Daytime Sleep Behaviors and Cognitive Performance in Middle- to Older-Aged Adults Living with and without HIV Infection

Abstract

We investigated whether daytime sleep behaviors (DSBs) such as frequent daytime sleepiness or napping are associated with worse cognitive performance, and whether HIV infection moderates this relationship. Methods: Among 502,507 participants in the UK Biobank study, we identified 562 people living with HIV infection (PLWH; M age = 50.51±7.81; 25.09% female; 78.83% white) and extracted 562 uninfected controls who matched on age, sex, ethnic background, social-economic status, and comorbidities. DSB burden was assessed based on answers to two questions on DSBs. Participants who answered "sometimes" or "often/usually" to one of them were considered to have poor DSB burden, or otherwise were considered not having any. A composite cognition score was computed by averaging the available standardized individual test results from four neurocognitive tests: ie, a reaction time test for information processing speed, a pairs matching test for visual episodic memory, a fluid intelligence test for reasoning, and a prospective memory test. Mixed-effects models with adjustment for the variables used in extracting matched uninfected controls were performed to test the hypotheses. Results: Having poor DSB burden was associated with a 0.15 -standard deviation (SD) decrease in cognitive performance (p = 0.006). People living with HIV infection (PLWH) also performed worse on the cognitive tasks than uninfected controls, with an effect size similar to that of having poor DSB burden (p = 0.003). HIV infection significantly modified the negative association between DSB burden and cognition (p for interaction: 0.008). Specifically, the association between DSB burden and cognition was not statistically significant in uninfected controls, whereas PLWH who reported having poor DSB burden had a 0.28 -SD decrease in cognitive performance compared to PLWH who did not. Conclusion: HIV infection significantly increased the adverse association between DSBs and cognitive performance. Further studies are needed to investigate the potential mechanisms that underlie this interaction effect and whether poor DSBs and worse cognitive performance are causally linked.

Do sleep disturbances contribute to comorbidities in HIV?

“…Self-reported sleep symptoms often lack good correlation to actigraphy-based measures [26,27], but symptoms and actigraphy capture different dimensions of sleep. Although POPPY found no association between RU-SATED sleep dimensions and cognitive test results [19 ▪▪ ], other studies have demonstrated worse cognitive test results in PWH with self-reported daytime sleepiness (reported by 67% of n = 562 PWH in UK Biobank data and 58% of n = 562 matched controls) [28] and worse subjective cognitive complaints in PWH with self-reported poor sleep satisfaction (reported by 62% of n = 435 PWH in China), even after controlling for anxiety and fatigue symptoms [29].…”

“…Self-reported sleep symptoms often lack good correlation to actigraphy-based measures [26,27] [28] and worse subjective cognitive complaints in PWH with self-reported poor sleep satisfaction (reported by 62% of n ¼ 435 PWH in China), even after controlling for anxiety and fatigue symptoms [29].…”

Habitual glucosamine use, APOE genotypes, and risk of incident cause-specific dementia in the older population

“…The signs of the z -scores for Reaction Time and Pairs Matching were reversed, so a higher z -score for each cognitive function test represents a better performance. In addition, a composite measure of global cognitive function was then calculated by averaging the available z-scores for each participant [ 30 ].…”

Delayed circadian rhythms in older Africans living with human immunodeficiency virus (HIV)

“… 7 While generalised sleep disturbances are widely reported in PLWH, the exact nature of these disturbances is scarcely discussed in the existing literature and generally lacks biological precision. 8 Reports describe cognitive performance decrements associated with higher daytime sleepiness, 9 symptoms associated with insomnia 10 and atypical, apparently weight‐independent presentations of obstructive sleep apnoea 11 in PLWH. Additionally, in a cohort of veterans, it was observed that PLWH with ‘highly bothersome symptoms of insomnia’ had a higher risk of incident CVD than PLWH without insomnia, suggesting an independent role of sleep in enhancing CVD risk in PLWH.…”