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Insomnia in HIV Infection: A Systematic Review of Prevalence, Correlates, and Management

From the Department of Psychological Medicine, Imperial College, London, UK (S.R.); and the Department of Liaison Psychiatry, St. Mary’s Hospital, London, UK (S.R., J.D.).

Address correspondence and reprint requests to Steven Reid, MB, BS, PhD, MRCPsych, Department of Liaison Psychiatry, Paterson Centre, St. Mary’s Hospital, 20 South Wharf Road, London, U.K., W2 1PD. E-mail: steve.reid{at}nhs.net

Objective: Insomnia in people with HIV and AIDS has been widely but inconsistently reported. We present the results of a systematic review of the subject.

Methods: MEDLINE, EMBASE, PSYCHLIT, and CINAHL databases were searched, and inclusion criteria were applied. The study results were then collated and described.

Results: Twenty-nine studies were identified, and there was wide variation in both method and quality. Insomnia was reported frequently and at all stages of HIV infection. Early reports of sleep-specific electroencephalographic changes were not confirmed. The role of immune dysregulation, virus progression, and adverse drug effects in contributing to insomnia is unclear. The presence of cognitive impairment, an AIDS-defining illness, and treatment with efavirenz were found to be significant risk factors, but the most notable association was with psychologic morbidity. There was limited evidence for the effect of specific treatments for insomnia in HIV infection.

Conclusions: This review found that psychologic morbidity was a major determinant of insomnia in HIV infection. Further study would be of value in clarifying the role of other factors, as well as measuring the impact of insomnia on functioning and quality of life in this population.

Key Words: HIV infections • acquired immunodeficiency syndrome • sleep disorders • insomnia

Abbreviations: HIV = human immunodeficiency virus; AIDS = acquired immunodeficiency syndrome; CNS = central nervous system; PSG = polysomnography; EEG = electroencephalogram; CIDI = Composite International Diagnostic Interview; PSQI = Pittsburgh Sleep Quality Index; SWS = slow wave sleep; CDC = Centers for Disease Control and Prevention; REM = rapid eye movement; OR = odds ratio; CI = confidence intervals; GH = growth hormone.