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Inter-Relationships Of Sleep, Fatigue, and HIV/AIDS
Between 850,000 and 950,000 Americans are living with HIV infection and suffering from devastating effects on health, performance, and overall quality of life (QOL). As new therapies extend life expectancy of HIV patients, long term adverse impacts on QOL become increasingly important. Although relatively unstudied, sleep disturbance and fatigue are highly prevalent and disabling symptoms in a majority of individuals infected with human immunodeficiency virus (HIV).
Sleep complaints are among the first symptoms of HIV infection and correlate with decreasing CD4+ lymphocyte counts in otherwise asymptomatic HIV seropositive individuals. Fatigue symptoms are associated with increased napping, diminished alertness, difficulty falling asleep, and frequent awakening during sleep. Polysomnographic studies indicate that HIV infection disrupts the normal cycle of alternating rapid eye movement (REM) and non-REM periods associated with restorative sleep; advanced HIV infection is associated with a loss of normal sleep patterns. These impairments in sleep quality may diminish immunological and cognitive-motor function. The onset of these
disturbances in sleep architecture occurs early in the course of HIV disease and appears to be a characteristic of the long clinical latency preceding the development of acquired immunodeficiency disease syndrome(AIDS). For patients with HIV infection, sleep disturbance and fatigue interfere with daily activities, diminish the quality of life, and contribute to a greater risk of unemployment. Advanced HIV infection is associated with a loss of normal sleep patterns.
Common complications of advanced HIV infection, such as peripheral neuropathy, can also be a source of sleep disturbance and exacerbate fatigue symptoms. Some findings suggest that symptoms of sleep disturbance and fatigue are independently associated with survival among people with HIV infection. Although relatively little is known about the pathophysiology or etiology of sleep disturbances and fatigue in patients with HIV disease, it is known that there are reciprocal interactions between sleep and neuroendocrine and immune factors. For example, immune molecules alter sleep architecture, sleep deprivation alters neuroendocrine and immune responses, immune system activation and neuroendocrine responses alter sleep, and sleep quality appears to affect the course of and susceptibility to infectious diseases in general.
HIV infection may also increase the risk of sleep disordered breathing. Adenotonsillar hypertrophy is an early manifestation of HIV infection and can lead to reductions in upper airway dimensions that increase the risk for sleep-disordered breathing in HIV-infected adults compared to the general population. Accumulating evidence indicates that mild to moderate sleep-disordered breathing may be an independent risk factor for hypertension, cardiovascular disease, and stroke. Whether HIV infection modifies these risks is unknown. Studies are needed to determine the epidemiological risks, natural history, and causal mechanism(s) linking HIV-related infections, lymphadenopathy, and other complications of HIV infection to an increased risk of sleep-disordered breathing. Screening instruments and optimal treatment regimens for airway obstruction also need to be developed since available surgical treatment approaches indicated in selected patients present significant added risks for HIV-infected adults.
Insomnia, independent of drug or alcohol use, appears to be a highly prevalent and under-diagnosed disorder in patients with HIV-infection. It is also a common side-effect of anti-retroviral therapies used in HIV treatment. Epidemiological and clinical research are needed to elucidate the neurological and neurobehavioral characteristics of insomnia in HIV-infected individuals, the role in the progression of HIV infection, and the relationship to other symptoms of HIV infection including pain, anxiety, and depression. Developing biomarkers and imaging techniques that define brain sites associated with insomnia may lead to indicators alerting to potential HIV infection.
Source: Department of Health and Human Services (DHHS)
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