Background
Obstructive sleep apnea and diabetes are common among people with HIV (PWH). Cardinal features of obstructive sleep apnea such as intermittent hypoxia and sleep fragmentation have been associated with the development of diabetes in the general population. Among PWH, HIV-associated inflammation and the use of certain ART medications have also been associated with the development of diabetes. We examined whether HIV status modifies the association between obstructive sleep apnea and diabetes in a cohort of men with HIV (MWH) and without HIV (MWOH).
Methods
Obstructive sleep apnea was assessed using in-home polysomnography in 779 men participating in the Multicenter AIDS Cohort Study (438 MWH, 341 MWOH). The apnea-hypopnea index (AHI), the number of apneas and hypopneas per hour of sleep, was used to classify participants by obstructive sleep apnea severity (none: < 5 events/h; mild: 5 – 15 events/h; moderate: 15 – 30 events/h; severe: > 30 events/h). Diabetes was defined as meeting at least one of the following criteria: (1) a fasting blood glucose ≥ 126 mg/dL after ≥ 6 hours of fasting; (2) a self-reported diagnosis of diabetes; or (3) a self-reported use of anti-diabetes medications. Associations between HIV status, sleep apnea severity, and prevalent diabetes were assessed using multivariable logistic regression models adjusted for age, race, BMI, and family history of diabetes.
Results
MWH were younger (median age: 56 years vs. 62 years; p < 0.001) and more likely to be non-white (43.9% vs. 23.1%; p < 0.001); BMI was similar by HIV status (median: 27 kg/m2). MWH and MWOH had similar crude prevalences of sleep apnea (52.7% vs. 54.0%, respectively; p = 0.74) and diabetes (21.5% vs. 19.4%, respectively; p = 0.47). The adjusted prevalence of diabetes was significantly greater among men with severe sleep apnea and HIV than among men with severe sleep apnea and no HIV (41.2% vs. 23.7%, respectively; p = 0.046). No significant interaction between HIV status and sleep apnea severity on prevalent diabetes was observed. In models restricted to MWH, duration (years) of protease inhibitor use was independently associated with prevalent diabetes (aOR: 1.05; 95% CI: 1.01 – 1.09; p = 0.014).
Conclusions
Among men with severe obstructive sleep apnea, living with HIV was associated with a higher prevalence of diabetes. These data suggest that the metabolic impact of obstructive sleep apnea is more pronounced among PWH.
Table or Figure
