Effects of Treating Obstructive Sleep Apnea on Common Symptoms of HIV

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 PWLH and might contribute to these symptoms, yet the impact of OSA treatment in this population is under-investigated. Setting: Academic university-affiliated HIV and Sleep Medicine Clinics. Methods: 120 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, RHI), heart rate and blood pressure. Results: 70 persons had OSA and 41 (59%) elected to use PAP. Participants demonstrated a mean (SD) 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), RHI (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. Conclusion: 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.