Treating obstructive sleep apnea cuts fatigue, improves heart health in people living with HIV

Three months of positive airway pressure (PAP) therapy reduced fatigue and improved cardiovascular markers in people living with HIV and obstructive sleep apnea (OSA), with benefits similar to those observed in individuals without HIV infection.

METHODOLOGY:

• Researchers conducted a prospective cohort study to examine the impact of OSA treatment on sleep quality, fatigue, and cardiovascular health in people living with HIV.
• They enrolled 70 patients with HIV infection and OSA from September 2018 to August 2021, of whom 41 (mean age, 52.8 years; 95.1% men) had at least five breathing events per hour that caused their oxygen levels to drop by 4% or more. These participants were assigned to continuous PAP therapy for 3 months.
• Relevant questionnaires and scales/indexes were used to measure fatigue, level of daytime sleepiness, functional capacity, and sleep quality and disturbances at baseline and after 3 months of PAP therapy.
• Markers of cardiovascular outcomes included the Reactive Hyperemia Index (RHI; where lower values indicated poorer endothelial function), heart rate, and blood pressure.

TAKEAWAY:

• Patients with OSA who received continuous PAP therapy experienced a clinically significant reduction in fatigue at 3 months (mean change in Functional Assessment of Chronic Illness Therapy-Fatigue scale score, 3.6; P = .0012).
• Daytime sleepiness, sleep quality, and functional capacity showed statistically significant but clinically modest improvements.
• The median RHI score improved significantly from baseline to 3 months of PAP therapy (1.6 vs 2.1; P = .0056), and the proportion of patients with poor endothelial function decreased significantly after PAP therapy (P = .016).
• In patients receiving PAP therapy, heart rate decreased significantly by a median of 5 beats/min (P = .014), whereas blood pressure measurements showed no significant changes.

IN PRACTICE:

“Treatment of OSA in PLWH [people living with HIV] can improve fatigue and markers of cardiovascular health, consistent with the effect of PAP treatment of OSA in non-PLWH populations. Therefore, clinicians treating PLWH should consider routinely screening for OSA and, if found, encourage treatment,” the authors wrote.

SOURCE:

The study was led by David L. Berry, BS, Division of Pulmonary, Critical Care, Sleep Medicine & Physiology, University of California, San Diego. It was published online on August 26, 2025, in the Journal of Acquired Immune Deficiency Syndromes.

LIMITATIONS:

Protocol adjustments during the COVID pandemic required reliance on self-reported adherence to PAP instead of objective data. Additionally, the pandemic may have discouraged participation of people living with HIV who had greater comorbidities, potentially affecting the study’s generalizability.

DISCLOSURES:

This study was supported by the National Institutes of Health (NIH) through its institutes. Some authors reported receiving funding, advisory board fees, consulting fees, and research support from the NIH, the American Heart Association, and other organizations outside the present work.

By Shreyasi Asthana