Sleep Profile and Self-Reported Neuropsychiatric Symptoms in Vertically HIV-Infected Adolescents on cART

Abstract

Background Sleep quality (SQ) data in human immunodeficiency virus (HIV) pediatric population are scarce. Our main objective was to assess SQ in our cohort and to determine the impact of antiretroviral therapy (ART) on sleep in a cohort of HIV-infected adolescents on cART. Materials and Methods The SQ was assessed through the Pittsburgh Sleep Quality Index (PSQI). Neuropsychiatric symptoms (NS) were recorded using an auto-administered questionnaire. To determine the antiretroviral (ARV) impact of efavirenz (EFV) on SQ, patients on EFV versus protease inhibitors-based regimens were compared. Results Forty-six patients were evaluated (median age: 16 years, interquartile range [IQR]: 10.8, 17)). Age at the start of ART: 1.3 years (0.4, 5.2); 23.9% showed acquired immunodeficiency syndrome (AIDS) category. Median CD4 at baseline was 656 (550, 808) cells/mm3; 91.3% had viral load <50 copies/mL. Median time on cART was 11.3 years (7.5, 15.2). Fifty-two percent of the patients were on EFV-based regimen. No differences were found in clinical and immunovirological variables although patients on EFV were older and were exposed for a longer time to ARV. Poor SQ was found in 26.1% of patients. Most frequent complaints were: sleep disturbances (76.1%), sleep latency (63%), and daytime dysfunction (54.3%). Similarly, there were no significant differences in NS between both treatment groups according to patients' reports but were significantly more common in bad sleepers. Patients on EFV-based regimen were more likely to repeat one or more school grades after the adjustment for age at evaluation and nadir CD4 percentage (odds ratio [OR]: 14.421, confidence interval [CI] 95%: 1.207–172.249, p = 0.035). Conclusions Sleep complaints and NS are common among our cohort of HIV adolescents on long-term cART and interestingly, not only in those who were receiving EFV.

Sleep Disturbance in the Context of HIV: A Concept Analysis

“…The third antecedent, physical symptoms, includes fatigue (Chenxi et al, 2019; Han et al, 2021; Voss et al, 2021), pain (Nogueira et al, 2019; Redman et al, 2018; Sabin et al, 2020), apnea (Chen et al, 2021; Gutierrez et al, 2019), gastrointestinal symptoms (Nogueira et al, 2019), and nocturnal sweats (Thorarinsdottir et al, 2019). The fourth antecedent of sleep disturbance is the side effects of the ARV therapy (González-Tomé et al, 2018; Ren et al, 2018; Shikuma et al, 2018; Venkataraman et al, 2021), and the fifth antecedent is social factors, including family and social support (Bedaso et al, 2020; Ren et al, 2018), internalized HIV stigma (Fekete et al, 2018), unsatisfactory lifestyles (dos Santos et al, 2018), low-income (Yan et al, 2021), unemployment (Najafi et al, 2021), and behavioral risk factors (Costa et al, 2019; Downing et al, 2020; Ogunbajo et al, 2020).…”

“…In this analysis, the exemplar was determined from the reviewed articles to maintain the analysts' neutrality. Rodgers (2000) warned analysts not to introduce personal biases by creating or Fatigue and pain (Cody et al, 2021;Han et al, 2021;Pujasari et al, 2021;Redman et al, 2018;Sabin et al, 2020;Sun-Suslow et al, 2022;Voss et al, 2021) Reduced neurocognitive functions (Alikhani et al, 2020;Azimi et al, 2020;Campbell et al, 2019;De Francesco et al, 2021c;González-Tomé et al, 2018;Mahmood et al, 2018) Reduced health outcome and quality of life (Campbell et al, 2019;Downing et al, 2020;Pujasari et al, 2021;Rogers et al, 2020Rogers et al, , 2021Zhang et al, 2021) Poor ARV therapy adherence (Abdu & Dule, 2020;Chaponda et al, 2018;Downing et al, 2020;Pujasari et al, 2021) Day time sleepiness (Milinkovic et al, 2020;Redman et al, 2018;Thorarinsdottir et al, 2019) Depression, anxiety, and maladaptive coping (Cody et al, 2021;Huang et al, 2021;Sun-Suslow et al, 2022) Increased diseases progression and cardiovascular mortality (Gutierrez et al, 2019) Social phobia, living arrangement, sexual dysfunction selecting an exemplar that best represented the analysts' interests. Although multiple exemplars seem beneficial for clarity, locating an appropriate exemplar is not always easy (Rodgers, 2000).…”

“…The concept of sleep disturbance has been used inconsistently in the HIV context. Although sleep disturbanc e was most used among the terms referring to similar concepts, several other concepts have been used interchangeably, including poor sleep (Abdu & Dule, 2020; Alikhani et al, 2020; Cody et al, 2020), sleep complaint (Faraut et al, 2021; González-Tomé et al, 2018), sleep difficulty (Mahmood et al, 2018), sleep disruption (Aouizerat et al, 2021; Hixon et al, 2020), sleep pattern problem (Bedaso et al, 2020), sleep alteration (Moore et al, 2020), sleep disorder (Chen et al, 2021; Chenxi et al, 2019), and insomnia (Buchanan et al, 2018; Cody et al, 2020; Luu et al, 2022; Pujasari et al, 2020). Many previous researchers have undertaken studies to examine sleep among PLWH; however, there is no consensus on an accurate definition of sleep disturbance.…”