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

Umesh Goswami, Jason V. Baker, Qi Wang, Wajahat Khalil, Ken M Kunisaki

Research output: Contribution to journalArticle

4 Citations (Scopus)

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/m2, 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; β =-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 (β =-5.53; p < 0.001), depression (β =-4.18; p = 0.02), antidepressant use (β =-4.25; p = 0.02), and sleep duration < 6 h (β =-3.42; p = 0.02). Our data strongly support the need for increased efforts directed at OSA screening and treatment in PLWH.

Original languageEnglish (US)
Pages (from-to)591-596
Number of pages6
JournalAIDS Patient Care and STDs
Volume29
Issue number11
DOIs
StatePublished - Nov 1 2015

Fingerprint

Sleep Apnea Syndromes
Obstructive Sleep Apnea
Fatigue
HIV
Snoring
Apnea
Linear Models
African Americans
Opioid Analgesics
Antidepressive Agents
Medical Records
Sleep
Obesity
Demography
RNA
Depression
Therapeutics
Population

Cite this

Sleep Apnea Symptoms as a Predictor of Fatigue in an Urban HIV Clinic. / Goswami, Umesh; Baker, Jason V.; Wang, Qi; Khalil, Wajahat; Kunisaki, Ken M.

In: AIDS Patient Care and STDs, Vol. 29, No. 11, 01.11.2015, p. 591-596.

Research output: Contribution to journalArticle

@article{cec075afc64c443a81929c5c9285c138,
title = "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/m2, 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; β =-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 (β =-5.53; p < 0.001), depression (β =-4.18; p = 0.02), antidepressant use (β =-4.25; p = 0.02), and sleep duration < 6 h (β =-3.42; p = 0.02). Our data strongly support the need for increased efforts directed at OSA screening and treatment in PLWH.",
author = "Umesh Goswami and Baker, {Jason V.} and Qi Wang and Wajahat Khalil and Kunisaki, {Ken M}",
year = "2015",
month = "11",
day = "1",
doi = "10.1089/apc.2015.0079",
language = "English (US)",
volume = "29",
pages = "591--596",
journal = "AIDS Patient Care and STDs",
issn = "1087-2914",
publisher = "Mary Ann Liebert Inc.",
number = "11",

}

TY - JOUR

T1 - Sleep Apnea Symptoms as a Predictor of Fatigue in an Urban HIV Clinic

AU - Goswami, Umesh

AU - Baker, Jason V.

AU - Wang, Qi

AU - Khalil, Wajahat

AU - Kunisaki, Ken M

PY - 2015/11/1

Y1 - 2015/11/1

N2 - 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/m2, 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; β =-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 (β =-5.53; p < 0.001), depression (β =-4.18; p = 0.02), antidepressant use (β =-4.25; p = 0.02), and sleep duration < 6 h (β =-3.42; p = 0.02). Our data strongly support the need for increased efforts directed at OSA screening and treatment in PLWH.

AB - 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/m2, 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; β =-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 (β =-5.53; p < 0.001), depression (β =-4.18; p = 0.02), antidepressant use (β =-4.25; p = 0.02), and sleep duration < 6 h (β =-3.42; p = 0.02). Our data strongly support the need for increased efforts directed at OSA screening and treatment in PLWH.

UR - http://www.scopus.com/inward/record.url?scp=84946053283&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84946053283&partnerID=8YFLogxK

U2 - 10.1089/apc.2015.0079

DO - 10.1089/apc.2015.0079

M3 - Article

VL - 29

SP - 591

EP - 596

JO - AIDS Patient Care and STDs

JF - AIDS Patient Care and STDs

SN - 1087-2914

IS - 11

ER -