Background
Adverse sleep patterns are common in people living with HIV generally and have been associated specifically with dolutegravir (DTG) use in studies from high-income countries. Pregnancy and obesity are both known to adversely affect women’s sleep, however there are few data assessing the impact of HIV/DTG on sleep patterns among pregnant women in Africa.
Methods
The ORCHID cohort follows pregnant women recruited from primary care clinics from the beginning of antenatal care, including women living with HIV (WLH) on tenofovir/lamivudine/DTG (TLD) and HIV-seronegative (HIV-) women. Sleep patterns were assessed at 24-28w gestation using the Pittsburgh Sleep Quality Index (PSQI). Sleep apnoea risk was assessed using the Berlin Questionnaire. Anthropometric data were collected and gestational dating was via research ultrasound. PSQI global and subscale scores were calculated for: good sleep (PSQI ≤5), recommended onset latency (≤20mins), duration (≥7hrs), efficiency (>85%), good quality and daytime dysfunction. Apnoea risk was defined as Berlin score=2. Logistic regression assessed the associations between (i) HIV and (ii) TLD duration (either initiating <28d before study enrolment or continuing for ≥28d before enrolment) and sleep patterns, adjusted for age and employment, and stratified by body mass index (BMI) (under/normal weight [BMI<25] and overweight/obese [BMI≥25]).
Results
Overall 1746 women were included: 1010 HIV- women and 736 WLH (197 initiating TLD, 539 continuing TLD; mean age 28y, mean BMI 31kg/m2; 29% employed). Compared to HIV- women, WLH had similar overall PSQI scores, and similar sleep latency, duration and efficiency. However WLH reported significantly better sleep quality (aOR: 1.27, 95%CI: 1.04,1.54) and significantly reduced daytime dysfunction (aOR: 0.78, 95%CI: 0.61,0.99) compared to HIV- women. These associations were most marked in WLH who were overweight/obese (Figure). Among WLH, women initiating TLD had higher sleep efficiency than women continuing TLD (aOR: 1.45; 95%CI:1.04,2.05) but similar sleep patterns on all other measures.
Conclusions
In this novel investigation of sleep in pregnant WLH, adverse sleep patterns during the second trimester of pregnancy appeared less common in WLH receiving TLD compared to HIV- women in this setting. Ongoing follow-up is required to understand how sleep patterns vary in WLH over time and the implications of sleep patterns for their long-term health.
Table or Figure
