High prevalence of insomnia in an outpatient population with HIV infection

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.