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  Conference on Retroviruses
and Opportunistic Infections
Seattle, Washington
Feb 19-22 2023
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Sleep disturbances are associated with cognitive function in women living with HIV
  Distinct Aspects of Poor Sleep Tied to Cognitive Problems With HIV
30th CROI, Conference on Retroviruses and Opportunistic Infections, February 19-22, 2023, Seattle
Mark Mascolini
In women with HIV and global cognitive impairment, distinct aspects of poor sleep pointed to specific cognitive performance deficits that could affect how well women cope with HIV and its comorbidities, according to results of a careful analysis involving 102 US women [1]. Researchers who conducted this study believe "targeted interventions that improve these potentially modifiable aspects of sleep" may spare aging HIV-positive women from rapidly worsening cognitive function.


Previous research links HIV infection to both poor sleep quality and cognitive impairment. Two familiar culprits in long-term HIV conditions-inflammation and immune activation-could underlie poor sleep in people with HIV. Because little is known about how sleep and cognition interact in women with HIV, researchers from Johns Hopkins University and collaborating centers conducted this study using the Pittsburgh Sleep Quality Index (PSQI), a validated, easy to administer, under-5-minute questionnaire.
In 2018 and 2019, more than 300 women with HIV completed the PSQI and neuropsychological testing within 12 months. The researchers used linear regression analysis to look for links between overall sleep quality and neuropsychological performance based on unadjusted T scores. Then the investigators explored associations between modifiable sleep problems-like midsleep waking, pain, and snoring-and neuropsychological performance. These analyses adjusted for enrollment site, age, education, race or ethnicity, smoking, drinking, menopause status, lowest-ever CD4 count, viral load, and body mass index.


Among all 337 women tested, age averaged 51 years and years on antiretroviral therapy 12.8. The group averaged 12.4 years of education. While 63% of women were black, 15% were Hispanic, and 13% white. Most women, 54%, abstained from alcohol, 39% had up to 7 drinks per week, and 6.3% had more than 7 drinks per week. Body mass index averaged 33 kg/m2 (in the obese range), CD4 count 700, and viral load about 50 copies.
Of the 337 women with HIV who completed the PSQI, 102 (30%) had global cognitive impairment. Associations between total PSQI score and cognitive domains could be observed only in these women with global cognitive impairment. In this cognitively impaired group, further analysis linked specific components of the PSQI with distinct aspects of neuropsychological performance:
• Midsleep waking was associated with poorer processing speed and executive function.
• Pain disturbing sleep was associated with poorer working memory.
• Snoring was associated with poorer executive function.
• Bad dreams were associated with poorer processing speed.
• Short (under 6-hour) and long (over 8-hour) sleep durations were associated with poorer attention and poorer executive function.
In women with HIV who had global cognitive impairment, the researchers concluded, distinct types of poor sleep could be linked to distinct aspects of poor neuropsychological performance, including diminished working memory, slowed processing speed, and poorer executive function. Because "these cognitive functions are essential for managing HIV and associated comorbidities well," the investigators proposed, "targeted interventions that improve these potentially modifiable aspects of sleep may prevent worsening of cognitive function as women with HIV age."
The research team called for larger prospective studies to map causal relationships between sleep disturbance and cognition in women with HIV, especially vulnerable women.
1. Dastgheyb RM, Weber K, Daubert E, et al. Sleep disturbances are associated with cognitive function in women living with HIV. 30th CROI, Conference on Retroviruses and Opportunistic Infections, February 19-22, 2023, Seattle. Abstract 473.