Sleep disorders in patients with HIV

The improved survival of people with HIV (PWH) comes with increasing exposure to age-related, metabolic, neuropsychiatric, and cardiovascular risk factors that predispose them to sleep disorders and associated comorbidities. This narrative review examines the current burden, spectrum and causes of sleep disorders in PWH as well as current practice recommendations for their management.

Insomnia and sleep apnea and hypopnea syndrome (SAHS) remain the most common sleep disorders in PWH. Although there is paucity of data on the prevalence of circadian rhythm abnormalities and parasomnias, in particular rapid eye movement (REM) sleep behavior disorder (RBD) in PWH, emerging evidence suggests that these disorders abound and deserve further attention regarding their burden, impact and implication for management in PWH. While cognitive behavioral therapy for insomnia (CBT-I) remains the first line management of Insomnia, updated recommendation by AASM allows for the use of CBT-I plus medication in individuals who desire increased sleep time early on in the condition. Continuous positive airway pressure (CPAP) and auto-adjusting PAP (APAP) are preferred modalities of treatment of obstructive sleep apnea. In the same vein, PAP therapies are recommended in patients with CSA. Refractory CSA might benefit from transvenous phrenic nerve stimulation. Gabapentinoids rather than dopamine agonists are now the first line treatment for restless leg syndrome (RLS). Recent recommendation for Iron supplementation lacks HIV specific modification hence, cautious clinical monitoring for Iron overload and symptomatic control of RLS in PWH is suggested.

Current evidence supports the use of guideline-directed interventions. The implication of iron supplementation for RLS in this population deserves future trial.