In addition to sleep variability, concomitant opioid use and depressive symptoms influenced rates of fatigue in patients with HIV.

Among people with HIV, fatigue was not more prevalent in those with obstructive sleep apnea (OSA) than in those without OSA, although daytime sleepiness was.

“These findings suggest that OSA contributes to sleepiness but not fatigue in people living with HIV,” Robert L. Owens, MD, of the University of California San Diego in La Jolla, California, and study coauthors wrote in JAIDS.

Because fatigue is frequently reported by patients with HIV, even when viral loads are suppressed, Dr. Owens and colleagues conducted the study to investigate whether OSA could be an underlying cause.

The study included 120 adults with HIV who had suppressed viral loads; 102 were men. The researchers collected data on comorbidities, current and past antiretroviral medications, opioid use, and depression symptoms via the Beck Depression Inventory–II scale.

The Functional Assessment of Chronic Illness Therapy Fatigue Scale (FACIT-F) was used to assess the primary outcome of fatigue, and the Epworth Sleepiness Scale assessed daytime sleepiness. Patients underwent actigraphy for 7 days to determine daily sleep duration and activity amplitude and rhythms, and laboratory polysomnography was used to evaluate for OSA.

Multifaceted Interventions Needed to Reduce Fatigue

The rate of OSA in the cohort was high, with 75% of patients meeting the American Academy of Sleep Medicine criteria of 3% oxygen desaturation or arousal criteria with an apnea-hypopnea index greater than five per hour, according to the study results. Nevertheless, FACIT-F scores did not differ between patients with and without OSA. However, patients with OSA reported more daytime sleepiness than those without OSA.

Non-sleep factors associated with fatigue included concomitant opioid use, ART regimen, and increased depressive symptoms, Dr. Owens and colleagues noted. Depressive symptoms alone were linked with greater daytime sleepiness.

In multivariable analysis, fatigue predictors included more variable daily sleep durations and decreased activity.

“Thus, while sleep interventions might ultimately be useful to reduce fatigue in people living with HIV, other possible interventions might be changes in medications and/or assessment and treatment of depression,” the researchers wrote.

Dr. Owens and colleagues also recommended that future studies investigate whether OSA treatment and improved sleep consistency and timing could reduce fatigue in the population.