Naresh M Punjabi, Todd T Brown, Darko Stefanovski, Rashmi Nisha Aurora, Sanjay R Patel, Valentina Stosor, Joshua Hyong-Jin Cho, Gypsyamber D’Souza, Joseph B Margolick

The landscape of HIV infection has shifted dramatically over the last few decades. An extended lifespan has led to an increase in comorbidities, including disorders of sleep. While self-reported sleep disturbances in people living with HIV are common, differences in sleep architecture between those living with and without HIV have not been previously described. Polysomnography data from the Multicenter AIDS Cohort Study were used to characterize differences in sleep architecture between men living with and without HIV. Parameters assessed included total sleep time, sleep stage distribution, arousal index, and frequency of sleep stage transitions. Multivariable regression was employed to adjust for demographic variables and explore effect modification by sleep-disordered breathing (SDB) severity. Compared to men without HIV (N = 349), men with HIV (N = 447) exhibited comparable total sleep time, but lower sleep efficiency and greater wake time after sleep onset. Independent of HIV status, SDB was associated with a greater percentage of N1 sleep and lower percentages of N2 and REM sleep. However, those with both HIV and severe SDB displayed the lowest sleep efficiency, the highest percentage of N1 sleep, and the lowest frequency of sleep stage transitions from nonrapid eye movement (non-REM)-to-REM sleep compared to all other HIV and SDB subgroups. This study found an independent association between HIV, SDB, and altered sleep architecture, characterized by lower sleep efficiency, greater time in stage N1 sleep, and higher sleep stage instability. Further research is needed on the potential health implications of disrupted sleep in those with HIV and SDB.