High prevalence of insomnia in an outpatient population with HIV infection

Mark L. Rubinstein, Peter A. Selwyn

Research output: Contribution to journalArticle

102 Citations (Scopus)

Abstract

Objective: To determine the prevalence, characteristics, and clinical recognition of insomnia in HIV-seropositive outpatients. Design: Systematic sample of patients attending an outpatient HIV/AIDS clinic at an urban teaching hospital. Methods: Patients were recruited for standard interviews including Pittsburgh Sleep Quality Index (PSQI); Mini Mental State Exam (MMSE); Trail Making Test A and B, and Hospital Anxiety and Depression Scale. Abstraction of medical records was used to assess clinician identification of insomnia. Results: 115 of 127 (91%) patients who were approached agreed to be interviewed for the study. Of these, 79 (69%) were male, 36 (31%) female; 38 (33%) black, 64 (56%) white, 12 (10%) Hispanic, 1 (1%) native American; 45 (39%) were injection drug users. Eighty-four (73%) respondents were classified as having a sleep disturbance according to the PSQI. Patients with cognitive impairment had a higher prevalence of insomnia (100% versus 70%; p = .034). A trend was shown for drug-using patients to report a higher prevalence of insomnia than nondrug users (86% versus 69%; p < .07). Using multivariate analysis, cognitive impairment (odds ratio [OR] = 1.4) as defined by the neuropsychiatric test battery and depression (OR = 1.2) were the best predictors of insomnia (p < .05). Only 28 (33%) patients with insomnia had any documentation of sleep disturbance in their clinical medical records. Conclusions: Insomnia is widespread and underdiagnosed in HIV- seropositive ambulatory patients. Insomnia is especially prevalent among those with cognitive impairment. These findings suggest the importance for clinicians to inquire specifically about sleep disorders in HIV-seropositive patients. Prompt diagnosis and treatment may improve the quality of life in patients living with HIV.

Original languageEnglish (US)
Pages (from-to)260-265
Number of pages6
JournalJournal of Acquired Immune Deficiency Syndromes and Human Retrovirology
Volume19
Issue number3
StatePublished - Nov 1 1998
Externally publishedYes

Fingerprint

Sleep Initiation and Maintenance Disorders
HIV Infections
Outpatients
Population
HIV
Sleep
Medical Records
Odds Ratio
Depression
Trail Making Test
North American Indians
Urban Hospitals
Drug Users
Hispanic Americans
Teaching Hospitals
Documentation
Acquired Immunodeficiency Syndrome
Multivariate Analysis
Anxiety
Quality of Life

Keywords

  • AIDS
  • HIV
  • Insomnia

ASJC Scopus subject areas

  • Immunology and Allergy
  • Immunology
  • Virology

Cite this

High prevalence of insomnia in an outpatient population with HIV infection. / Rubinstein, Mark L.; Selwyn, Peter A.

In: Journal of Acquired Immune Deficiency Syndromes and Human Retrovirology, Vol. 19, No. 3, 01.11.1998, p. 260-265.

Research output: Contribution to journalArticle

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abstract = "Objective: To determine the prevalence, characteristics, and clinical recognition of insomnia in HIV-seropositive outpatients. Design: Systematic sample of patients attending an outpatient HIV/AIDS clinic at an urban teaching hospital. Methods: Patients were recruited for standard interviews including Pittsburgh Sleep Quality Index (PSQI); Mini Mental State Exam (MMSE); Trail Making Test A and B, and Hospital Anxiety and Depression Scale. Abstraction of medical records was used to assess clinician identification of insomnia. Results: 115 of 127 (91{\%}) patients who were approached agreed to be interviewed for the study. Of these, 79 (69{\%}) were male, 36 (31{\%}) female; 38 (33{\%}) black, 64 (56{\%}) white, 12 (10{\%}) Hispanic, 1 (1{\%}) native American; 45 (39{\%}) were injection drug users. Eighty-four (73{\%}) respondents were classified as having a sleep disturbance according to the PSQI. Patients with cognitive impairment had a higher prevalence of insomnia (100{\%} versus 70{\%}; p = .034). A trend was shown for drug-using patients to report a higher prevalence of insomnia than nondrug users (86{\%} versus 69{\%}; p < .07). Using multivariate analysis, cognitive impairment (odds ratio [OR] = 1.4) as defined by the neuropsychiatric test battery and depression (OR = 1.2) were the best predictors of insomnia (p < .05). Only 28 (33{\%}) patients with insomnia had any documentation of sleep disturbance in their clinical medical records. Conclusions: Insomnia is widespread and underdiagnosed in HIV- seropositive ambulatory patients. Insomnia is especially prevalent among those with cognitive impairment. These findings suggest the importance for clinicians to inquire specifically about sleep disorders in HIV-seropositive patients. Prompt diagnosis and treatment may improve the quality of life in patients living with HIV.",
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