Background
Anticholinergic burden (ACB) and related effects affect the quality of life of people with HIV (PWH) through a broad range of mechanisms: e.g., increased risk of falls, pleomorphic symptoms, and cognitive decline. To date, no study has investigated whether ACB influences also the quality of sleep (SQ) in PWH.
Methods
Cross-sectional single-centre multidimensional assessment of the relationship between sleep metrics (Pittsburgh Sleep Quality Index, PSQI, ≥5 for poor SQ; Insomnia Severity Index, ISI, score ≥15 for moderate/severe insomnia; Epworth Sleepiness scale, ESS, ≥13 for daily sleepiness) and ACB (ACB scale, ACBS) in 1200 PWH on antiretroviral therapy.Comorbidities, comedications, and mood disorders (General Anxiety disorder-7, GAD7, and Patient Health Questionnaire-9, PHQ9) were also considered. Generalized linear models to investigate these associations were adjusted for relevant factors (e.g., psychiatric diagnoses and treatments, comorbidities).
Results
Among the 1200 participants (age 52±12, 74.7% male, 95.5% undetectable viremia, CD4+ T cells 642/µL [483-823]), 11.9%,50.9% and 5.8% had ISI, PSQI, and ESS scores suggesting clinically relevant insomnia, poor SQ, and significant daily sleepiness. Two hundred two (16.8%) participants were on at least one AC drug: 11.0% ACBS=1 and 5.8% ACBS≥2. Increasing ACBS was associated with worsening in all the sleep metrics: the correlations are shown in Fig.1. Polypharmacy (20.4%), multimorbidity (63.7%), depressive mood (13.2%) and anxiety symptoms (20.4%) were also prevalent and associated with both sleep metrics and ACB (Fig.1). In models adjusted by these and other confounding variables (e.g., age, sex, HIV acquisition route, GAD7, PHQ9, use of benzodiazepines, antidepressants), higher ACBS was independently associated with worse scores at both ISI (aβ 0.35 [0.17-0.54], p<0.001) and PSQI (aβ 0.28 [0.16-0.41], p<0.001).
Conclusions
These results highlight the complex network between ACB, polypharmacy, multimorbidity, mood and sleep disorders in PWH. However, ACB revealed to be a factor that could disrupt SQ and increase risk of insomnia independently from the underlying clinical indications and other confounding factors in PWH.
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