| Summary: | 博士 === 國立成功大學 === 護理學系 === 106 === Background: Obstructive sleep apnea (OSA) is a common disease in HIV patients and as an independent risk factor for all-cause mortality. A few studies have focused on OSA, a treatable and manageable disease. In the other hand, Recognition of comorbid sleep disorders in patients with HIV is hampered by limited knowledge on the differences of sleep-related symptoms, sleep architecture, and types of sleep disorders to controls.
Purposes: This study includes two parts: In part one: to toward determining the impact of highly active antiretroviral therapy (HAART) on the incidence of OSA; in part two: we aimed to compare the difference of sleep related symptoms, sleep architecture, and sleep disorders between HIV-infected persons and controls in HIV clinics.
Methods: In part one, a population-based cohort design was conducted using the National Health Insurance Research Database (NHIRD) from 2000 to 2010 containing 13,962 HIV-positive and 738,482 HIV-negative individuals from the general population. The age- and sex-standardized incidence ratio (SIR) will be calculated to estimate the relative risk of OSA, and Cox proportional hazards models are used to evaluate the correlation between HAART and OSA among HIV-infected persons. In part two, the study included 170 men with a Pittsburgh sleep quality index (PSQI) greater than 5, composed of 44 HIV-infected men and 126 male controls who were frequency-matched by sex, age (-/+ 3.0 years) and BMI (-/+ 3.0 kg/m2). For all participants an overnight sleep study using a Somte V1 monitor was conducted. Differences in sleep-related symptoms and sleep disorders between HIV-infected patients and controls were examined using t-tests or Chi-square tests.
Results: In our population-based study, we found that the HIV-infected persons had a 1.4-fold OSA risk compared to that of the general population. The most increased risk for OSA was observed in HIV-infected women and aged between 15-39 years. HAART is a protection factor for OSA (aHR, 0.18; 95% CI, 0.11-0.30) in HIV-infected persons, particularly in those with greater than or equal to 95% adherence to HAART. An increased risk of OSA could be more frequent in those regimens with protease inhibitors (PIs), compared with those containing non-nucleoside reverse transcriptase inhibitors (NNRTIs) regimens. In part 2 study, the data showed that HIV-infected persons with sleep disturbances more often had psychological disturbances (72.7% vs. 40.5%, p〈0.001) and rapid eye movement (REM) behavior disorder (RBD) (25.0% vs. 4.8%, p〈0.01) than that of controls. The sleep-disordered breathing (SDB) in HIV-infected persons was less common than that in controls (56.8% vs. 87.3%, p〈0.001). The mean percentage of REM sleep among HIV-infected patients was higher than that among the controls (20.6% vs. 16.6%, p〈0.001). Enuresis was more common in HIV-infected persons than controls (40.9% vs. 22.2%, p=0.02).
Conclusions: HIV-infected persons have an elevated risk for OSA compared to the general population. Early detection and continuing HAART over 95% adherence may reduce the risk of OSA. Additionally, psychological disturbances and SDB can be the possible explanations of sleep disturbances in HIV-infected persons, in which RBD is notable. Suggested a potential benefit of continued HAART use for at least six months and achieved 95% adherence to reduce the incidence of OSA for persons with an HIV infection. Further studies are warranted to examine underlying factors of RBD among HIV-infected persons with sleep disturbances.
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