Revista de SIDA e investigación clínica

Prevalence of Nocturnal Oxygen Desaturation in Subjects with HIV Infection

Abstract

Linh Nguyen, Juliana C Stradley, Mona White, Joanne Giordano, Sara Dingwall, John Suen and Gerald Pierone

Background: Obstructive sleep apnea (OSA) is a common disorder that is linked to daytime fatigue and increased risk of cardiovascular disease. The general population prevalence of OSA is estimated to be 2-9%. The prevalence of OSA in people with HIV infection is unknown, although many patients with HIV report daytime fatigue. The diagnosis of OSA is typically established during an overnight study in a sleep laboratory. Sleep surveys designed to select have been previously validated for selecting patients for definitive study. Nocturnal oxygen desaturation index (ODI) measurement has also been used to screen for reliably predicting over 85% of moderate to severe cases when the ODI >10.

Methodology: Patients with HIV infection presenting for routine medical care were invited to participate in this prospective OSA screening trial. Informed consent was obtained; subjects completed the Four-Variable Screening Tool, the STOP-BANG questionnaire, Epworth Sleepiness Scale, and were provided a fingertip oximeter for overnight use at home. Overnight oxygen saturation data was analyzed and correlated to corresponding sleep surveys. All subjects with ODI >10 were referred for a formal sleep study.

Results: 156 subjects completed the study and 66 (42.3%) demonstrated an ODI >10. Of the 66, 21 pursued formal sleep studies. 14 of the 21 tested positive for OSA. The Four-Variable Screening Tool had the highest positive predictive value of 59.5%, and the STOP-BANG questionnaire had the highest negative predictive value of 76.9%.

Conclusions: HIV-infected patients in our clinic demonstrated a high prevalence of nocturnal oxygen desaturation suggesting a high prevalence of OSA. Three commonly used screening tools did not reliably predict nocturnal desaturation in our population. The high prevalence of nocturnal oxygen desaturation and in HIV patients indicates the need for additional HIV-related OSA research.