Sleep Apnea Symptoms as a Predictor of Fatigue in an Urban HIV Clinic

Abstract

Fatigue is common among persons living with HIV (PLWH), and risk factors for obstructive sleep apnea (OSA) such as older age and obesity are increasingly prevalent. Studies of OSA among PLWH are lacking, so we aimed to characterize OSA symptoms and associated clinical consequences (e.g., fatigue) among a contemporary population of PLWH. Self-administered surveys containing 23 items that included self-reported snoring, witnessed apneas, estimated sleep duration, the Epworth Sleepiness Score (ESS), and the FACIT-Fatigue score were mailed to PLWH receiving care at an urban HIV clinic. Clinical/demographic data were collected from the medical record. Multivariable linear regression models were created to study relationships between fatigue, clinical variables, and OSA symptoms. Of 535 surveys, 203 (38%) responded. Eight patients (3.9%) had known OSA. Among those without known OSA, mean respondent characteristics included: age 47 years; 80% male, 41% African American, 48% Caucasian, BMI 26.4 kg/m 2 , duration of HIV diagnosis 12 years, 93% on antiretroviral therapy, and 81% with <50 HIV RNA copies/mL. 27% reported snoring, 24% reported witnessed apneas, and 38% had excessive daytime sleepiness. Witnessed apnea was the strongest independent predictor of fatigue (lower FACIT-Fatigue score; b = -6.49; p < 0.001); this difference of 6.49 points exceeds the accepted minimal clinically important difference of 3.0 points. Other predictors included opioid use (b = -5.53; p < 0.001), depression (b = -4.18; p = 0.02), antidepressant use (b = -4.25; p = 0.02), and sleep duration < 6 h (b = -3.42; p = 0.02). Our data strongly support the need for increased efforts directed at OSA screening and treatment in PLWH.

Burden of fatigue among adults living with HIV/AIDS attending antiretroviral therapy in Ethiopia

“…In our study, participants who had anemia had approximately five times higher risk for developing fatigue than those without anemia which is in line with the studies done in the USA [38] and China [31]. Anemia is a wellknown reason for fatigue.…”

“…This consistent result can be explained by the use of large sample size, similarities in study population and similarities in eligibility criteria. On the other hand the prevalence in our study was lower than the finding of other studies done in South Africa, 66.7% [9], United Kingdom (UK), 65.1% [17], Uganda (61%) [38], and China, 86.8% [31]. This discrepancy could be due to difference in study criteria, for example, the study in South Africa used study-subjects who were extremely ill and the other two studies (Uganda and the UK) used participants who developed at least two HIV-related symptoms, which may increase the prevalence of fatigue.…”

Burden of Fatigue among Adults Living with HIV/AIDS Attending Antiretroviral Therapy in Ethiopia

“…On the other hand the prevalence in our study was lower than the finding of other studies done in South Africa, 66.7% [9], UK, 65.1% [17], Uganda (61%) [38], and China, 86.8% [31]. This discrepancy could be due to difference in study criteria, for example, the study in South Africa used study-subjects who were extremely ill and the other two studies (Uganda and UK) used participants who developed at least two HIV-related symptoms, which may increase the prevalence of fatigue.…”

Experience of fatigue and related factors among HIV-infected adults attending ART clinic in Ethiopia; a cross-sectional study

“…In this study, the key predictors that were signi cantly associated with fatigue among HIV/AIDS adults were clinically diagnosed anemia, low income, parity, and living without a spouse. Likewise, studies done in the USA and China reported an association between fatigue and anemia [42,44,45]. Fatigue is the cardinal symptom of anemia, a prognostic marker of disease progression, and frequently reported as a predictor of morbidity and mortality among HIV/AIDS patients.…”