% C, 1.011-1.037) and direct effect (OR = 1.036; 95% CI, 1.006-1.07). Depression also mediated the association of poor sleep quality and sleep duration with frailty, indicating a significant indirect effect (OR = 1.031; 95% CI, 1.017-1.049 and OR = 0.991; 95% CI, 0.987-0.995, respectively) but nonsignificant direct effect (OR = 1.021; 95% CI, 0.992-1.051 and OR = 1.005; 95% CI, 0.995-1.016, respectively).

“This study revealed that sleep disorders including insomnia, poor sleep quality, short and long sleep duration were significantly associated with physical frailty among middle-aged and older HIV-positive patients, and depression symptom was a mediator of this association,” the authors wrote. “Although future longitudinal studies are necessary to further confirm these findings, our results emphasize that early detection of sleep disorders and psychological disturbances by regular monitoring and timely intervention would be helpful for preventing or delaying physical frailty progression in middle-aged and older people living with HIV.”

By Caitlyn Stulpin

Source:

Zhou Q, et al. Open Forum Infect Dis. 2023;doi:10.1093/ofid/ofad566.

Disclosures: The authors report no relevant financial disclosures.