Background
Brain health disorders continue to occur in older adults with HIV (OAWH), underscoring the importance of addressing reversible causes. We sought to determine if obstructive sleep apnea (OSA) is associated with cognitive difficulties among OAWH.
Methods
The + Brain Health Now cohort study enrolled 856 individuals aged 35 or older with HIV for ≥ 1 year from 5 HIV clinics in Canada between 2013-2016. Participants were assessed every 9-12 months for up to 10 years. We screened for the presence of OSA with the Berlin (low/high risk) and the STOP-Bang (low/intermediate/high risk) questionnaires. Self-reported cognitive difficulties (SRCD) were assessed with the Patient-Deficit Questionnaire and the HIV-specific Communicating Cognitive Concerns. Rasch analysis was used to combine items to create a harmonized measure of Self-Reported Cognitive Difficulties (range -5.74 to 6.17, SD: 1.66). Performance-based cognition was measured with the B-CAM, a computerized battery of multiple domains (range -2.57 to 4.03, SD: 0.76). Generalized linear models analyzed associations between OSA screening, cognition, age, and sex.
Results
1881 assessments in 707 participants, who were mostly men (84.7%) with mean age 55.0 years (SD: 8.2). The proportion of visits with a positive OSA screen were 35.7% for the Berlin and, for the STOP-Bang, 35.5% with intermediate and 33.0% with high risk. More self-reported cognitive difficulties were associated with a positive screen on the Berlin (-0.38, 95% CI: -0.53 to -0.23) or positive screen in the high-risk category on the STOP-Bang (-0.35, -0.52 to -0.17), this latest also being associated with worse performance on the B-CAM (-0.11, -0.22 to -0.01). The presence of loud snoring, nearly daily breathing interruptions, and fatigue were predictive of cognitive difficulties.
Conclusions
Among OAWH, over 1 in 3 individuals screened positive for OSA, which was associated with higher self-reported cognitive difficulties and worse performance-based cognition, although the impact was lower than the 0.5 SD generally considered clinically meaningful. Validation of the screening questionnaires and impact of treatment in HIV would be next steps. In the meantime, since the treatment of OSA has several health benefits, screening and treatment should be considered.