Sleep and quality of life in HIV and AIDS

Abstract

Insomnia is a common complaint in people living with HIV and AIDS. It contributes to fatigue, functional impairment, and an overall reduction in the quality of life; yet, there remains considerable uncertainty about its cause and significance. Early reports of sleep-specific EEG changes related to HIV infection, in particular an increase in slow wave sleep, have not been confirmed in later controlled studies. Sleep disturbance is reported at all stages of HIV infection, but the presence of cognitive impairment or an AIDS-defining illness is a significant risk factor. Antiretroviral medications have not demonstrated a class effect, but plasma levels of the non-nucleoside reverse transcriptase inhibitor, efavirenz, do correlate with insomnia. Amongst the recognized risk factors, the most notable is psychological morbidity which has shown a consistent and strong association with insomnia in seropositive patients. Insomnia in HIV infection is associated with a reduced quality of life, but in this population, it remains both under-recognized and under-treated. This may in part be a reflection of uncertainty about approaches to management, as there is little data on treatment of insomnia in this population. Insomnia in HIV presents a considerable challenge for the clinician and requires careful evaluation, in particular screening for anxiety and depression, and a familiarity with non-pharmacological interventions as well as drug treatments for sleep disturbance. © 2008 Humana Press, Totowa, NJ.