Abstract
BACKGROUND: Even with modern therapy, people living with HIV (PLWH) commonly experience fatigue and face increased risk of cardiovascular disease. Obstructive sleep apnea (OSA) is common in PLWH and might contribute to these symptoms, yet the impact of OSA treatment in this population is underinvestigated. SETTING: Academic university-affiliated HIV and sleep medicine clinics. METHODS: One hundred twenty PLWH underwent polysomnography and completed questionnaires measuring fatigue, daytime sleepiness, perception of cognitive functioning, and sleep quality. Those with OSA were offered positive airway pressure (PAP) therapy. All measurements were repeated after 12 weeks of treatment. Cardiovascular outcome markers included peripheral arterial tonometry (reactive hyperemia index), heart rate, and blood pressure. RESULTS: Seventy persons had OSA and 41 (59%) elected to use PAP. Participants demonstrated a mean (secure digital) age of 52.8 (8.8) years, 39 men, mean body mass index 28.2 (3.9) kg/m 2 , and apnea hypopnea index 4% 33.5 (26.1). PAP therapy was associated with statistically ( P < 0.05) and clinically significant improvements in fatigue [pre 39 (27 to 44) vs. post 42 (32 to 48)], reactive hyperemia index [1.6 (1.4 to 2.2) vs. 2.1 (1.7 to 2.7)], and heart rate [73 (64 to 80.50) vs. 68 (61 to 73) beats per minute]. Daytime sleepiness, sleep quality, and perception of cognitive functioning all showed improvement ( P < 0.05), although changes were clinically modest. CONCLUSIONS: Treatment of OSA in PLWH can improve fatigue and markers of cardiovascular health, consistent with PAP treatment of OSA in non-PLWH populations. Our findings support assessment and treatment of OSA in PLWH to address commonly experienced symptoms.