Prevalence and factors associated with excessive daytime somnolence in adults with HIV - A single-centre UK observational study

Introduction Excessive daytime somnolence is common in people with HIV. The importance of possible contributors such as mental health and obstructive sleep apnoea syndrome is poorly understood. We investigated the prevalence of daytime somnolence and obstructive sleep apnoea syndrome in people with HIV in the UK and assessed what factors were associated with somnolence. Methods In this cross-sectional study, adults with HIV attending Royal Free London HIV outpatient service appointments were recruited between May 2018 to October 2019. Participants completed questionnaires as outpatients assessing somnolence, sleep quality, fatigue, mental health symptoms and quality of life. Binary logistic regression was used to identify factors independently associated with excessive daytime somnolence (defined as Epworth Sleepiness Scale scores >10/24), and prevalence of somnolence and obstructive sleep apnoea syndrome were calculated with 95% confidence intervals. Results 313 adults (median age 52 years, body mass index (BMI) 25.9 kg/m 2 , and 80% male) participated. The excessive daytime somnolence prevalence was 72/313 (23%, 95% CI: 18.5-28.1). Somnolent individuals had more frequent and more severe: anxiety, depression, fatigue and poor sleep quality, with more reported cardiovascular and respiratory disease (p < 0.01). Factors independently associated with excessive somnolence included male gender (OR 3.45; 1.36-8.95; p < 0.01), poor sleep quality (OR 1.12; 1.02-1.22; p = 0.01) and fatigue (OR 1.04; 1.01-1.06; p < 0.01). The minimum detected prevalence of obstructive sleep apnoea syndrome was 8.6% (n = 27/313) in the study population – which represented 54% (n = 27/50) of those participants who had a sleep study. Conclusions Excessive daytime somnolence is common in people with HIV and frequently identified in individuals reporting poor mental health. Obstructive sleep apnoea syndrome is a potentially treatable contributor to daytime somnolence. Integrated screening for somnolence, sleep disorders and mental health within routine HIV care may improve identification and treatment of common, modifiable and interacting comorbidities.