Association between systemic inflammation and obstructive sleep apnea in men with or at risk for HIV infection

Background: We sought to determine whether markers of systemic inflammation are associated with the presence of moderate/severe obstructive sleep apnea (OSA) and whether this association differs based on HIV and HIV treatment status. Methods: HIV-uninfected men (HIV-; n= 60), HIV-infected men receiving HAART (HIV+/HAART; n= 58) and HIV-infected men not receiving HAART (HIV+/no HAART; n= 41) underwent polysomnograpy and measurement of plasma levels of tumour necrosis factor (TNF)-alpha, soluble TNF-alpha receptors I and II (sTNFRI and sTNFRII) and interleukin (IL)-6. The relationship between moderate/severe OSA (respiratory disturbance index = 15 apnea/hypopnea events/h) and inflammatory markers was assessed with multivariable regression models. Results: Compared with the HIV-men, HIV+/HAART men and HIV+/no HAART men had higher levels of TNF-alpha, sTNFRI and sTNFRII, independent of age, race, smoking status, obstructive lung disease (OLD) and body mass index (BMI). Moderate/severe OSA was present in 48% of the sample (HIV-57%; HIV+/HAART 41%; HIV+/no HAART 44%). Among the HIV+/no HAART men, but not in the other groups, TNF-alpha, sTNFRII and IL-6 levels were higher in those with moderate/severe OSA compared to men with no/mild OSA after adjustment for age, race, smoking status, OLD and BMI. Within this group, the association of high TNF-alpha concentrations with moderate/severe OSA was also independent of CD4+T-cell count and plasma HIV RNA concentration. Conclusions: Compared with HIV+/HAART men and HIVmen, markers of systemic inflammation were higher in HIV+/no HAART men. In these men, TNF-alpha was significantly related to OSA, independent of HIV-related covariates.