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Sleep Disorders and Challenges in People Living with Human Immunodeficiency Virus: A Narrative Literature Review

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Abstract

Purpose of Review

Understanding the prevalence, presentation, and outcomes of the contribution of sleep disorders to sleep disruption and quality of life of persons living with human immunodeficiency virus (HIV) infection (PLWH) is crucial for planning comprehensive patient care and management strategies. This review focuses on the presence of sleep disorders in PLWH and identifies possible challenges and treatment options.

Recent Findings

The prevalence of insomnia among PLWH is significantly higher than in the general population (29–97%), due to complex and multifactorial mechanisms. A multidisciplinary approach that incorporates behavioral therapies and, when appropriate, pharmacological interventions, while closely monitoring for potential drug interactions, should be carried out. Men with HIV may have an increased frequency of sleep disordered breathing, possibly associated to inflammatory markers which can be counteracted by adequate ventilation at night. Also, restless legs syndrome (RLS) seems to be frequent in PLWH with a possible main involvement of iron metabolism and dopaminergic dysfunction. HIV directly affects the suprachiasmatic nucleus, with the potential contribution of specific genetic factors, potentially resulting in circadian rhythm sleep-wake disorders. Also, narcolepsy might be hypothesized to be favored by HIV infection.

Summary

Sleep disorders, such as insomnia, OSA, and RLS are common in PLWH, but other less common disorders, such as narcolepsy and circadian rhythm sleep-wake disorders, can also be present. Although there is literature on the complexity of the pathophysiology in these disorders, evidence is lacking on the effectiveness of treatment options and on the specific effects of sleep disorders in all populations affected by HIV.

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Data Availability

All data was sourced from existing literature and can be accessed by reviewing the appropriate referenced material.

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Authors and Affiliations

  1. University of California San Francisco, Fresno, CA, USA

    Lourdes M. DelRosso, Deacon Yang & Muhammad S. Khan

  2. Vita-Salute San Raffaele University, Milan, Italy

    Maria P. Mogavero

  3. Sleep Disorders Center, Division of Neuroscience, San Raffaele Scientific Institute, Milan, Italy

    Maria P. Mogavero

  4. Department of Neurology, Department of Imaging Sciences, University of Rochester Medical Center, Rochester, NY, USA

    Giovanni Schifitto

  5. Sleep Research Centre, Department of Neurology IC, Oasi Research Institute – IRCCS, Troina, Italy

    Raffaele Ferri

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  1. Lourdes M. DelRosso
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DelRosso, L.M., Yang, D., Khan, M.S. et al. Sleep Disorders and Challenges in People Living with Human Immunodeficiency Virus: A Narrative Literature Review. Curr Sleep Medicine Rep 10, 217–225 (2024). https://doi.org/10.1007/s40675-024-00283-y

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