Rising Trend of Obstructive Sleep Apnea in the Aging HIV Population

This article is part of Infectious Disease Advisor’s In-Depth HIV coverage of the IDWeek 2020 meeting.

Incidence of obstructive sleep apnea (OSA) has increased in people living with HIV (PLWHIV), particularly in those over 50 years of age who have other comorbidities such has obesity, restless leg syndrome, lipodystrophy, and peptic ulcer disease, according to research presented at IDWeek, held virtually from October 21 to 25.

There are frequent reports of fatigue and disturbed sleep by PLWHIV over the age of 50, which might be a reflection of the rising incidence of OSA. Investigators conducted a large-scale analysis across the United States using the National Inpatient Sample database to determine the incidence of OSA and related risk factors in inpatient admission from 2007 through 2016.

Of the 1,361,514 patients with HIV, 21,413 (1.6%) had concurrent OSA.  The number of admissions for PLWHIV and OSA increased from 0.5% in 2007 to 2.7% in 2016 (P <.001). Not only were women more likely to be diagnosed with OSA (odds ratio [OR], 1.40) compared to men, the peak incidence of OSA occurred earlier in women.

Geographically, OSA was more likely to be diagnosed in PLWHIV in the Midwest and Western United States (OR, 1.59 and 1.14, respectively). Compared to Whites, African-Americans, Hispanics, and Asian/Pacific Islanders had lower odds of OSA diagnoses (OR, 0.88, 0.77, and 0.28, respectively).

Compared to people with OSA in the general population, a lower percentage of PLWHIV and OSA were obese (16.0% vs 18.7%). Researchers noted that the lower obesity rate could be due to the higher risk of visceral adiposity in PLWHIV and OSA compared to the general population with OSA, regardless of BMI.

Logistic regression models limited to PLWHIV showed that obesity was the leading comorbid condition associated with OSA (relative risk [RR], 12.77; 95% CI, 12.33-13.21; P <.001). Other associated comorbidities were as follows:

• Hypertension (RR, 1.97; 95% CI, 1.90-2.04, P <.001)
• Diabetes (RR, 1.98; 95% CI, 1.90-2.05; P <.001)
• Congestive heart failure (RR, 1.92; 95% CI, 1.84-2.01; P <.001)
• Chronic lung disease (RR, 1.97; 95% CI, 1.91-2.04; P <.001)
• Peptic ulcer disease (RR, 2.06; 95% CI, 1.10-3.87; P =.024)
• Arthritis (RR, 1.41; 95% CI, 1.24-1.60; P <.001)
• Depression (RR, 1.65; 95% CI, 1.59-1.72; P <.001)
• Lipodystrophy (RR, 6.84: 95% CI, 6.02-7.77; P <.001)
• Restless leg syndrome (RR, 7.90; 95% CI, 7.10-8.78; P =.039).

Researchers speculated that the significant increase in the rate of OSA among PLWHIV might be in part due to an increasing awareness of OSA. They suggested that the incidence reported in this study is likely underestimated since the study only included people with HIV admitted to a hospital.

“This study highlights the need for proactive screening for OSA in an aging population of PLWHIV,” the researchers concluded.

Reference

Mansoor A, Badami VM, Sharma SS, Sarwari AR. Increasing incidence of obstructive sleep apnea in patients with HIV: a nationwide database analysis. Presented at: IDWeek 2020; October 21-25, 2020. Poster 922.

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