Obstructive Sleep Apnea Syndrome and HIV/AIDS

Photo couresty of pixabay

Photo couresty of pixabay

In June of 1981, five young, homosexual, males presented with unusual symptoms that stumped doctors in Los Angeles. These previously healthy and otherwise normal patients received a diagnosis known only to the immunosuppressed, Pneumocystis pneumonia (PCP) and Kaposi's sarcoma (KS). A few weeks later, 26 more gay-identifying men in San Francisco fell ill to the same diseases. By the fall of 1981, 100 cases had been reported to the CDC, and by February 1983, that number was in the 1000’s (Osmond, 2003). The disease was spreading. Due to the nature of this disease and the population it initially affected, it was termed gay-related immunodeficiency syndrome or GRIDS. By September of 1982, the Center for Disease Control (CDC) renamed this disease as we know it as today, acquired immunodeficiency syndrome, more commonly referred to as AIDS. Although the clinical diagnosis of AIDS and subsequently HIV did not come about until 1982, there is evidence that this disease existed in the U.S. as early as the 1960’s.

HIV/AIDS and Obstructive Sleep Apnea

People with HIV who also have obstructive sleep apnea syndrome (OSAS) frequently are not diagnosed with a sleep disorder. The development of body weight gain and lipodystrophy due to antiretroviral therapy may lead to disturbances in sleep, particularly OSAS. A retrospective review of the medical records of consecutively identified HIV-infected subjects who were diagnosed with OSA by overnight polysomnography between January 1, 2003 and December 31, 2004 was performed. Twelve HIV-infected subjects with OSA confirmed by polysomnography (total apnoea/hypopnoea index > or = 5) were identified. Daytime somnolence, fatigue, and snoring were the most common symptoms identified. Eleven (92%) subjects were overweight/obese, and seven (58%) had lipodystrophy. Eleven (92%) had a neck size > or =40.0 cm. Increased neck circumference, overweight or obese body mass index, and lipodystrophy are therefore potential risk factors for OSA among HIV patients. Clinicians caring for HIV patients with these characteristics should inquire about symptoms associated with OSAS

What is Obstructive Sleep Apnea

Sleep apnea occurs when the upper airway becomes blocked repeatedly during sleep, reducing or completely stopping airflow. This is known as obstructive sleep apnea.

Symptoms of Obstructive Sleep Apnea

Daytime Symptoms of OSAS

Non-refreshing sleep

Morning headaches

Low energy level

Difficulty concentrating

Involuntary napping

Memory problems

Easily frustrated

Attention deficit Disorder

 

Night-time Symptoms of OSAS

Difficulty falling asleep

Frequent night time awakenings

Frequently waking up to urinate

Restless sleep

Nightmares

DIY Sleep Apnea Screening Questionnaires

You can find free questionnaires to see if you are at risk for having obstructive sleep apnea

The Berlin Questionnaire https://www.sleepapnea.org/wp-content/uploads/2017/02/berlin-questionnaire.pdf

The Stop-Bang Questionnaire https://www.faa.gov/about/office_org/headquarters_offices/avs/offices/aam/ame/guide/media/STOP%20BANG%20Questionnaire.pdf

Both questionnaires can help you determine whether or not you need to talk with your doctor about obstructive sleep apnea.  Compared to the Stop-Bang Questionnaire, The Berlin Questionnaire is more commonly used in research settings.  The Stop-Bang was developed as a pre-surgical tool to rapidly screen patients before surgery. For those of you wanting to learn more about these questionnaires, here is an article that compares the two types of questionnaires. http://www.stopbang.ca/publication/pdf/pub6.pdf

What to Do When Your DIY Test is Positive For Obstructive Sleep Apnea Syndrome

You will need to confirm that you actually have OSAS. Obstructive sleep apnea is diagnosed based on signs, symptoms and objective testing such as a home sleep test or a polysomnogram.  

Home Sleep Testing

The home sleep test provides information about air flow during sleep and can help determine if you have mild, moderate or severe sleep apnea.  If your test is negative, you may need to sleep a sleep specialist or have a more detailed test called polysomnography. Home sleep test are not currently approved for testing in children.  Children should be evaluated by a polysomnogram.  

Polysomnography

Polysomnography is a test conducted to study sleep and to diagnose a variety of sleep disorders. Polysomnogram means “many lines”.  This polysomnogram is a recording of multiple body functions during sleep.  Commonly monitored body functions include:

  • Blood Oxygen Levels

  • Brain Waves (EEG)

  • Breathing Rates and Patterns

  • Body Positioning

  • Eye Movements

  • Heart Rates and Rhythms

  • Leg Movements

  • Sleep Stages

  • Snoring and Noises Made While Sleeping

  • Unusual Movements or Behaviors

References:

Sakyi et.al (2018). HIV and MSM in the United States. Virginia Commonwealth University.

https://www.aastweb.org/blog/what-is-polysomnography

https://www.ncbi.nlm.nih.gov/pubmed/16942653