The use of Clinical Scales in Diagnosing Sleep Disorders in adult HIV infected Cameroonians in the Yaounde Central Hospital: A Case Control Study.

NJOH ANDREAS ATEKE (princenjoh@yahoo.com)
Internal Medicine, University of Yaounde 1
June, 2013
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Abstract

Background: Sleep disorders are a group of syndromes characterized by disturbance in a person’s amount, quality, and timing of sleep or disorders that affect the normal physiology of sleep . Sleep is essential to our physical and mental health insofar as it has been proven that adequate sleep plays a role in helping our body recover from illness or injury. On the contrary lack of sufficient sleep may result in a loss of strength, impaired immune system, daytime fatigue and disturbed quality of life. This is true for people living with HIV (PLWH), an infection that is a major public health problem in Cameroon. Due to the free public delivery of Highly Active Antiretroviral Therapy (HAART), HIV infection has been transformed from a terminal disease to a chronic illness and this has significant implications for health. This thus requires a parallel shift in thinking and management of the disease.
Rationale: People living with HIV (PLWH) are particularly vulnerable to sleep disturbances and its negative effects. It has been noted that sleep disturbances appear soon after initial HIV infection and continue throughout the course of the disease. That is why early diagnosis of sleep disorders in this context using clinician-friendly and less costly clinical tools could go a long way to improve management. Given that clinical scales are not used to assess sleep disorders in PLWH in Cameroon, we therefore decided to embark on this important subject.
Objectives: The main objective was to evaluate the usefulness of the following clinical scales: Pittsburgh Sleep Quality Index (PSQI), Epworth Sleepiness Scale (ESS), Berlin Questionnaire (BQ) and the Hospital Anxiety and Depression Scale (HADS), to assess sleep and co-morbidities and screen for sleep disorders in HIV- positive adults. We specifically aimed at screening for sleep disorders in a sample of PLWH in Cameroon and their matched controls; compare the findings obtained from both groups; and also to characterize the sleep patterns and disorders observed in PLWH with respect to disease stage and viral genotype.
Methods: A case-control study including 39 PLWH age- and sex-matched with 43 HIV negative controls. We used the PSQI to assess sleep quality, the ESS for daytime sleepiness, the BQ for obstructive sleep apnoea (OSA) and the HADS to characterize anxiety and depression.
Results and discussion: Sleep disorders were significantly more common in PLWH and they had poorer sleep quality with a prevalence of 66.7% versus 11.6% for their controls respectively (AOR 20.60; 95% CI, 2.98-142.19, p<0.001) and took significantly longer to fall asleep (33.08 ± 27.35 minutes versus 20.81 ± 16.61 minutes, p=0.015). Poor sleep quality was significantly more common in HIV1 cases compared to HIV2 with a prevalence of 100.0% versus 0.0% respectively, p=0.001. No significant differences were observed with respect to age at HIV diagnosis, disease duration, CD4 count, disease stage (WHO), being on HAART or not, 1st or 2nd line treatment or being on Efavirenz.
Daytime sleepiness and the risk of OSA were significantly more prevalent in the cases compared to the controls: 23.1% versus 2.3% (p<0.001) and 43.6% versus 14.0%, (p=0.003) respectively. PLWH were also found to be significantly more depressed and more anxious; (6.6% versus 2.3% and 47.8% versus 4.7% respectively p<0.001) than their controls.
These results were similar to findings obtained from Cameroon, other developing nations like Botswana, Uganda, Nigeria, Tanzania and also developed nations like the United States of America and Germany.

Conclusions: We have demonstrated the feasibility of sleep scales to assess sleep and screen for sleep disorders in adult HIV infected individuals in Yaounde. We also found that sleep disorders are common in Cameroonian PLWH, thus the use of sleep scales in the clinical assessment of PLWH could go a long way to improve management and thus quality of life in PLWH. Recommendations: PLWH should be systematically screened for sleep disorders using clinical sleep scales. Also similar studies should be carried out in different geographic locations of Cameroon to complete our findings. Finally measures should be taken to educate and facilitate the use of clinical sleep scales to screen for sleep disorders in PLWH in Cameroon.


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