High anticholinergic burden tied to poor sleep quality in people living with HIV

Anticholinergic burden (ACB) is significantly associated with sleep disorders among people living with HIV, according to a study.

A team of investigators conducted a cross-sectional, single-centre assessment of the relationship between patient-reported outcomes (PROs) such as sleep quality (SQ; the Pittsburgh Sleep Quality Index [PSQI], the Insomnia Severity Index [ISI], and the Epsworth Sleepiness Scale [ESS]) and ACB (ACB scale) in people living with HIV. They also obtained and analysed data on comorbidities and comedications.

Finally, generalized linear models were used to examine the associations following adjustments for factors such as psychiatric diagnoses, treatments, and comorbidities.

A total of 1,200 participants (mean age 52 years, 73.5 percent male, 95.5 percent undetectable HIV-RNA, median CD4 642/μL) were analysed. Of these, 10.0 percent had ISI, 46.8 percent had PSQI, and 10.2 percent had ESS scores, indicating clinically relevant insomnia, poor SQ, and significant daily sleepiness.

Moreover, 202 (16.8 percent) participants were being treated with one or more anticholinergic drugs: 11.0 percent had ACB scale=1 and 5.8 percent had ACB scale ≥2.

Higher ACB scale correlated with worse sleep metrics. There was also a substantial prevalence of polypharmacy (20.4 percent), multimorbidity (63.7 percent), depressive mood (13.2 percent), and anxiety symptoms (20.4 percent), which were all associated with both SQ and ACB.

In models adjusted by these and other confounding variables, higher ACB scale showed an independent association with worse scores for both ISI (aβ, 0.36, 95 percent confidence interval [CI], 0.21‒0.50; p<0.0001) and PSQI (aβ, 0.28, 95 percent CI, 0.16‒0.41; p<0.0001).

“Clinicians should take [this association] into account, by investigating SQ (measuring PROs) and routinely reviewing comedications, deprescribing those with a high ACB,” the investigators said. “This will contribute to pursuit a better quality of life for people living with HIV, as also recently endorsed by EACS guidelines.”