HIV患者的睡眠障碍

文献信息

中文摘要

目的：
随着HIV感染者（PWH）生存率的提高，他们越来越多地暴露于与年龄相关的、代谢性、神经精神性和心血管危险因素，这些因素使他们易患睡眠障碍及相关合并症。本叙述性综述探讨了PWH中睡眠障碍的当前负担、谱系和原因，以及当前的管理实践建议。

近期发现：
失眠和睡眠呼吸暂停低通气综合征（SAHS）仍然是PWH中最常见的睡眠障碍。尽管关于PWH中昼夜节律异常和异态睡眠，特别是快速眼动（REM）睡眠行为障碍（RBD）的患病率数据缺乏，但新出现的证据表明这些障碍普遍存在，值得进一步关注其在PWH中的负担、影响和管理意义。虽然失眠的认知行为疗法（CBT-I）仍然是失眠的一线管理，但AASM的更新建议允许在疾病早期希望增加睡眠时间的个体中使用CBT-I加药物治疗。持续气道正压通气（CPAP）和自动调节PAP（APAP）是治疗阻塞性睡眠呼吸暂停的首选方式。同样，PAP疗法推荐用于中枢性睡眠呼吸暂停（CSA）患者。难治性CSA可能受益于经静脉膈神经刺激。加巴喷丁类药物而非多巴胺激动剂现在是治疗不宁腿综合征（RLS）的一线药物。最近的铁补充建议缺乏HIV特异性修改，因此建议在PWH中谨慎临床监测铁过载和RLS的症状控制。

总结：
当前证据支持使用指南指导的干预措施。铁补充对PWH中RLS的意义值得未来试验研究。

英文摘要

PURPOSE OF REVIEW: The improved survival of people with HIV (PWH) comes with increasing exposure to age-related, metabolic, neuropsychiatric, and cardiovascular risk factors that predispose them to sleep disorders and associated comorbidities. This narrative review examines the current burden, spectrum and causes of sleep disorders in PWH as well as current practice recommendations for their management.
RECENT FINDINGS: Insomnia and sleep apnea and hypopnea syndrome (SAHS) remain the most common sleep disorders in PWH. Although there is paucity of data on the prevalence of circadian rhythm abnormalities and parasomnias, in particular rapid eye movement (REM) sleep behavior disorder (RBD) in PWH, emerging evidence suggests that these disorders abound and deserve further attention regarding their burden, impact and implication for management in PWH. While cognitive behavioral therapy for insomnia (CBT-I) remains the first line management of Insomnia, updated recommendation by AASM allows for the use of CBT-I plus medication in individuals who desire increased sleep time early on in the condition. Continuous positive airway pressure (CPAP) and auto-adjusting PAP (APAP) are preferred modalities of treatment of obstructive sleep apnea. In the same vein, PAP therapies are recommended in patients with CSA. Refractory CSA might benefit from transvenous phrenic nerve stimulation. Gabapentinoids rather than dopamine agonists are now the first line treatment for restless leg syndrome (RLS). Recent recommendation for Iron supplementation lacks HIV specific modification hence, cautious clinical monitoring for Iron overload and symptomatic control of RLS in PWH is suggested.
SUMMARY: Current evidence supports the use of guideline-directed interventions. The implication of iron supplementation for RLS in this population deserves future trial.